Accelerating Delivery System and Payment Reform in the Safety Net

Accelerating Delivery System and Payment Reform in the Safety Net


Safety net organizations play a critical role in providing care to low-income, historically marginalized populations, yet they exist within a fragmented system that contributes to duplication and gaps in patient care. There is a growing consensus that value-based payment (VBP) models can be an effective tool to address this fragmentation and improve the quality and efficiency of care for patients served by safety net organizations. However, safety net providers have participated in VBP models at lower rates than non-safety net providers due to a number of unique challenges including regulatory constraints, high rates of uninsured patients, and historical silos that hamper their ability to transition into VBP models. There is substantial interest in addressing these barriers and enhancing the ability of safety net providers to furnish longitudinal, comprehensive care for their communities through VBP arrangements.

Project Overview

This project aims to engage safety net organizations in value-based care initiatives by assessing the current payment landscape for safety net institutions and identifying practical policy reform opportunities. Guided by an executive leadership team of safety net leaders and health policy experts, we will gather broad stakeholder input from advisory convenings and informational stakeholder interviews with safety net organizations, payers and funders, and federal and state policymakers to identify strategies to improve care in the safety net using the tools of VBP models. We will synthesize our findings into policy recommendations to expand safety net provider participation in VBP models, support care coordination and integration in the safety net, and achieve high-value, comprehensive care for traditionally under-resourced patient populations.


This project is supported by a grant from Arnold Ventures and supported by The Commonwealth Fund, a national, private foundation based in New York City that supports independent research on health care issues and makes grants to improve health care practice and policy.

Research Team

Robert Saunders

Robert Saunders, PhD

Senior Research Director, Health Care Transformation
Adjunct Associate Professor
Senior Team Member
Margolis Core Faculty

Sherrie Wang Headshot

Sherrie Wang

Policy Research Assistant