Successful Implementation of a New Care Delivery Model

The Patient Protection Affordable Care Act has created momentum for many organizations to consider a complete redesign of their care delivery systems. Seamless care coordination and care management are pivotal components of clinically integrated delivery systems, ensuring that high quality care is provided effectively and efficiently across the care continuum. After a common vision is established, physician leaders are identified, and a budget is allocated — what is next?

Understand the organization's culture and appetite for care model change. Change requires provider and staff buy-in. Clinical leadership needs to embrace the change as a united front, and clinical staff must understand why change is necessary and agree to move forward.  Successful implementation depends on a culture shift. Change management should be inherent to the implementation plan — engage with providers in the development processes, clearly communicate plans and expectations, provide education, design financial incentives and implement protocols. Individuals need to feel accountable for their actions and thereby the success of the model.

Invest in and prioritize information technology capabilities. Care model processes and population management techniques should drive information technology development and decisions. With key IT systems in place, the result is seamless coordination between providers and across care delivery settings. Providers use a wide array of systems, but consider these for a successful care management implementation:

  • Electronic medical record: to review and document clinical data
  • Reporting services: to measure outcomes
  • Care management system: to document and develop patient care plans
  • Disease registries: to identify gaps in care and patients with specific conditions
  • Risk stratification: to identify high risk patients

Assess and maximize clinical workflow. Poor hand-offs, unclear communication, inconsistent processes and unstructured approaches create additional risk for patients. Care should be coordinated, not complicated; consistent, not varied. Workflows should be integrated into the care model to reduce disparities in approach. Consider processes, resources, roles and timing when developing these key workflows:

  • Referrals in/out of the program
  • Patient enrollment process
  • Program interventions
  • Communications with other providers
  • Escalation or triage process
  • After-hours care
  • Transition to another level of care

As programs scale, well-defined clinical workflows ensure consistency in care and limit clinical variability. They should be dynamic, evolving alongside the care model.

Stratify and identify target populations. Plug the leaks — target patients whose healthcare needs are the greatest and most costly. Using tools like predictive modeling, risk stratification, and risk adjustment factor scores can help identify high risk patients. In addition, providers should be aware of enrollment criteria for clinical programs and should utilize these guidelines when making referrals. Proper "level of care" is essential for efficient resource consumption and effective cost containment. Ensure efforts are focused, and dollars are used appropriately (i.e., right time, right patients and right programs).  

Routinely measure and report performance. It is critical to track and measure success, whether that is compliance with quality measures, return on investment or decreases in utilization. Initially, reports will determine if the care model needs tweaking or redesigning, which may require further evaluation of workflows, staffing, resources, vendors and IT. As the organization scales, outcome data will identify where there are additional opportunities to improve. Consider sharing outcomes with all providers. Transparency in data drives competition, which drives better care.

Dedicate and invest in project management. After a clear vision for a care model is established, ensure that this vision is successfully implemented. In order to move from the chalkboard to the real world, the use of a dedicated project manager is essential. This resource will manage an implementation plan, balancing tasks, scope, communications, timeline, resources and budget. Although a successful implementation will inevitably involve interdisciplinary input from executives, managers and staff, it is imperative to identify a single individual who is held accountable for tracking and communicating the progress of the project.

It is impossible to be prepared for everything, but successful programs come from successful plans. Take the time for research, design, development, communication and evaluation of success. In general, allow six to twelve months for operational adjustments, staff training and enrollment ramp-up before determining the success of a program. Executives often pull the plug on a new program before it has time to mature. And remember these tips as you start to implement your new care delivery model.

Sylvia Hastanan, BSN, is a manager at The Camden Group, specializing in clinical integration and Megan Calhoun is a consultant. To contact the authors, email Sylvia Hastanan at

More Articles on Improving Care Delivery:
10 Critical Service Line Strategies Following a Merger, Acquisition or Affiliation
10 Questions to Address in a Hospital Strategic Plan

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