The U.S. health system continues its path to a more integrated approach to serving consumers. The push is driven largely by demands for better value—lower costs, better outcomes, and improved consumer experience. But if you were talking about integration a decade ago, the discussion would have been focused on developing integrated models for primary care and behavioral health services. It’s been ten years since the National Council introduced its four-quadrant grid for planning integrated behavioral health and primary care services (see Four Quadrant Clinical Integration Model).
What a difference a decade “plus” makes. The integration that matters for strategy in the health care system is far different now —from virtual specialty care professionals embedded in health plans to fully-integrated health plan/health system models (for more on the ten types of health system integration, see The Changing Face Of Integration).
To address long-term sustainability in this shifting market, executive teams need to make the fundamental decision about whether to remain independent specialist organizations or become part of integrated service delivery systems. That was the key theme of my closing keynote address, The Integration Imperative: What You Need To Know & Do To Remain Relevant, wrapping up The 2020 OPEN MINDS Performance Management Institute. In their strategy development process, executive teams need to know the answers to four key questions –
- What are the emerging integration models that affect specialty provider organization market position the most? What are the effects of the model?
- What are the key elements needed to remain relevant in “integrated” systems?
- What is required for specialty provider organizations to remain “independent specialists”?
- Whatever the strategic choice, what are the “management musts” for managing for sustainability?
The many models of integration—that integrate consumer information, financial incentives, and/or service delivery to different degrees—present a sustainability challenge to specialty provider organizations. The adoption of these new models affects the relevance and revenue of specialty provider organization service lines, leading to a few questions. Executive teams need to understand in each of their markets, the proportion of the population in each type of integrated model. With that high-level market map, the questions that need to be answered are: What is the effect on my current service delivery? What services can I provide in the new market models? How many of those services? In each model, how does my organization acquire new contracts and new referrals? What is the cost of marketing in the new market models? What reimbursement model is preferred? What are the new rates?
With that market mapping, executive teams can make the decision about whether to change their service line portfolio – and whether they can remain an independent specialist organization or need to join forces in some with way with the dominant integrated systems in their markets. As we look ahead, either market position will demand changes in operation. And, regardless of that decision, most organizations need to ramp up their management models for navigating the changing landscape.
These strategic decisions weigh heavily on executive teams and board members of most specialty provider organizations in the health and human service market. And it is not wise for executives to avoid the issue – their charge is to create the future vision, develop the plan for that vision, and ensure its execution. Or, to use the phrase attributed to General John Buford, “The leader’s role is to assure their organization is positioned and their team is prepared… ”
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