32, No. IPAs initially emerged in response to the growth of managed care in the United States during the 1990s but continue to be a relevant model in the context of payment reform, as they help network physicians assume and share financial risk while also enabling them to maintain their independence [14, 15, 16]. Shortell, Casalino, and Fisher (2010) noted, “Because they include multiple specialties, they can provide most care that patients need within the group…” [15, p. 54]. Information Knowledge Systems Management, 2009; 8: 369–382. Integrated Health Care: Literature Review. Integration, on the other hand, is composed of projects that do not tend to last as long. The fair market test, for purposes of understanding the organizational trajectory of managed care, is not between vertically integrated delivery systems and the fragmented cottage industry of yesteryear but between vertically integrated systems and virtually integrated structures in which coordination is achieved through contract. (2014) found little evidence that hospital-physician structural integration alone yields improved cost and quality outcomes, pointing to research suggesting that organizational change should be coupled with enabling care management and governance processes to support performance improvement [39, 42]. 0 �Us�!.Ԡ&+��8N.�0 �>\SRM92"[#e� However, the authors noted the role of organizational factors such as use of electronic health records or implementation of quality improvement initiatives that could influence outcomes . 145, No. Journal of American Medical Association, 2013 Nov; 310(18): 1964–1970. DOI: http://doi.org/10.5334/ijic.4635, Heeringa, Jessica, Anne Mutti, Michael F. Furukawa, Amanda Lechner, Kristin A. Maurer, and Eugene Rich. Major policy shifts, such as the Patient Protection and Affordable Care Act (ACA) of 2010, have in part fueled a resurgence in efforts to promote integrated care. Dr Jason Cheah, Deputy Group Chief Executive Officer (Transformation), National Healthcare Group/Chief Executive Officer, Woodlands Health Campus, Singapore. Results from a national survey. Some hospital systems in California are investing in medical groups and IPAs in an attempt to develop “integrated delivery systems.” Others, however, are being forced to adjust to a new role as price-taking subcontractors in the managed care food chain. , *, Strategic integration of hospitals and physicians, Results of a randomized controlled trial to increase colorectal cancer screening in a managed care health plan, Comparing the Impact of News: A Tale of Three Health Care Sectors, The Alignment and Blending of Payment Incentives within Physician Organizations, Physician supply, physician diversity, and outcomes of primary health care for older persons in the United States. The central role played by organized physicians—whether in integrated medical groups or in IPAs—distinguishes the California model of managed care from managed care in other states, in which physicians often are employed by hospitals or contract as individuals with HMOs. Willig R.D. In: Elhauge, E (ed. Given current efforts to reform the U.S. delivery system, future research should seek to systematically examine the role of organizational structure in cost and quality outcomes. Increasingly, hospitals, physicians, and other providers are consolidated into health systems [5, 6]. 12 The independent medical group or IPA can escape paying the maintenance costs of the excess capacity that the hospital systems are unable or unwilling to eliminate. 39, No. Even when supplemented by performance bonuses, salary payment mechanisms provide considerably weaker performance incentives than does the profit incentive. Medical Group Structural Integration May Not Ensure That Care Is Integrated, From the Patient’s Perspective. Burns and Pauly (2002) noted that these systems “feature common asset ownership but separate system versus hospital boards and executives” [24, p. 131]. 29, No. 3, Journal of Media and Religion, Vol. We describe the diverse relationships between health care providers that have arisen in the U.S. context as providers respond to policy and payment reforms, in order to aid researchers and policymakers seeking to characterize the further evolution of health care delivery. Conceptualizing and Measuring Integration: Findings from the Health Systems Integration Study. Healthcare integration is the partnership between healthcare providers, payers, vendors, etc. DOI: https://doi.org/10.1377/hlthaff.26.1.w44. We highlight excess capacity and the need for external sources of investment capital as major short-term determinants of vertical versus virtual integration decisions. [Cited 2018 Nov 26]. 29, No. In 1987 an entrepreneurial physician created the Camino Real Medical Group, an IPA that included nearly all of the primary care physicians in the other two IPAs, but a much smaller subset of specialists. 4, New England Journal of Medicine, Vol. Physicians tend to form these organizations to share governance, resources, and patients and essentially achieve greater care coordination [13, 15]. These models of care are characterized by provider collaborations among hospitals, primary and specialty care physicians, behavioral health, community-based organizations, and potentially other providers along the care continuum. “Horizontal and Vertical Integration of Health Care Providers: A Framework for Understanding Various Provider Organizational Structures”. In general, contractual relations are strong where ownership relations are weak, and vice versa. Although policy strategies emphasize integration, U.S. policymakers currently lack clear evidence on the forms of integration that are most effective. Strategic Integration of Hospitals and Physicians. 2, Health Care Management Review, Vol. Thus, to the extent these systems also include other care providers, they would be more appropriately classified as a form of vertical integration. 8, No. Shortell, SM, McCurdy, RK. Specialists who belong to primary care groups are more likely to be concerned with the group's success in attracting patients and with managing costs than are independent specialists under contract.
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