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Medicine and Public Policy |

Denver Health: A Model for the Integration of a Public Hospital and Community Health Centers

Patricia Gabow, MD; Sheri Eisert, PhD; and Richard Wright, MD
[+] Article and Author Information

From Denver Health, Denver, Colorado.


Acknowledgments: The authors thank the Office of Data Evaluation, Analysis, and Research of the Bureau of Primary Health Care and the National Association of Public Hospitals and Health Systems for the data they provided for this research.

Requests for Single Reprints: Patricia Gabow, MD, Denver Health, 660 Bannock Street, MC 0278, Denver, CO 80204; e-mail, PGabow@dhha.org.

Current Author Addresses: Dr. Gabow: Denver Health, 660 Bannock Street, MC 0278, Denver, CO 80204.

Dr. Eisert: Denver Health, 777 Bannock Street, MC 8701, Denver, CO 80204.

Dr. Wright: Denver Health, 660 Bannock Street, Denver, CO 80204.


Ann Intern Med. 2003;138(2):143-149. doi:10.7326/0003-4819-138-2-200301210-00016
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Two major pillars of the United States' safety net system are urban public hospitals and community health centers. Their common mission is to care for the uninsured and other vulnerable populations. However, in most communities these important components of the safety net remain organizationally and functionally separate, which inhibits the continuum of care and creates substantial inefficiencies. Denver Health is a long-standing vertically and horizontally integrated system for vulnerable populations. The integration benefits the patient and the system and serves as a model for the U.S. safety net. This paper outlines the benefits of integration to the patient, provider, and health system, using data from the National Association of Public Hospitals and Health Systems, the Bureau of Primary Health Care, and Denver Health.

Figures

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Figure 1.
Organizational components of Denver Health and Hospital Authority.

HMO = health maintenance organization.

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Figure 2.
Users by source of payer: urban public hospitals (1997) and urban community health centers (CHCs(2)(3)

) (1998). Based on data from National Association of Public Hospitals and Health Systems 1997 Annual Survey and Bureau of Primary Health Care 1998 Uniform Data System .

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Figure 3.
Net revenues of urban community health centers (white barsgray bars(2)(3)

) (1998) and urban public hospitals ( ) (1997). *Includes disproportionate share payments for urban public hospitals. †Includes local subsidy from local government for public hospitals. Based on data from National Association of Public Hospitals and Health Systems 1997 Annual Survey and Bureau of Primary Health Care 1998 Uniform Data System .

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Figure 4.
Urban community health center users by payer source (1998).(3)

White bars represent urban community health centers; gray bars represent Denver Health. Based on data from the Bureau of Primary Health Care 1998 Uniform Data System .

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Figure 5.
Urban community health center net revenue (1998).(3)

Denver Health community health centers receive disproportionate share payments that are included in Medicaid revenues. Denver Health community health centers received $6.25 million in disproportionate share payments during 1998. Based on data from the Bureau of Primary Health Care 1998 Uniform Data System . White bars represent urban community health centers; gray bars represent Denver Health.

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