Abstract
Introduction:Current U.S. policy and payment initiatives aim to encourage health care provider accountability for population health and higher value care, resulting in efforts to integrate providers along the continuum. Providers work together through diverse organizational structures, yet evidence is limited regarding how to best organize the delivery system to achieve higher value care.Methods:In 2016, we conducted a narrative review of 10 years of literature to identify definitional components of key organizational structures in the United States. A clear accounting of common organizational structures is foundational for understanding the system attributes that are associated with higher value care.Results:We distinguish between structures characterized by the horizontal integration of providers delivering similar services and the vertical integration of providers fulfilling different functions along the care continuum. We characterize these structures in terms of their origins, included providers and services, care management functions, and governance.Conclusions and discussion:Increasingly, U.S. policymakers seek to promote provider integration and coordination. Emerging evidence suggests that organizational structures, composition, and other characteristics influence cost and quality performance. 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.
Highlights
Current U.S policy and payment initiatives aim to encourage health care provider accountability for population health and higher value care, resulting in efforts to integrate providers along the continuum
We solicited key references from experts in the field associated with the AHRQ Comparative Health System Performance Initiative, with the goal of including historical and contemporary literature addressing a range of health care delivery organizational strategies in the aggregate
We searched Google Scholar to search for new articles that cited the original 22 articles. We supplemented these searches with additional key author searches and targeted hand searching to fill in gaps on identified organizational structures for health care delivery systems
Summary
Current U.S policy and payment initiatives aim to encourage health care provider accountability for population health and higher value care, resulting in efforts to integrate providers along the continuum. Individuals obtain health insurance through private or public sources that target certain patient populations on the basis of employment, age, disability status, income status, military service, or other factors, while a portion of society remains uninsured for various reasons The result of this heterogeneous coverage environment is that multiple players, including federal and state policymakers and private payers, influence the health care delivery system and patient care. These players develop eligibility policies, determine which services will be covered, contract with provider networks, establish provider reimbursement models, and engage in some level of care management. “Integrated care” has been defined as “a coherent set of methods and models on the funding, administrative, organizational, service delivery and clinical levels designed to create connectivity, alignment and collaboration within and between the cure and care sectors” [2]
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