Defining and Describing the US Safety-Net System as a Foundation for Payment and Delivery Reform

The problem: Successful payment reform requires participation and engagement from a wide range of providers, including safety-net organizations that disproportionately care for historically marginalized populations. However, there are two major barriers to progress in this area.

First, there are currently multiple definitions of hospital safety-net status used by researchers and policymakers. For example, some definitions focus solely on insurance status, whereas others focus more on the higher costs associated with caring for lower income or disabled populations.

Second, while policymakers have recognized safety-net hospitals as stakeholders, less attention has been paid to safety-net physicians and groups caring for marginalized populations in the outpatient setting.

Our project addresses existing knowledge gaps by developing a methodology for defining inpatient and outpatient safety-net providers across payers in the US, describing the geographic distribution and characteristics of these providers, and translating such insight into deliverables for use by policymakers to drive payment and delivery reform.

The specific aims of this project are three-fold:

(1) to develop methodologies for defining hospital and outpatient safety-net providers across payers in the US

(2) to use these methodologies to describe the geographic distribution and characteristics of these providers

(3) to produce information about the providers (identifiers), areas, and populations served by safety-net providers for use by policymakers to support payment and delivery reform

The below documents are available for download:

Advanced Practice Professionals Methodology White Paper

Illustrative Examples and Preliminary Findings from Systematic Review


This project is made possible by funding and support from Arnold Ventures