Serving a similar disenfranchised population, safety net hospitals can be a natural fit with health centers seeking the improve the health care system. This paper provides a unique perspective from safety net hospitals facing the conundrum of adding value to the health care system with the ACO model while taking losses for reducing inpatient days, emergency room visits, and imaging services. Funded by the Robert Wood Johnson Foundation, this paper drafted by John Snow, Inc. and Bailit Health, discusses the role health centers have played for safety net hospitals navigating accountable care development efforts.  The paper highlights efforts from four safety net hospital systems: AltaMed Health Care Services in Los Angeles, CA; Baystate Health in Springfield, MA; Commonwealth Care Alliance in Boston, MA; and Hennepin Health in Minneapolis, MN.