Intermountain Healthcare is a high-performing integrated health system with facilities in Utah and Idaho. The health system has a long-standing clinical integration structure that encourages professional collaboration. Despite this, in 1999, many physicians at Intermountain Healthcare found it difficult to fulfill the needs of patients with co-occurring physical and mental health conditions. To efficiently and effectively address this issue, Intermountain Healthcare adopted a mental health integration model in many of its primary care facilities, as well as some of its specialty clinics and partner clinics. The team-based approach has improved the coordination of services, resulting in higher quality care at a savings of cost.

Consider the example above. What advantages does integration afford Intermountain Healthcare? Do other integrated health systems experience similar benefits? Are there disadvantages to integration? If so, what are they?

To prepare for this Assignment, review the information related to vertical and horizontal integration presented in the Learning Resources.

Select one of the following horizontally integrated health systems:

·         DaVita

·         Apria

·         Sunrise Senior Living

·         Labcorp

·         Quest Diagnostics

Also select one of the following vertically integrated health systems:

·         Kaiser Permanente

·         Mayo Clinic

·         Cleveland Clinic

·         MedStar Health

·         Memorial Hermann Healthcare System Houston

As an alternative, you may use Becker’s Hospital Review resource to identify a vertically integrated health system.

Using the Walden Library and credible sources on the Internet, research your selected health systems. Investigate the rationale for pursuing integration and the strategies each health system has used to achieve integration. Note information related to the size of each health system, settings/locations, and types of services it provides.

Based on your research, consider the ways in which the two health systems are similar to and/or different from one another.

Assess the business and health care-related implications of horizontal and vertical integration of your selected health systems. How does integration impact the management of your selected organizations and the patients/consumers they serve, especially in terms of cost, quality, and access?

Consider any applicable insights you have gained through the Discussion for this module.

The Assignment

Write a 3- to 4-page paper in which you:

·         Compare the horizontally integrated health system and the vertically integrated health system you have selected (e.g., size, settings/locations, and types of services).

·         Explain each health system’s rationale for pursuing integration and the strategies it has used to achieve integration.

·         Assess the business and health care-related implications of integration for your selected health systems, including how integration impacts the patients/consumers the organization serves.

Your Assignment must be written in standard edited English. Be sure to support your work with specific citations from this module’s Learning Resources and additional scholarly sources as appropriate.

 

 

 

Resources

 

Readings

·         Shi, L., & Singh, D. (2015). Delivering health care in America: A systems approach (6th ed.). Burlington, MA: Jones & Bartlett.

o    Chapter 9, “Managed Care and Integrated Organizations” (pp. 361–368)

·         Cohen, A., Klein, S., & McCarthy, D. (2014). Hill Physicians Medical Group: A market-driven approach to accountable care for commercially insured patients. Retrieved fromhttp://www.commonwealthfund.org/~/media/files/publications/case-study/2014/oct/1770_cohen_hill_physicians_aco_case_study.pdf

·         Cutler, D. M., & Morton, F. S. (2013). Special communication: Hospitals, market share, and consolidation. JAMA, 310(18), 1964–1970.
Retrieved from the Walden Library databases.

·         Sanford, K. D. (2013). Integration requires new roles and responsibilities. Healthcare Financial Management, 67(3), 56–60.
Retrieved from the Walden Library databases.

·         Summer, L. (2014). Research insights: Integration, concentration, and competition in the provider marketplace. Retrieved fromhttp://www.academyhealth.org/files/publications/AH_R_Integration%20FINAL2.pdf

Use the following resources to select integrated health systems on which to focus for your Assignment. You may also use this list to develop background information as you research health systems in your area for the Discussion.

