Publications on Health Care Organization and Capacity

RAND Health Care research on the organization and capacity of the health care system takes a broad perspective. Our work has examined how organization affects the system’s ability to provide high-quality care and to use resources efficiently and effectively. Many studies have focused on the link between health system organization and the ability of the public health system to respond to public health emergencies, whether natural or the result of hostile action.

2020

• The Case for a Telemedicine Coordinator: Lessons Learned from the Sustainable Models of Telemedicine in the Safety Net Initiative 2020

  Jessica L. Sousa, Alina I. Palimaru, Allison J. Ober, Lori Uscher-Pines

  This report offers lessons learned about telemedicine staffing and the coordinator role from the experience of nine community health centers in California that participated in the Sustainable Models of Telehealth in the Safety Net initiative. Experiences with the coordinator role might be informative for health care settings that are planning for or currently implementing clinic-based telemedicine programs.

• Consolidation by Any Other Name: The Emergence of Clinically Integrated Networks 2020

  M. Susan Ridgely, Justin W. Timbie, Laura J. Wolf, Erin Lindsey Duffy, Christine Buttorff, Ashlyn Tom, Mary E. Vaiana

  In this report, the authors offer an initial assessment of clinically integrated networks (CINs) based on interviews with health system executives, describe how health systems (large and small) are using CINs strategically to compete in crowded health care markets, and identify why CINs bear watching by the Federal Trade Commission and the larger health care community.

• Costs of Maintaining a High-Volume Telemedicine Program in Community Health Centers 2020

  Mark Zocchi, Lori Uscher-Pines, Allison J. Ober, Kandice A. Kapinos

  Research on the costs of telemedicine programs shows that they are not self-sustaining and require grants and other resources to operate. However, given the significant changes to state telemedicine policies that have occurred in the past few years, this research base is outdated. RAND researchers describe telemedicine-related costs incurred by health centers participating in the Sustainable Models of Telehealth in the Safety Net initiative.

• Experiences of Community Health Centers in Expanding Telemedicine 2020

  Lori Uscher-Pines, Jessica L. Sousa, Alina I. Palimaru, Mark Zocchi, Kandice A. Kapinos, Allison J. Ober

  RAND researchers evaluated the experiences of health centers that participated in the Sustainable Models of Telehealth in the Safety Net initiative, which aimed to support the growth of telemedicine. Although this evaluation occurred before the coronavirus disease 2019 pandemic dramatically altered the health care system, the findings are relevant to health centers that are trying to rapidly expand telemedicine in response to the pandemic.

• Factors Influencing Physician Practices' Adoption of Behavioral Health Integration in the United States: A Qualitative Study 2020

  Angele Malatre-Lansac, Charles C. Engel, Lea Xenakis, Lindsey Carlasare, Kathleen Blake, Carol Vargo, Christopher Botts, Peggy G. Chen, Mark W. Friedberg

  Practices currently using behavioral health integration face barriers to implementing and sustaining behavioral health integration. Tailored, context-specific technical support to guide practices' implementation and payment models that improve the business case for practices may enhance the dissemination and long-term sustainability of behavioral health integration.

• Health Center Implementation of Telemedicine for Opioid Use Disorders: A Qualitative Assessment of Adopters and Nonadopters 2020

  Lori Uscher-Pines, Pushpa Raja, Ateev Mehrotra, Haiden A. Huskamp

  Although use of telemedicine for the treatment of opioid use disorders is growing, there is limited research on how it is actually being deployed in treatment. We explored how health centers across the U.S. are using it.

• Maternal Cash Transfers Led To Increases In Facility Deliveries And Improved Quality Of Delivery Care In Nigeria 2020

  Edward N. Okeke, Zachary Wagner, Isa Sadeeq Abubakar

  A randomized controlled trial in Nigeria evaluated an intervention that paid pregnant women to deliver in a health facility, which led to a 41% increase in facility deliveries. We found improvements in the quality of delivery care and in satisfaction with care.

• Promises and Pitfalls of Health Information Technology for Home and Community-Based Services 2020

  Sangeeta C. Ahluwalia, Esther M. Friedman, Daniel Siconolfi, Debra Saliba, Jessica Phillips, Regina A. Shih

  Structural reforms required by the Medicaid Balancing Incentive Program gave states an opportunity to modernize their HCBS systems through health information technology. Barriers to technology adoption persist, underscoring the need for continued support in future rebalancing efforts.

• Promising Practices for Telemedicine Implementation 2020

  Alina I. Palimaru, Jessica L. Sousa, Allison J. Ober, Lori Uscher-Pines

  RAND researchers describe promising practices identified by staff from nine health centers in California that were participating in the Sustainable Models of Telehealth in the Safety Net initiative. These practices show the potential to support the growth and sustainability of telemedicine programs in safety-net settings. However, there is not yet sufficient evidence to prove that such practices will be effective across settings.

• What Are the Determinants of Health System Performance? Findings from the Literature and a Technical Expert Panel 2020

  M. Susan Ridgely, Sangeeta C. Ahluwalia, Ashlyn Tom, Mary E. Vaiana, Aneesa Motala, Marissa Rose Silverman, Alice Y. Kim, Cheryl L. Damberg, Paul G. Shekelle

  This study is part of an ongoing effort to discover how and why some health systems in the United States are high performing and others are not.

