Evolution of an integrated health system: A life cycle framework

This life cycle framework can help administrators, planners, community leaders, physicians, and other healthcare professionals anticipate and plan for the challenges of health system integration. Integrated health systems (IHSs) are dynamic entities whose alliances and resources expand and shift in response to patient and market demands. The evolving IHS faces new goverance, management, and planning challenges in its attempt to create a continuum of patient care. We have developed a four-phase life cycle model to describe these challenges. The demands of the five key components (mission, planning, management, governance, and medical staff) are progressively described and illustrated through each stage of the IHS life cycle (development, transition, maturity, and decline). A case study of an evolving IHS provides illustrative examples of infrastructure and human resource challenges. The evolving IHS will need to address the following infrastructure issues: a systemwide mission statement; a corporate culture that welcomes and integrates previously independent entities; an information system that will clinically and financially integrate the system; a clinical support system that emphasizes clinical efficiency and patient-focused care; and an actuarial approach to healthcare planning. The IHS's human resource challenges include recruiting and retaining administrators to initiate and manage complex arrangements among acute, subacute, long-term, and ambulatory care services; requiring governance to be proactive, structured, and focused on the resources and services of the entire system versus individual entities; and preparing physicians for the transition from independent fee- for-service ambulatory and hospital practices to integrated, clinically efficient managed care.