GAO: Integrated delivery systems assist patient care, face operational challenges

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Integrated systems assist patient care strategies and access to care, but face various operational challenges, including care in underserved populations, according to a November report from the Government Accountability Office (GAO).

The HealthCare Safety Net Act of 2008 directed GAO to report on integrated delivery systems (IDSs) that serve underserved populations—those that are uninsured or medically underserved.

In the report, the GAO described:

  • Organizational features that IDSs use to support strategies to improve care;
  • Approaches that IDSs use to facilitate access for underserved populations; and
  • Challenges that IDSs encounter in providing care, including to underserved populations.

GAO selected a sample of 15 private and public IDSs clinically integrated across primary, specialty and acute care; with varying degrees of integration, specific organizational features and payor mix. GAO interviewed chief medical officers or other system officials at all 15 IDSs and conducted site visits at four IDSs, interviewing system executives and clinical staff.

“Some IDSs said that using EHRs supports their patient care strategies, such as care coordination, disease management and use of care protocols, by increasing the availability of individual patient and patient population data and by improving communication among providers,” the report stated. “IDSs also reported that operating a health insurance plan can support patient care strategies by providing to the IDS both financial resources, such as savings from reducing avoidable hospitalizations for health insurance plan members, and data on plan members.”

Financial resources could be used to fund services such as care coordination and the data could assist with strategies such as disease management, according to GAO.

Employment of physicians was reported to facilitate physician accountability for quality of care because physicians who are employed by the IDS must meet certain performance indicators, and the IDSs collect data on and review physician performance. Employment of physicians was also reported to increase adherence to care protocols and to facilitate provision of care to underserved populations through compensation that mitigates physicians’ concerns that they might not receive payment from uninsured patients, GAO added.

IDSs in the sample discussed several approaches used to facilitate access to care for underserved populations. These approaches include using community-based settings, such as school-based health centers and federally qualified health centers (FQHC); conducting outreach; helping patients apply for coverage programs such as Medicaid; providing financial assistance; and collaborating with community organizations, including faith-based organizations.

“Some IDSs operate FQHCs within their system, and others collaborate with local FQHCs that are not part of their system. In addition, to improve access to mental healthcare services for patients, including those in underserved populations, some IDSs integrate mental health and primary care services,” reported GAO.

However, some IDSs reported that not receiving reimbursement from healthcare insurance companies for the care coordination services they provide to patients is a financial challenge.

Other operational challenges IDSs identified included finding specialty care for underserved patients, including mental healthcare; sharing clinical information in patients’ EHRs with providers outside the system; and changing management and physician cultures to adapt to organizational change.

Click here to read the report.