Health Care Economies: San Francisco and Fresno

California’s large and diverse population is spread across a vast area, occupying health care regions that vary greatly in affordability, access, and quality of care. In a continuing effort to capture these differences, the California HealthCare Foundation (CHCF) published reports on the San Francisco Bay Area and Fresno regions as part of six market analyses that examine how health care is delivered and financed across the state.

CHFC reports that Bay Area providers and health plans are aligning aggressively. Health plans and providers formed narrow-network accountable care organizations (ACOs) in 2011. Safety-net providers are coordinating care through the medical home model while a surge of physicians and hospitals have collaborated to expand geographic reach.

HMOs have a weak presence in Fresno, with PPOs as the dominant model. Most Fresno hospitals survived the poor economy, but face mounting financial pressures from rising Medi-Cal enrollment and high rates of the uninsured, which have strained provider capacity. Fresno hospitals face strong competition for physicians with federally qualified health centers and hospital-operated rural health clinics, which remain rooted in independent practices and show little interest in alignment.

CHCF recently released regional analyses on Riverside/San Bernardino and Sacramento. In the coming months, the organization will report on Los Angeles and San Diego. For more information, visit

Last Updated 06/29/2022

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