It is the ability of different information systems, devices and applications (systems) to access, exchange, integrate and cooperatively use data in a coordinated manner, within and across organizational, regional and national boundaries, to provide timely and seamless portability of information and optimize the health of individuals and populations globally. 0000006501 00000 n 4, 22 June 2016 | Health Services Management Research, Vol. (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]. 0000001158 00000 n We then searched Google Scholar to search for new articles that cited the original 22 articles. 56, No. 2020. 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. hSome Mullikin patients go to Pioneer Hospital, which is owned by MedPartners. 0000004805 00000 n 1. 0000005916 00000 n This challenge has motivated the AHRQ Comparative Health System Performance Initiative . This initial list included seminal reviews, taxonomies of health care systems, and original studies of various provider organizational structures (see Appendix A for the list of 22 articles). Journal of American Medical Association, 2013 Nov; 310(18): 1964–1970. We begin with a discussion of the primary care-centered medical group and its advantages over a system of solo and small-group practices. 38, No. Integrated service delivery is“the organization and management of health services so that people get the care they need, when they need it, in ways that are user-friendly, achieve the desired results and provide value for money.” Rates of inpatient days per thousand capitated enrollees are 50 percent lower in the most efficient California medical groups than in the nation's HMO industry as a whole. 0000004769 00000 n Enthoven, AC. In part, however, reduction of transaction costs requires the pioneering of new ways to coordinate the activities of each component in the network: new payment incentives, new joint ventures, and new performance measures. As Exhibit 1 shows, virtually all large California integrated medical groups and IPAs are multi-specialty, albeit with a strong primary care base. 0000005080 00000 n 16, Health Care Management Review, Vol. There are now two principal sources of investment capital: hospital systems and publicly traded physician management companies such as PhyCor, Caremark, and MedPartners. Organizing a delivery system around the hospital has a less compelling logic with each passing year. To characterize care management, we looked for information regarding each organizational structure’s role in coordinating and managing the care of defined patient populations and available resources and capacity within each structure to facilitate care management, such as health information technology. Sudbury, MA: Jones and Bartlett Publishers; 2000. 3, International Journal of Management Reviews, Vol. Multihospital systems. x�bb�e`b``Ń3� �����'> c^! 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. Three researchers developed, tested, and refined a code list to apply to the literature text. As an example, Hill Physicians Medical Group, one of the largest IPAs in the United States, contracts with health insurers on behalf of its large primary care and specialist physician network . Compared to many other industrialized countries, the U.S. health care system has been found to incur higher costs but yield lower access, quality, and population health outcomes . California medical groups and IPAs have negotiated with HMOs to receive the part of each capitation dollar that goes for physician services and, in many cases, part or all of the dollars earmarked for hospital and ancillary services as well, which enables them to purchase these services in what they believe is the most efficient way possible. “Sources, Procedures, and Microeconomic Effects of Innovation,”, “Variations in Resource Utilization among Medical Specialties and Systems of Care,”, “Economies of Scope and the Scope of the Enterprise,”. Impact of Accountable Care Organizations on Utilization, Care, and Outcomes: A Systematic Review. [Cited 2018 Nov 26]. 2, Health Care Management Review, Vol. 48, 23 August 2018 | Cancer Causes & Control, Vol. Serra was centered in the northern part of the county and was composed of virtually the entire medical staff of the hospital (many of whom were also members of the San Mateo IPA). The contemporary health care economy has inherited from the era of unmanaged care a vast surplus of hospital beds and clinical subspecialists. After removing duplicates, three reviewers screened the titles and abstracts of 1,750 articles for relevance. DOI: https://doi.org/10.1097/00004010-200301000-00009, Casalino, LP, Chenven, N. Independent practice associations: Advantages and disadvantages of an alternative form of physician practice organization. Multihospital systems are characterized by “horizontal integration of facilities…that provided similar acute care services in multiple locations.” [22, p. 15]. Small independent practices cannot stand alone in San Mateo County or elsewhere in California; the advantages of belonging to a large integrated medical group or IPA are overwhelming. These practices may also be owned by hospitals, health plans, or other firms . Despite the adoption of integration as a primary reform strategy, there is presently a gap in evidence regarding which underlying structural changes in local health care delivery systems are most effective in achieving higher value care .
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