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Safety Net Medical Home Initiative

  • Need: To help healthcare providers serving underserved and vulnerable populations become patient-centered medical homes (PCMH).
  • Intervention: A 5-year project was launched to develop a replicable model for practice transformation for safety net providers, including rural practices.
  • Results: Eighty-three percent of participating safety net clinics earned state or national PCMH recognition as of September, 2013.

In 2008, the Commonwealth Fund launched the Safety Net Medical Home Initiative (SNMHI), a 5-year program to develop a replicable model for safety net providers to become patient-centered medical homes (PCMHs). The first year of the project focused on planning and developing resources, with the remaining 4 years devoted to implementing the PCMH model at participating sites.

The Commonwealth Fund appointed Qualis Health and the MacColl Center for Health Care Innovation as the SNMHI National Program Team. Regional Coordinating Centers (RCCs) were selected to support participating sites in Colorado, Idaho, Massachusetts, Oregon and Pittsburgh, Pennsylvania. Medical Home Facilitators (MHFs) at the RCCs provided technical assistance to participating practices in their region, supported by a set of implementation guides, toolkits, webinars, and other resources developed by the national program.

Sixty-five safety net clinics, 20 of which serve rural or frontier communities, participated in the program, including:

  • Federally Qualified Health Centers (FQHCs)
  • Rural Health Clinics (RHCs)
  • Critical Access Hospital (CAH) affiliated clinics
  • Rural private practices
  • Other safety net providers
Services offered

Before funding for the program ended in December of 2015, SNMHI offered participating sites a step-by-step, long-term approach to practice transformation with a wide range of support, including:

  • Technical assistance
  • Interactive learning tools
  • Site visits for one-on-one help
  • Access to learning communities for peer-to-peer support
  • Guidance on using data to improve care
  • Stipends for learning experiences
  • Help with the NCQA PCMH Recognition process

All participating sites achieved some level of PCMH implementation, and as of September 2013, 83% of sites had either NCQA PCMH or state-based PCMH recognition.

A survey of 49 sites found 91.8% agreed or strongly agreed that the training materials helped them learn and 87.8% felt SNMHI was helpful in the transformation process.

For more information on the program implementation and results, please see Safety Net Medical Home Initiative Bibliography.


Concerns faced by all types of participating sites, as described in The Safety Net Medical Home Initiative: Transforming Care for Vulnerable Populations, included:

  • Impact of turnover
  • Getting staff support
  • Financial constraints
  • Competing priorities, particularly electronic health record (EHR) implementation
  • Data collection capabilities

Challenges encountered by 3 of the rural participating sites included:

  • Developing acceptance of the need for empanelment, given a sense that the clinic already served the entire community
  • Concerns related to provider turnover and how that might impact continuity of care
  • Limited access to specialist care, due to both distance and availability of specialists who accept particular types of insurance coverage, such as Medicaid
  • Concerns about retaining staff who fill integrated care roles not reimbursed under current fee-for-service models

For an in-depth discussion of these challenges and how they were addressed by the rural sites, please see:

Derrett, S., Gunter, K.E., Nocon, R.S., Quinn, M.T, Coleman, K., Daniel, D.M., …Chin, M.H. (2014). How 3 Rural Safety Net Clinics Integrate Care for Patients: A Qualitative Case Study. Medical Care, 52(11), S39-S47.


The SNMHI experience suggested that 3-4 years may be necessary for many practices to achieve PCMH implementation. Organizations should anticipate that NCQA PCMH Recognition will take a considerable amount of staff time and effort.

The Safety Net Medical Home Initiative suggested the following key changes for organized, evidence-based care:

  • Use planned care according to patient need.
  • Identify high-risk patients and ensure they are receiving appropriate care and case management services.
  • Use point-of-care reminders based on clinical guidelines.
  • Enable planned interactions with patients by making up-to-date information available to providers and the care team at the time of the visit.

SNMHI still offers a full set of resources and tools to help primary care practices learn about and implement the PCMH model, including:

A curriculum for practice transformation facilitators based on the SNMHI approach is available from Coach Medical Home.

Contact Information
Evan Stults, Executive Director
QSI Communications, Qualis Health
Safety Net Medical Home
800.949.7536 ext 2458
Care coordination
Critical Access Hospitals
Federally Qualified Health Centers
Medical homes
Rural Health Clinics
States served
Colorado, Idaho, Massachusetts, Oregon
Date added
October 23, 2014
Date updated or reviewed
October 31, 2017

Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.