Hospital executives have a different perspective than medical group, nursing home and home health agency representatives on what components are most essential to creating a comprehensive integrated delivery system, according to preliminary results of a new survey.
The survey polled 69 hospitals, 39 medical groups, 60 nursing homes and 60 home health agencies to determine the knowledge and interest of their executives, physicians and board members in developing an integrated delivery system.
Most respondents said physicians and home health were essential elements in an integrated delivery system. While hospitals were viewed as extremely important to an integrated delivery system, they were not seen as essential by most respondents.
Only 86% of hospital administrators agreed that acute-care services are "extremely" important to an integrated delivery system. In fact, more home health executives, 94%, said they believed acute care was essential. Some 87% of medical group administrators and 77% of nursing home executives also said acute care was extremely important.
Nursing homes also were seen as less important to an integrated delivery system than other components, the findings showed.
Goals in focus.While the survey indicated some general agreement between the four key provider groups, it also pointed out the need for potential partners to assess their goals carefully before signing contracts to avoid misunderstandings after the integrated delivery system has been created.
The survey was conducted earlier this year by Connie Evashwick, director of the Center for Health Care Innovation at California State University, Long Beach, and Allen C. Meadows, chief executive officer of Pennsylvania State University at Altoona. The survey was partially funded by CSU through a $5,000 grant.
"It's very important that administrators doing the relationships understand what they get into and what they want to get out of the (integrated delivery system)," Ms. Evashwick said. "It's important that they educate their staff and physicians so that integration can do what it is supposed to do."
Hospital executives surveyed were most knowledgeable about the impact on their organizations of integrated delivery systems. However, more than half the executives from medical groups, nursing homes and home health agencies said they weren't very knowledgeable of such systems' impact.
Many aren't ready.Ms. Evashwick said the survey results indicated many nursing homes and home health agencies aren't ready to join an integrated delivery system. But, she added, "hospitals and medical groups need to understand that nursing homes and home care are critical (components of an integrated delivery system that can) help manage patients over time."
One possible hindrance to hospitals and medical groups seeking to form an integrated delivery system with other groups is that some home health and nursing home executives are afraid of becoming swallowed up into larger organizations, Ms. Evashwick said.
"Hospitals and medical groups need to develop a relationship of trust tohelp them get up to speed on the legal and strategic issues," she said.
Toward a definition.The survey's other purpose was to reach consensus on a definition of an integrated delivery system. Ms. Evashwick said she was not surprised that less than half the 228 respondents agreed with the researchers' proposed definition (See graphic, p. 52). She said the definition will be further refined for the survey's final report, which is expected in late October.
The researchers also believe that administrators' perceptions of integrated delivery systems influence decisions about operations, contract negotiations and strategic planning.
"Few people on top are knowledgeable (about such systems)," Ms. Evashwick said. "There is even less knowledge throughout the organization. If staff have no idea, they won't know how the contracts should be organized."
The survey also uncovered misunderstanding of the management structure needed to oversee such a system, Ms. Evashwick said.
While more than half the respondents agreed about the importance of various components integrating through affiliation, less than one-third of the medical groups, nursing homes and home health agencies believed in joint management structures, she said.
For example, 22% of medical groups indicated it was "extremely" important to manage the integrated delivery system jointly; 58% said it was "somewhat" important. Nursing home executives were less supportive, with 19% believing it extremely important and 45% thinking it to be somewhat important.
Home health executives were more accepting of joint management, with 33% deeming it extremely important and another 30% considering it to be somewhat important.
"I don't know how you can have an integrated system without having integrated management," Ms. Evashwick said. "This indicates a lack of awareness and a lot of problems down the road."
Capitation key for hospitals.In several questions on financial arrangements, hospital executives viewed capitation and managed-care arrangements as being more important than did executives in the other groups, Ms. Evashwick said.
"Hospitals see managed care and enrolled populations as the heart of integrated delivery systems," she said. "Others don't see it as that important yet."
Some 79% of hospital executives said capitated payment arrangements were "extremely" important for an integrated system. On the other hand, 58% of medical group administrators said it was extremely important, followed by 36% of nursing home executives and 22% of home-care executives.