San Francisco General Hospital

Healthy San Francisco - Transforming a Traditional Safety Net

With the Affordable Care Act (ACA) on the horizon, safety net providers will be faced with the dual challenge of keeping up with care demands for the newly insured people while continuing to care for the estimated 23 million people that will remain uninsured after reform.

Since 2007, the city of San Francisco has taken efforts to ameliorate these concerns by designing a comprehensive coordinated health care coverage program. These efforts offer valuable insights into how safety net providers can overcome the challenges posed by the ACA.

Healthy San Francisco is a program through which a group of local providers deliver a specified package of services. It is not an insurance program, but rather a network incorporating primary care homes, linkage to specialty care, prepaid program fees, and customer service. These managed care-like features can help retain patients that are newly insured as well as improving health outcomes for those who are new to insurance.

Adults ages 18 to 64 who live in San Francisco are eligible for the program. Participants are also required to meet one of two conditions: family income no higher than 500 percent of the federal poverty level, or employer participation in Healthy San Francisco. They pay a sliding fee for services based on income level, and multilingual customer service staff assist them in enrolling for other public programs for which they were eligible, such as CHIP of Medicaid.

The initial outcomes are promising. Almost 54,000 uninsured adults were enrolled in Healthy San Francisco by July 2010. Client opinion surveys revealed the 94 percent of respondents were either “very satisfied” or “satisfied” with Healthy San Francisco. Ninety-two percent reported they would recommend the program to a friend.

The total cost of the program for fiscal year 2008-2009 was $126 million, due in part to San Francisco’s low 5 percent administrative cost. The cost per participant was approximately $298 per member per month. Allowing clients to select a provider from across an entire system helped the program manage capacity. Furthermore, the establishment of primary care homes may decrease unnecessary emergency department visits and hospitalizations. Care coordination minimized duplicative services and fragmentation of medical information. These outcomes indicate that comprehensive, universal coverage is possible on a local level.
 
References:
Katz MH, Brigham TM. Transforming a traditional safety net into a coordinated care system: Lessons from Healthy San Francisco. Health Affairs, 2011; 30(2):237-245.

For more information about the Healthy San Francisco program at San Francisco General Hospital, please contact:

Tangerine Brigham
Deputy Director of Health, City and County of San Francisco
Director, Healthy San Francisco Program
Tangerine.Brigham@sfdph.org