ABSTRACT
Integration is a common goal when health systems acquire medical practices, but may take various forms and continue to evolve beyond the classic model. Characteristics of the classic model of integration include strong and committed physician leadership, an emphasis on care coordination, easy access to primary care, integrated IT and business intelligence, and a willingness to accept financial risk. Leaders of integrated delivery systems continue to strive for greater levels of coordination and leveraging of collected talents and resources.
Subject(s)
Delivery of Health Care, Integrated/organization & administration , Health Facility Merger/organization & administration , Hospital-Physician Relations , Medical Informatics/organization & administration , Systems Integration , Delivery of Health Care, Integrated/economics , Delivery of Health Care, Integrated/trends , Health Facility Merger/economics , Health Facility Merger/trends , Humans , Medical Informatics/economics , Medical Informatics/trendsABSTRACT
In the emerging healthcare environment, providers will require many capabilities of traditional health plans simply to remain viable. Providers that are contemplating entering the health plan business should consider the likely strategic, structural, and cultural effects of such a strategy on their organizations. Providers that own health plans will need to determine how they will differentiate themselves in the markets to foster patient loyalty and which insurance lines of business they will pursue (e.g., individual, small group, large group, or other).
Subject(s)
Insurance, Health , Ownership , Health Personnel , Risk Management/economics , United StatesABSTRACT
The U.S. healthcare system's focus on population health management is prompting experimental care models aimed at strategically filling gaps in care coordination for targeted patient populations. Examples include: Extensivists. Care coordinators. Home visits. Polyclinics. Reorganized hospitalists. Predictive modeling.
Subject(s)
Delivery of Health Care/standards , Humans , Models, Organizational , Patient Care Management/organization & administration , Patient Care Management/standards , United StatesABSTRACT
Big data is a concept that is being widely applied in the retail industries as a means to understand customers' purchasing habits and preferences for followup promotional activity. It is characterized by vast amounts of diverse and rapidly multiplying data that are available at or near real-time. Conversations with executives of leading healthcare organizations provide a barometer for understanding where the industry stands in its adoption of big data as a means to meet the critical information requirements of value-based health care.
Subject(s)
Access to Information , Delivery of Health Care , Information Management , Efficiency, Organizational , Humans , Organizational Case Studies , Quality Improvement , United StatesABSTRACT
The nation's annual growth rate of medical costs could be halved if the nation were to rigorously pursue the following initiatives, among others: Move rapidly from fee-for-service to value-based contracting. Increase the supply and effective utilization of primary care physicians and physician extenders. Focus more on chronic disease management. Pass tort reform. Encourage the formation of multispecialty group practices and integrated systems. Reduce administrative complexity.
Subject(s)
Economics, Hospital/organization & administration , Efficiency, Organizational/economics , Health Care Costs , Cost Control/methods , Cost Control/organization & administration , Costs and Cost Analysis/methods , Diffusion of Innovation , Primary Health Care/economics , Specialization/economics , United StatesABSTRACT
Key considerations facing a hypothetical and typical health system as it transitions to value-based payment provide a guide for systems as they undertake this transition. The health system's first step is to review its current environment and strategies and the building blocks it has in place. Next, the system needs to add more building blocks, build a financial cushion, and revise targets and dashboards. Next steps include testing value-based payment contracting, realigning incentives, implementing new care management strategies, and communicating extensively. All of these steps will be unique to each organization.
Subject(s)
Multi-Institutional Systems , Value-Based Purchasing , Delivery of Health Care/organization & administration , Hospital Information Systems , Multi-Institutional Systems/economics , Multi-Institutional Systems/organization & administration , Organizational Case Studies , Organizational Innovation/economics , Organizational Objectives/economicsABSTRACT
Case studies of three healthcare organizations reinforce the premise that business intelligence--the ability to convert data into actionable information for decision making--is critical to demonstrating improved value.
