This report summarizes findings from a small qualitative study of six health centers that are pursuing a diverse range of approaches to facilitating specialty care for patients. Approaches vary by specialty, patient insurance status and community opportunities and constraints. Key approaches include hospital affiliation, providing specialty care at primary care sites and remote visits and consultations. All study sites provided mental health services and are working to integrate these services with primary care: two covering a full range, four focusing on services most linked to primary care. Only two provided substance use disorder services. A per member per month payment for case management appears to have a direct positive impact on access to specialty care.