What Have We Learned About Health Systems – A Synthesis

As part of the RAND Center of Excellence on Health System Performance, researchers from RAND Corporation, Penn State, UCLA, Stanford, and Harvard have taken a “deep dive” into 24 health systems and their affiliated physician organizations in four regions of the United States. For these studies, a health system is defined as having at least one hospital and at least one physician organization affiliated through shared ownership or a contractual relationship.

In brief:

  • If you’ve seen one health system, you’ve seen one health system
  • Integration is a multi-layered concept—structural, functional, and clinical—each of which may affect health system performance
  • A single interoperable EHR—accessible to allaffiliated physicians—is considered the gold standard—but implementation is by no means universal
  • Health systems are taking a highly individualized approach to care delivery redesign, with an emphasis on standardizing and increasing the efficiency of existing practices over disruptive innovation
  • The pace at which value-based payment arrangements are being implemented by the government and commercial payers may be too slow to support transformation of care delivery
  • Structural integration does not necessarily signal clinical integration