What is the healthcare delivery system?

Healthcare Delivery System: Structure, Models, and Components

A healthcare delivery system is broadly defined as the organized way in which health services are delivered to individuals and populations as they experience various stages of health and illness, ideally ensuring people receive "the right care, at the right time, by the right team and in the right place." 1

Core Components of Healthcare Delivery Systems

Structural Elements

• Organizations and Providers: Hospitals, clinics, physician practices, long-term care facilities, and other entities that deliver care
• Workforce: Healthcare professionals including physicians, nurses, allied health professionals, and support staff
• Technology and Infrastructure: Medical equipment, facilities, and health information technology
• Financing Mechanisms: Payment systems, insurance, and reimbursement structures

Process Elements

• Care Coordination: Methods for ensuring continuity across different providers and settings
• Information Flow: Systems for sharing patient data and clinical information
• Decision Support: Tools and processes that facilitate evidence-based clinical decisions
• Quality Management: Approaches to measuring and improving care quality

Evolution of Healthcare Delivery Models

Healthcare delivery has evolved from traditional episodic care toward more systematic approaches designed to address chronic conditions, which account for more than 70% of all deaths and 50% of total healthcare costs in the United States 1.

Traditional Model

• Focused on acute, episodic care
• Fragmented delivery with providers operating in silos
• Limited information sharing between providers
• Reactive rather than proactive approach to health management

Modern Integrated Models

Chronic Care Model (CCM)

The CCM has been shown to be an effective framework for improving quality of care 1 with six core elements:

1. Delivery System Design: Moving from reactive to proactive care through team-based approaches
2. Self-Management Support: Empowering patients to manage their own health
3. Decision Support: Basing care on evidence-based guidelines
4. Clinical Information Systems: Using registries to support care teams
5. Community Resources: Developing resources to support healthy lifestyles
6. Health Systems: Creating a quality-oriented culture

Patient-Centered Medical Home (PCMH)

The PCMH model improves quality and efficiency by 2, 3:

• Placing the patient at the center of care
• Reinvigorating primary care
• Enhancing coordination of services
• Improving provider access
• Supporting self-management
• Implementing team-based approaches

Integrated Delivery Systems (IDSs)

IDSs are organized, coordinated networks that 4:

• Link various healthcare providers in a coordinated continuum of services
• Accept accountability for clinical outcomes and health status of populations
• Have systems to manage and improve outcomes
• Can improve quality and reduce costs, especially for complex patients

Person-Centered Care in Healthcare Delivery

Person-centered models of care require 1:

1. Focused assessment of the patient narrative
2. Care plans co-designed by patients and clinicians
3. Iterative reassessment of patient goals over time

These models consider both internal capacity (physical ability, skills, knowledge) and external capacity (financial and community resources, lifestyle, culture) of individuals.

Challenges in Current Healthcare Delivery

• Fragmentation: Lack of coordination across providers and settings 4
• Misaligned Incentives: Payment policies not aligned with quality improvement goals 1
• Information Discontinuity: Incomplete information sharing between providers 1
• Complex Financing: Confusing array of service providers, reimbursement mechanisms, and eligibility requirements 1

Emerging Solutions

• Informational Continuity: Developing systems to accumulate and share information across all patient encounters 1
• Personalized Medicine: Tailoring treatment approaches to individual patients, especially those with multiple morbidities 1
• Care Management: Coordinating different types of health care provided by multiple providers across all care settings 1
• Quality Improvement: Implementing industrial-strength quality management approaches 1
• Health Information Technology: Supporting coordination, access, and patient engagement 5

Impact of Delivery System Type on Outcomes

Research shows that different healthcare delivery system types yield different outcomes 6:

• Integrated Delivery and Finance Systems: Show decreased emergency department use, primary care use, and costs
• Government Systems: Demonstrate increased primary care use
• Non-Integrated Systems: Generally show less improvement in utilization metrics

Healthcare delivery systems continue to evolve toward more integrated, patient-centered approaches that can better address the complex needs of populations with chronic conditions while improving quality and controlling costs.