| Organization type | Included health care providers and services | Care management functions | Administrative oversight of providers |
|---|
| Horizontally integrated structures |
|---|
| Single specialty group practice | Physicians Physician services
| | Hospitals, health plans, physicians, and other firms may own or manage single specialty practices, which could influence the degree of administrative oversight over included providers.
|
| Multispecialty group practice | | May facilitate patient referral, improve care coordination, and be better-positioned to manage the costs of care [12, 15]
| Multispecialty group practices share governance and infrastructure, which can result in tighter management control; however, control can vary depending on factors such as size and whether the practice is physician-owned, owns a hospital, or is owned by hospital/system [12, 15].
|
| Independent practice association | | Largely serve contracting role and provide administrative and contractual functions [15] May provide infrastructure services to support performance improvement and care management [20, 32] May provide processes and resources to support care management such as disease registries, nurse care managers, etc. [14]
| |
| Virtual physician networks | | Entities that organize these networks, such as medical foundations or state Medicaid agencies, may provide care coordination networks; certain infrastructure resources, such as health information technology and information exchange; and care management services to member physicians, who in turn could use those services in the provision of care [15, 18, 20]
| |
| Multihospital systems | | | As multihospital systems are characterized by shared ownership or management, administration may have more direct control over included hospitals, including care processes, shared organizational missions, and the like. However, they may also maintain separate hospital boards and executives, despite shared asset ownership [24].
|
| Vertically integrated structures |
| Physician hospital organization | Hospitals and their affiliated physicians Hospitals and physician services, which vary depending on included specialties
| Facilitate managed care contracting, provide administrative services to physicians, facilitate natural referral relationships around one hospital, and manage ambulatory care facilities where physicians work [15, 28] Closed physician-hospital organizations selectively contract with physicians on the basis of quality and cost performance and have exclusive relationships with physicians and close relationships with hospitals, which may facilitate care coordination [28] May provide processes and resources to support care management [14]
| |
| Management services organization | | These organizations provide administrative and infrastructure services, which may include care coordination, care management services and health information technology, to physician members [12, 27, 28]
| |
| Clinically integrated network | | Providers seeking to form these networks must demonstrate integration clinically through a number of activities, including implementation of a program to evaluate and modify practice patterns and creation of a high degree of interdependence and cooperation among network physicians to control costs and ensure quality. Example features of programs include: Implementing systems to ensure appropriate utilization of services Deploying evidence-based practice standards and protocols Performance evaluation and feedback to included providers Case management and care coordination [29, 30]
| Providers are either integrated via ownership or contractual relationships; the clinical integration framework requires physicians to use consistent care protocols and to monitor quality, suggesting greater oversight and management of included providers [29, 30].
|
| Foundation model | Varies; primarily limited to physicians; however, in some states with corporate practice of medicine laws, certain hospitals such as nonprofit health corporations or federally qualified health centers, may employ physicians, provided physician autonomy is maintained [33]. Physician services are explicitly included, but these structures are often formed to facilitate collaboration between hospitals and physicians [28, 33].
| | A key feature of this model is the salaried employment of physicians by a non-profit entity; while employment may suggest greater management control of included providers, states with corporate practice of medicine laws – where these models are relevant – are explicitly focused on maintaining the clinical independence of physicians [31, 33].
|
| Integrated delivery system | Varies; may include hospitals, physicians, and other health care providers such as post-acute care providers, behavioral health, community-based organizations, as well as health plans [15, 31, 39] Comprehensive, full continuum of care [15, 39]
| Care coordination and information sharing along care continuum [13, 15, 31] Population health and care management [13] Data collection, analysis, and reporting capabilities to inform quality improvement [13, 15, 31] Health information technology capacity [15] Use of evidence-based practices [31] Interdisciplinary, team-based care [31]
| Providers join systems through ownership or formalized contractual agreements, which typically establish some degree of administrative control. Administrative control may vary depending on the extent to which the system centralizes management activities, engages in physician-system integration, and employs physicians [12, 28].
|
