Are health systems redesigning how health care is delivered?

Abstract

Objective To explore why and how health systems are engaging in care delivery redesign (CDR)—defined as the variety of tools and organizational change processes health systems use to pursue the Triple Aim. Study Setting A purposive sample of 24 health systems across 4 states as part of the Agency for Healthcare Research and Quality's Comparative Health System Performance Initiative. Study Design An exploratory qualitative study design to gain an “on the ground” understanding of health systems’ motivations for, and approaches to, CDR, with the goals of identifying key dimensions of CDR, and gauging the depth of change that is possible based on the particular approaches to redesign care being adopted by the health systems. Data Collection Semi‐structured telephone interviews with health system executives and physician organization leaders from 24 health systems (n = 162). Principal Findings We identify and define 13 CDR activities and find that the health systems’ efforts are varied in terms of both the combination of activities they are engaging in and the depth of innovation within each activity. Health system executives who report strong internal motivation for their CDR efforts describe more confidence in their approach to CDR than those who report strong external motivation. Health system leaders face uncertainty when implementing CDR due to a limited evidence base and because of the slower than expected pace of payment change. Conclusions The ability to validly and reliably measure CDR activities—particularly across varying organizational contexts and markets—is currently limited but is key to better understanding CDR’s impact on intended outcomes, which is important for guiding both health system decision making and policy making.

Impact of Hospital Affiliation With a Flagship Hospital System on Surgical Outcomes

“…Hospital systems have often said that their mergers and acquisitions—which have accelerated in recent years 1,14,16,46,47 —are associated with higher quality due to improved care coordination and economies of scale 1–7 . Prior literature has suggested that, despite evidence of variation in surgical outcomes within highly rated hospital systems, 10 many, if not most, patients expect hospitals from the same system to offer the same standard of care, regardless of whether they are at a flagship hospital or its local affiliate 8 …”

“…Hospital systems have often said that their mergers and acquisitions-which have accelerated in recent years 1,14,16,46,47 are associated with higher quality due to improved care coordination and economies of scale. [1][2][3][4][5][6][7] Prior literature has suggested that, despite evidence of variation in surgical outcomes within highly rated hospital systems, 10 many, if not most, patients expect hospitals from the same system to offer the same standard of care, regardless of whether they are at a flagship hospital or its local affiliate. 8 To study this, we performed a large, carefully matched study across 35 of the largest HRRs, controlling for 32 general surgical procedures, 55 comorbidities and functional status indicators, multimorbidity status, emergent admission status, and sociodemographic variables including age, sex, race, dual-eligibility, and neighborhood education and poverty levels.…”

“…A lthough primarily driven by financial and regulatory considerations, 1,2 hospital system mergers and acquisitions are typically presented to patients and policymakers as beneficial to patient care, 3,4 such as through improved care coordination across hospitals 5,6 or economies of scale that facilitate process efficiency and investments in advanced technology. [5][6][7] Perhaps most fundamentally, affiliation with a major regional hospital system is often promoted by these same systems as an opportunity for patients to benefit locally from the same standard of care experienced at their flagship hospital. 8,9 This branding association with one of the best hospitals in the region offers affiliates the ability to distinguish themselves from surrounding hospitals.…”