title: Integrated delivery systems: non fait accompli.
abstract: This article explores the themes that advocates of integrated delivery systems (IDSs) hoped would allow them to favorably leverage the final stages of managed care evolution: revenue generation, cost control, and quality improvement. In reality, however, IDSs have been highly unsuccessful in growing market share, competing against other managed care forms, and integrating delivery systems--their raison d'être. Two key concepts in global theory, risk and episodic management, are introduced, and utilized to show how IDSs addressed these fundamental properties inappropriately. As a result, financial results and system performance have been dismal. A prognosis is given as well as suggestions for improvement through risk bifurcation, global fees, and integrated episodes of care.
authors.affiliation: Watson Wyatt Worldwide, USA.
authors.forename: E B
authors.initials: EB
authors.lastname: Engert
authors.forename: D W
authors.initials: DW
authors.lastname: Emery
mesh_terms: D003284:Contract Services / Q000191:economics; D019033:Delivery of Health Care, Integrated / Q000191:economics* / Q000458:organization & administration; D004465:Economic Competition; D017050:Episode of Care; D005245:Fee Schedules; D005377:Financial Management, Hospital / Q000639:trends; D019981:Health Care Sector; D006279:Health Maintenance Organizations / Q000191:economics* / Q000458:organization & administration; D006801:Humans; D011785:Quality Assurance, Health Care; D020414:Risk Sharing, Financial; D014481:United States