Are health systems redesigning how health care is delivered?

• Published in: Health services research 2020-12, Vol.55 (6), p.1129-1143
• Main Authors: Scanlon, Dennis P., Harvey, Jillian B., Wolf, Laura J., Vanderbrink, Jocelyn M., Shaw, Bethany, Shi, Yunfeng, Mahmud, Yasmin, Ridgely, M. Susan, Damberg, Cheryl L.
• Format: Article
• Language: English
• Subjects: Analysis; care delivery redesign; Clinical outcomes; Comparative analysis; Data collection; Decision making; Delivery of Health Care, Integrated - organization & administration; Evaluation; Gaging; Health care; health care delivery; Health care industry; Health services administration; Health Services Research; Health status; health systems; Humans; Innovations; Interviews as Topic; Medical care; Medical care quality; Medical research; Motivation; Organizational change; Organizational Culture; Organizational Innovation; Organizational Objectives; Outcome and Process Assessment, Health Care; Policy making; Qualitative Research; Quality management; Theme Issue: Comparative Health System Performance; Uncertainty; value‐based care
• ISSN: 0017-9124; 1475-6773; 1475-6773
• DOI: 10.1111/1475-6773.13585

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.