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Horizontal and Vertical Integration of Health Care Providers: A Framework for Understanding Various Provider Organizational Structures

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...

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Autores principales: Heeringa, Jessica, Mutti, Anne, Furukawa, Michael F., Lechner, Amanda, Maurer, Kristin A., Rich, Eugene
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Ubiquity Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978994/
https://www.ncbi.nlm.nih.gov/pubmed/31997980
http://dx.doi.org/10.5334/ijic.4635
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author Heeringa, Jessica
Mutti, Anne
Furukawa, Michael F.
Lechner, Amanda
Maurer, Kristin A.
Rich, Eugene
author_facet Heeringa, Jessica
Mutti, Anne
Furukawa, Michael F.
Lechner, Amanda
Maurer, Kristin A.
Rich, Eugene
author_sort Heeringa, Jessica
collection PubMed
description 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.
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spelling pubmed-69789942020-01-29 Horizontal and Vertical Integration of Health Care Providers: A Framework for Understanding Various Provider Organizational Structures Heeringa, Jessica Mutti, Anne Furukawa, Michael F. Lechner, Amanda Maurer, Kristin A. Rich, Eugene Int J Integr Care Research and Theory 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. Ubiquity Press 2020-01-20 /pmc/articles/PMC6978994/ /pubmed/31997980 http://dx.doi.org/10.5334/ijic.4635 Text en Copyright: © 2020 The Author(s) http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.
spellingShingle Research and Theory
Heeringa, Jessica
Mutti, Anne
Furukawa, Michael F.
Lechner, Amanda
Maurer, Kristin A.
Rich, Eugene
Horizontal and Vertical Integration of Health Care Providers: A Framework for Understanding Various Provider Organizational Structures
title Horizontal and Vertical Integration of Health Care Providers: A Framework for Understanding Various Provider Organizational Structures
title_full Horizontal and Vertical Integration of Health Care Providers: A Framework for Understanding Various Provider Organizational Structures
title_fullStr Horizontal and Vertical Integration of Health Care Providers: A Framework for Understanding Various Provider Organizational Structures
title_full_unstemmed Horizontal and Vertical Integration of Health Care Providers: A Framework for Understanding Various Provider Organizational Structures
title_short Horizontal and Vertical Integration of Health Care Providers: A Framework for Understanding Various Provider Organizational Structures
title_sort horizontal and vertical integration of health care providers: a framework for understanding various provider organizational structures
topic Research and Theory
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978994/
https://www.ncbi.nlm.nih.gov/pubmed/31997980
http://dx.doi.org/10.5334/ijic.4635
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