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.

2019

• Evaluation of Technology-Enabled Collaborative Learning and Capacity Building Models: Materials for a Report to Congress 2019

  Shira H. Fischer, Adam J. Rose, Ryan K. McBain, Laura J. Faherty, Jessica Sousa, Monique Martineau

  Technology-enabled collaborative learning and capacity-building models connect generalist providers, often located in remote areas, with specialist teams that help train these providers so that they can deliver care for conditions that generalists might not otherwise feel adequately prepared to handle. This report focuses on the quality of evidence for the effectiveness of such models and describes ways to improve measurement of effectiveness.

• Experiences of Medicaid Programs and Health Centers in Implementing Telehealth 2019

  Lori Uscher-Pines, Kathryn E. Bouskill, Jessica Sousa, Mimi Shen, Shira H. Fischer

  Despite telehealth's potential to improve access to care, it is underutilized by safety-net providers, including Federally Qualified Health Centers (FQHCs), due to a range of policy, organizational, and logistical barriers. This research facilitates state-to-state learning to inform both Medicaid policy and Medicare policy going forward and provide lessons learned for FQHCs interested in starting or expanding telehealth programs.

• 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.

• Medical Practice Consolidation and Physician Shared Patient Network Size, Strength, and Stability 2019

  Claire E. O'Hanlon, Christopher Whaley, Deborah Anne Freund

  Practice consolidation can increase the stability of physician networks, which may have positive implications for organizational effectiveness.

• 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 L. 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.

• The Challenge of Determining Appropriate Care in the Era of Patient-Centered Care and Rising Health Care Costs 2019

  Ian D. Coulter, Patricia M. Herman, Gery W. Ryan, Lara Hilton, Ron D. Hays

  The goal of health care is to ensure that patients receive the right care for the right patient for the right problem at the right time from the right provider. Inappropriate care is costly. The challenge is to define and increase delivery of appropriate care.

• 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 L. 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 L. 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.

• The Problematic Economics of Integrative Oncology 2019

  Patricia M. Herman

  The economics of integrative oncology are problematic because of the lack of good studies, the lack of historic incentives for efficiency, and the high cost of cancer care and its financial toxicity on patients. However, these problems can be overcome, with help from one good economic evaluation at a time.

• 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.

• Using Health IT to Coordinate Care and Improve Quality in Safety-Net Clinics 2019

  Ashley M. Kranz, Sarah Dalton, Cheryl L. Damberg, Justin W. Timbie

  The use of health information technology (HIT) for such activities as arranging enabling services and engaging patients are underused tools for care coordination. There may be opportunities to improve quality of care for vulnerable patients by promoting health centers' use of HIT capabilities.

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.

2015

• Population Health Management and the Second Golden Age of Arab Medicine: Promoting Health, Localizing Knowledge Industries, and Diversifying Economies in the GCC Countries 2015

  Soeren Mattke, Lauren E. Hunter, Madeline Magnuson, Aziza Arifkhanova

  The Gulf Cooperation Council countries experience an alarming increase chronic disease, yet their health care systems are ill-prepared to handle that burden. We recommend that they pioneer a health care delivery model based on population health management principles and sophisticated health information technology, rather than copy existing Western models.