Healthcare Delivery Systems

Close to 850 integrated health care delivery systems present in the United States today. Presently most of the health care systems are considered to be in an evolving state of integration as they attempt to provide a full continuum of services in a user-friendly, one-stop-shopping environment that eliminates costly intermediaries, promotes wellness, and improves health outcomes.

Markers of integration subsequently include coordinated systems of care, geographic reach, strong physician-hospital links, quality management, contractual capabilities, utilization controls, financial strength, organized oversight and economies of scale. An honest evaluation of just how integrated health care system each component of a system is will determine the strategies necessary to contain its risks. The typically large size of health care organizations, the geographical distances and structural differences among components, and the differences in services and staff involved create formidable challenges to those responsible for risk management.

Skeptics have questioned the value of many health care integration efforts. The financial performance of hospitals affiliated with health care systems suggests only small gains in many instances. Proponents believe that attention to community health care needs has improved but that new risks have been created as health care providers' roles and degrees of authority have changed, immediacy of access to health care has been reduced, and providers' freedom of choice has been restricted. As a result of these several events, new avenues for potential errors and litigation to occur have emerged. Discussions surrounding the value and responsibility of integrated health care delivery systems and the necessity for health plan regulation overall have emerged rapidly as priority issues on the President's current agenda.

The review of the intended health care provisions of the Federal Employee and Income Security Act of 1974 (ERISA), in regard to states' rights to regulate the “business of insurance" and patients' rights to sue their managed care providers, complicates risk evaluations at this time. Medical and health care malpractice risks, antitrust issues, negligent credentialing risks, employment practices liabilities, shareholders derivative suits, and directors and officers liabilities are among those areas that must all be carefully reviewed with the disadvantage of not knowing the clear direction of the law.

From a risk management standpoint, the challenge within the integrated health care delivery systems is to institute an integrated risk management plan. A good starting point in the risk assessment of integrated health care delivery systems is to be familiar with determinants of their success. For the integrated health care delivery systems to be and remain successful, several actions must be taken by integrated health care delivery systems leaders. Particularly the integrated health care delivery systems should be engaging in several strategies like identifying and aligning the key economic initiatives and incentives of the participating provider organizations

Expanding upon health care system choices available to the medical consumers and accurately gauging their preferences of delivery mechanisms; Partnering with an array of inpatient and ambulatory care support services such as home care, hospice, medical transportation companies, and wellness centers; Managing patients' care “from cradle to grave" along a continuum of care versus treating episodic illnesses;Providing strong medical management of the IDS by highly skilled personnel and recruiting physician leaders.

• Juliana Breckinridge
• 04/02/2009, 12:59 AM
• 0 Comments