Chapter 5 Using Adaptive and Disruptive Change Strategies to Create an Integrated Delivery System: Montefiore Medical Center's Experience

Abstract

Purpose – This chapter explores the use of adaptive and disruptive change strategies to create an integrated health care delivery system that is both economically sustainable and patient-centered. Design/methodology – This case study of Montefiore Medical Center is based on a year of research that included focus-group interviews; individual interviews with executives, frontline staff, and union leaders; site visits; analysis of internal data; and a literature review. Findings – Montefiore Medical Center is using both adaptive and disruptive strategies to develop an integrated delivery system driven by capitated payments from health insurance companies, a focus on primary care and chronic disease management programs, and community outreach. The growth of these delivery system components in conjunction with Montefiore's Care Management Corporation (to help manage the health plan contracts) has contributed to an affordable cost of care, improved clinical outcomes, and proactive patient and community engagement. Originality and value – There is a paucity of case studies describing how safety-net hospitals – and health systems in general – can integrate the services they provide to create a positive, seamless, and economical patient experience. The story of Montefiore Medical Center offers an overview of how health care infrastructure and payment methods can be transformed to align financial and clinical incentives and to better serve a patient population that largely depends on government health insurance.