2019

• Federally Qualified Health Center Strategies for Integrating Care with Hospitals and Their Association with Measures of Communication 2019

  Justin W. Timbie, Ashley M. Kranz, Ammarah Mahmud, Claude Messan Setodji, Cheryl L. Damberg

  Health centers differ in the use of strategies to integrate care with hospitals. Overall, integration activity is associated with better communication.

• Primary and Behavioral Health Care Integration Program: Impacts on Health Care Utilization, Cost, and Quality 2019

  Joshua Breslau, Mark J. Sorbero, Daniela Kusuke, Hao Yu, Deborah M. Scharf, Nicole Schmidt Hackbarth, Harold Alan Pincus

  This report describes an extension of the RAND Corporation's evaluation of the Substance Abuse and Mental Health Services Administration's Primary and Behavioral Health Care Integration (PBHCI) grants program. The current study extends previous work by investigating the impact of PBHCI on consumers' health care utilization, total costs of care to Medicaid, and quality of care in three states.

• Sharing and Integrating HIV Client Data Across Provider Organizations to Improve Service Coordination: A Toolkit 2019

  Vivian L. Towe, Clare Stevens, Shira H. Fischer

  Recognizing the potential power of close collaboration, two federal programs that provide support to low-income people with HIV came together to determine how they could integrate data to improve outcomes for individuals with HIV who also experience housing instability. This toolkit, the result of that project, is an effort to demystify the data integration process and help others share data and coordinate services across providers.

• Understanding U.S. Health Systems: Using Mixed Methods to Unpack Organizational Complexity 2019

  M. Susan Ridgely, Erin Lindsey Duffy, Laura J. Wolf, Mary E. Vaiana, Dennis P. Scanlon, Christine Buttorff, Brigitt Leitzell, Sangeeta C. Ahluwalia, Lara Hilton, Denis Agniel, et al.

  Researchers need qualitative data to understand how health systems actually work and influence clinical practice.

2018

• Addressing Social Determinants of Health Needs of Dually Enrolled Beneficiaries in Medicare Advantage Plans: Findings from Interviews and Case Studies 2019

  Melony E. Sorbero, Ashley M. Kranz, Kathryn E. Bouskill, Rachel Ross, Alina I. Palimaru, Amanda Meyer

  Beneficiaries who are dually enrolled in Medicare and Medicaid are less likely to be enrolled in Medicare Advantage (MA) plans that perform well in the MA Star Rating program than non–dually enrolled beneficiaries. The authors identify the types of services that MA plans implement to meet the needs of dually enrolled and other high-cost, high-need beneficiaries, as well as the types of resources needed to implement these services.

• A Comprehensive Theory of Integration 2019

  Sara J. Singer, Michaela J. Kerrissey, Mark W. Friedberg, Russell S. Phillips

  This article presents a comprehensive theory describing how integrating structures, processes, and people within and across organizations might lead to integrated patient care and improved outcomes, including technical quality, efficiency, patient health, and both patient and provider experience.

• Integrating Department of Defense and Department of Veterans Affairs Purchased Care: Preliminary Feasibility Assessment 2018

  Carrie M. Farmer, Terri Tanielian, Christine Buttorff, Phillip Carter, Samantha Cherney, Erin Lindsey Duffy, Susan D. Hosek, Lisa H. Jaycox, Ammarah Mahmud, Nicholas M. Pace, et al.

  The U.S. Department of Defense and U.S. Department of Veterans Affairs health systems operate purchased care programs that govern how beneficiaries see providers in their communities. This preliminary feasibility assessment examined how an integrated approach to purchasing care could affect access, quality, and costs and identified general legislative, policy, and contractual challenges to implementing such a program.

• Preliminary Feasibility Assessment of DoD-VA Purchased Care Integration 2018

  Carrie M. Farmer, Terri Tanielian, Christine Buttorff, Phillip Carter, Samantha Cherney, Erin Lindsey Duffy, Susan D. Hosek, Lisa H. Jaycox, Ammarah Mahmud, Nicholas M. Pace, et al.

  An integrated approach to purchasing health care for U.S. Department of Defense and U.S. Department of Veterans Affairs could have important implications for access, quality, and costs but could face legislative, policy, or contractual challenges.

• Sustaining Alcohol and Opioid Use Disorder Treatment in Primary Care: A Mixed Methods Study 2018

  Sarah B. Hunter, Allison J. Ober, Colleen M. McCullough, Erik D. Storholm, Praise O. Iyiewuare, Chau Pham, Katherine E. Watkins

  Access to external funding and staff support are two important factors for the sustainability of substance use disorder treatment provision within primary care clinics.

2017

• Sources of Care for Alcohol and Other Drug Problems: The Role of the African American Church 2017

  Eunice C. Wong, Kathryn Pitkin Derose, Jeremy N. V. Miles

  Many Los Angeles-area African American churches provide recovery supports and services for alcohol and other drug (AOD) use and actively connect individuals to formal AOD treatment.

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