·         Rodak, S. (2013). 100 integrated health systems to know. Retrieved fromhttp://www.beckershospitalreview.com/lists/100-integrated-health-systems-to-know.html

Vertically Integrated Health Systems

·         Cleveland Clinic. (n.d.). Retrieved March 27, 2015, from http://my.clevelandclinic.org

·         Kaiser Permanente. (n.d.). Retrieved March 27, 2015, from http://kp.kaiserpermanente.org/

·         Mayo Clinic. (n.d.). Retrieved March 27, 2015, from http://www.mayoclinic.org

·         MedStar Health. (n.d.). Retrieved March 27, 2015, from https://www.medstarhealth.org/

·         Memorial Hermann Healthcare System Houston. (n.d.). Retrieved March 27, 2015, fromhttp://www.memorialhermann.org

Horizontally Integrated Health Systems

·         Apria. (n.d). Retrieved March 27, 2015, from www.apria.com

·         DaVita. (n.d). Retrieved March 27, 2015, from www.davita.com

·         Labcorp. (2014). Retrieved March 27, 2015, from https://www.labcorp.com/

·         Quest Diagnostics. (n.d.). Retrieved March 27, 2015, from http://www.questdiagnostics.com/

·         Sunrise Senior Living. (n.d.). Retrieved March 27, 2015, from http://www.sunriseseniorliving.com/

 

During the nineteenth and the twentieth century, the term “nursing home” was synonymous with long-term care. Although today the exclusive use of the term “long-term care” is no longer accurate for nursing homes, it continues to remain and will not change easily. However, newer terms such as “nursing facilities” will help clarify the role of specific long-term care organizations and will differentiate them from others in the health care industry.

Subacute care is a relatively new but rapidly growing medical service in the continuum of care. Today, it is considered the fastest growing segment of the health care delivery system.

Research the online references such as EBSCOhost, SocINDEX, Cumulative Index to Nursing and Allied Health Literature (CINAHL), or PubMed for information on nursing facilities and subacute units and respond to the following questions:

• Do you agree with the change in the terminology of nursing homes to nursing facilities? Why or why not? How do the terms relate with each other?
• What impact does the historical perspective of the nursing home have on the stigma related to the quality of care?
• How were nursing facilities developed? What have been the consequences of the change in terminology? Do you think the change in terminology will impact the quality of care in the future? If yes, how? If no, why?
• What changes do you see nursing homes making in the future in order to keep up with the ever changing needs of the demographics of seniors?
• What are subacute units? How did subacute care emerge? What are the strengths and limitations of the emergence of subacute care in long-term care as related to issues in levels of patients’ acuity (various levels of nursing care based on the needs of patients)? Support your answer with relevant examples.
• What is the impact of subacute care on the cost and quality of care? Do you think subacute care needs to be an integral component of hospitals, or should it be an integral part of the long-term care system? Provide a rationale for your answer.

Requirements

• Conduct the windshield survey using the template, linked in Resources.
• Use the template as a guide and write a report. If possible, look at other written documents used within your organization. How are they formatted? Follow that format as closely as possible, making sure you still use APA guidelines for your in-text references, citations, and reference page.

WINDSHIELD COMPLETED, SEE BELOW:

 

 

Housing: What is the age and condition of housing in the community/neighborhood? Are the houses and apartments kept up, or are they run-down and in need of repair? Are the yards neat or overgrown?

• These houses are newly built, I would say within the last 5-10 years. It is a beautiful community of houses, well kept. Yards are all neat, and well groomed.

   

   

• Other Buildings: Are other buildings mostly or fully occupied? Are public and commercial buildings accessible by people with disabilities?

  The building around are either restaurants, coffee shops, or PT, ST, OT buildings.

   

• Parks and Public Spaces: Are parks and other public spaces well-maintained? Are they used by a variety of people? Are there sports facilities such as baseball fields, basketball courts, and soccer fields?

   

  There are several open parks within the area, that are well maintained. They seem to be used by people on a break from work who are walking a few laps. I don’t see any sports facilities.

   

   

• Culture and Entertainment: Are there museums, libraries, theaters, restaurants, historic sites, and so forth? Do they reflect the culture of the community? Are they readily accessible?

  Within this community that I see, there are no museums, or theaters, but I do see restaurants, a church, and one library. They are within walking distance.

   

  Streets: Are there trees and/or plants along the streets? Are there sidewalks? Are the streets and sidewalks clean? Are there trash cans sitting out in sight? Are there people on the streets? Do they interact with each other? Are the streets well-lit at night?

• There are sidewalks next to every street, with plants, bushes, and trees along most of them. There are trash cans near the parks, but not along the regular streets. There are three groups of people that I see walking along the sidewalks, and two of the groups stopped to talk with each other. The neighborhood streets are well lit at night, though the main street to get to this community is not.

   

• Business and Industry: What kinds of businesses are there? Are there vacant storefronts? In what languages are business signs? Do the businesses provide the necessities for the community (such as groceries and medications)? Is there any kind of industry present?

