Success Principles in Integrated Delivery System

10 principles of Successfully integrated health systems 1.Comprehensive service offered across the continuum of care 2.Patient focus 3.Geographic coverage and rostering 4.Standardized care delivery through interprofessional teams 5.Performance management 6.Appropriate information technology and communication mechanisms 7.Organizational culture with strong leadership and shared vision 8.Physician integration 9.Strong governance structure 10.Sound financial management

1. Care across the continuum  Comprehensive scope of clinical and health related services; integration of services along the continuum to provide seamless patient care  Cooperation between health and social care organizations  Emphasis on wellness, health promotion and primary care with family physician as “gatekeeper” to secondary services

2. Patient and population focus  Patient-centred philosophy; focusing on patients’ needs, Market sensitivity and responsiveness  Population-based needs assessment; focus on defined population  Focus on meeting community’s health needs; needs-based planning and information management

3. Geographic coverage  Geographic coverage of service area or region to maximize accessibility and minimize duplication  Roster: responsibility for identified population; right of client to choose and exit  Geographic concentration: operating units of a system are located in proximity to each other

4. Best practice guidelines, protocols  Interdisciplinary teams across the service pathway; clearly defined roles and boundaries of each team member  Integration of clinical expertise with all professionals being equal members of multidisciplinary teams; jointly made decisions and control  Processes and structures to ensure smooth transitions from one type of care to another  Development of evidence-based clinical practice guidelines with automated tools to support their use

5. Quality improvement/ performance measurement  Well developed performance system with criteria for measuring and monitoring; continuous improvement process  Service utilization analysis capabilities throughout the system and by discrete member populations; tracking episodes of care, and determine care outcomes in all care settings  Measurement and reward systems are designed to identify, measure and reinforce achievement of a new set of organizational priorities; linkage between senior management compensation and indicator-based performance

6. IT and communication  State of the art information systems to collect, track and report activities (including population demographics and care needs, use of services, client satisfaction)  Centralized system-wide computerized patient record system; data accessibility from anywhere in the system;  Enterprise wide patient registration and scheduling coordination; common patient statements and billing capabilities

7. Organizational culture and leadership  Collective culture that reflects the new vision and values of the integrated organization; strong system culture instilled into all staff  Organizational support, i.e. organization demonstrates willingness to take this route; committed front line staff that take ownership; good communication to keep the information flowing  The organization fosters continuous learning whereby further changes can be quickly incorporated and adopted by the organization  Ability to foster innovation

8. Physician engagement  Physicians are well integrated in the system and play a key leadership role (e.g. CEOs or other leadership roles); effective physician involvement at all levels of the system  Primary care physicians are economically integrated  Cooperation between hospital and physicians; physician alignment  Operational support for physicians; sharing of cost information  Clinician-led change, i.e. medical specialists taking key role in identifying best practice, working with general practitioners and interdisciplinary teams; clinical leadership across integrated care pathways

9. Governance structure and management  Strong governance structure that includes community and physician representatives;  System-level strategic planning and decision making  Flatter and more responsive organizational structure that utilizes the skills and talents of employees to a greater degree  Centralization of only those functions that offer substantial savings or coordinate advantages  Accountability for the health status of the defined population  Strategic alliances and networks with external stakeholders, government, the public  Organizational structure promotes coordination

10. Financial management  Organization makes critical decisions regarding funding distribution, purchase of services  Risk is shared by system and providers; pooling of resources; blended funding models  Information-based decision making; clinical and financial decision support tools available at the point of service; care is delivered in the most cost- effective manner and in the most appropriate location  Development of financing arrangements that encompass medical and long-term services and provide incentives for cost control across both services  Weighted capitation: per person amount of funding adjusted to reflect organization’s membership (e.g., minimum of age and gender adjustment)