This discussion paper by Health Management Associates, commissioned by the Blue Shield Foundation of California and released in November 2010, makes the case for including safety net providers, including public health and hospital systems, Federally Qualified Health Centers, community hospitals, and physician groups, in developing and implementing accountable care organizations (ACOs).  The paper argues that these safety net providers will be likely providers for the expansions in health insurance coverage created by national health care reform but need the type of infrastructure support that will be available to ACOs to ensure that some of the most underserved patients in any service area be included in quality improvement and payment reform activities.

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