  The businesses I see include restaurants, therapy buildings, and locally owned shops. The signs are all in English. The business do seem to provide necessities for the community. It seems like there is a little bit of everything.

   

  Traffic and Transportation: Is there evidence of public transportation? Is it well-used? Is it easy to navigate and use? How much does it cost? Who uses it? How heavy is the traffic? Is there a major road or highway close by? Is the traffic mostly commercial (such as delivery vans and trucks) or private cars? Are there many bicycles? Are there bike lanes and bike racks?

• I haven’t seen any bus stops in this area, and I’ve seen a few bikes here and there. Most people walk in this neighborhood area, or drive their own vehicles to go elsewhere. The traffic along the main road is two way, and the area is growing in population, so at peak hours, the traffic is slow. But this traffic consists of commuters, and people that live in the area.

   

   

• Public Services: Are there identifiable public service providers such as mental health clinics, food banks, and homeless shelters? Are there police or fire stations nearby? Are they easy to reach?

  I don’t see any public services offered in this area. There is however a fire station about 5 minutes away, down the main road.

   

• Religious Centers: Are there churches or other religious institutions? Are they of one faith, or do they represent a variety of faiths? Is there one dominant religion represented?

   

  There is a church within this community. This church appears to be a Christian church.

   

   

• Health Services: How many hospitals and clinics are there? How big are they? Are they easy to get to?

  There is a building that offers PT, OT, ST within the community. It is a single story building, I would say about 2500 square feet. It is easily accessible.

   

   

• Education: Are there public or private K-12 schools nearby? Are they well-maintained? Are there any two- or four-year colleges and/or universities? Are they public or private?

   

  Yes, there is what appears to be an elementary school two blocks into this community. It is a public school.

   

   

   

• Population: Who lives in the community? Are there identifiable racial or ethnic groups? Do particular groups seem to live in particular areas? Is one age group or gender more obvious? Do the people who live in this community seem to interact with each other?

   

  I have seen mostly Caucasians in this area, with a few that appear to be of Asian descent, mostly in their 40’s and older. People who live within the same neighborhood seem to interact with each other.

   

• What is your overall impression of the community?

   

  My overall impression of the community is that it is a wealthy community, with people who care about the appearance of their neighborhoods and homes. There don’t seem to be any young couples living here just 40’s with young families, or retired couples. Everything is well kept, and easily accessible. I would say this is not exactly the norm for all Colorado communities.

 

Summary and Analysis

 

To help you analyze what you have seen and decide how to use it, here are some questions you should consider:

 

• What are the community’s outstanding strengths? Organizations and cleanliness
• What seem to be the community’s biggest challenges? I didn’t see any bus transportation
• What was the most unexpected thing you observed? The lack of diversity
• What aspect of the community really stood out for you? The accessibility of everything
• How can you use this information to help develop a health promotion and wellness plan for the population that lives here? An again population, puts them at risk for developing age related health issues, including greater transportation possibilities

   

 

 Based on your observations and notes, complete the following:

• Describe, briefly, the neighborhood or community you observed (for example, overall condition, types of spaces and businesses, and evidence of services).
• Describe a vulnerable or diverse population you observed living within the neighborhood or community.

Now you will need to do some research on the population you described:

• Explain how the demographics for the population have changed over the past 5–10 years. (Tip: this information should be readily available through the United States Census Bureau Web site or state Web sites, the Bureau of Labor Statistics, or other professional sites. Please be sure your information is current.)
• Describe the most prevalent health risks for the population. For example, if your population is senior citizens, then the health risks might be diabetes and loss of mobility. Include statistics on the health risks, such as frequency of occurrence in the population, and number of deaths per year in the population.
• Identify the health disparities and social determinants of health that can affect the population. In other words, what will you need to overcome to develop a successful health promotion and disease prevention program for the population?

Additional Requirements

• Length of paper: 2–3 double-spaced pages, not including the title page and reference page.
• References: At least three current scholarly or professional resources.
• Formatting: APA format for references and citations only.
• Font: Times New Roman, 12 pt.

YOU ARE USING THE AREA OF LAFAYETTE COLORADO, ZIP CODE 80026, FOR ALL OF YOUR STATISTICS