PubMed · 9410345
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1997-10-20. Technology ... build an information system.. https://pubmed.ncbi.nlm.nih.gov/9410345/
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BACKGROUND: integration of primary and hospital services has been the subject of health policy in The Netherlands in the 1990s. A bottom-up facilitating approach was chosen to stimulate development of 'transmural care' between traditionally separate sectors. Transmural care has been defined as, care, attuned to the needs of the patient, provided on the basis of co-operation and co-ordination between general and specialised caregivers with shared overall responsibility and the specification of delegated responsibilities'. We conducted a national survey to determine the success of the bottom-up policy and the extent of the development of transmural care. METHODS: a written questionnaire was distributed among members of two national networks of transmural care executives and project coordinators, which are representative for hospitals and home care organisations in The Netherlands. A total of 271 facilities were included in the study representing 71% of hospitals and 63% of the home care organisations in The Netherlands. The questionnaire covered topics as; type of care provided, participants, population, goals and type of evaluation. RESULTS: all hospitals in The Netherlands provide one or more of the seven types of transmural care, however, there is a great variation in the number of facilities per organisation. Most facilities cater to one or more groups of chronically ill patients. Project coordinators experience difficulties finding adequate financing options for the facilities. Evidence on the effects of transmural care on quality and efficiency is lacking. CONCLUSION: the bottom-up approach towards the development of transmural care has been successful but needs to be followed by top-down measures to insure adequate evaluation and encourage wide-spread implementation.
Integrated delivery systems (IDSs) that assume risk directly by starting their own health plans need to ensure that they have set realistic goals. Many provider-health plan integrations fail because either the conditions under which they are started are not optimal or the integration is faulty. Successful provider-plan integrations generally have developed in rural areas where they faced limited competition, had higher utilization rates, and enjoyed greater profit margins because of lower price competition and employers' acceptance of premium rates. These factors are uncommon today. IDDSs sponsoring health plans can face problems in partnering with physicians, who may not demonstrate concern for the success of the healthcare system as a whole. For these and other reasons, IDDSs should consider partnering with existing health plans rather than starting their own plans.
By implementing a process-centered revenue cycle, healthcare organizations and group practices can achieve a seamless payment process with clear lines of accountability to achieve target outcomes. The integrated, end-to-end, revenue-cycle process involves four key components: jobs, skills, staffing, and structure; information and information systems; organizational alignment and accountability; and performance measures and evaluation measures. The Henry Ford Health System (HFHS), based in Detroit, Michigan, exemplifies the type of results that are achievable with this model. HFHS includes a group practice with more than 1,000 physicians in 40 specialties. After implementing a process-centered revenue cycle, HFHS dramatically improved registration and verification transactions and optimized revenues.