Skip to main content

Stratis Health Twitter Stratis Health LinkedIn Stratis Health YouTube

Son hugging dad

Section Links


Transforming Care

Stratis Health has developed a framework to assist organizations with their visioning and planning for alternative payment models and delivery system reform. The framework gives health care and community organizations an image of how to respond to the changing marketplace and incentives, and successfully transform care delivery.

How to Use the Transforming Care Framework

This framework can help health care leaders:

  • Understand the full scope of actions required to build the foundation and relationships, manage populations, and add value to achieve the Triple Aim.
  • Assess their own organization's strengths and weaknesses, and readiness for health reform relative to where they are today and where they need to be in three to five years.
  • Understand organizational gaps and needs, set priorities, and allocate resources.
  • Identify the essential components to assist with defining a vision for their organization in the new marketplace.
  • Define strategies for the next three years.
  • Layout action steps their organization can take now.

How to Take Action to Succeed in Delivery System Reform

Select any of the actions in the boxes or circles below to see where you should be today in preparing for changes in care delivery and where you should be three to five years from now. Information includes action steps for what you can do now to build capacity for the Triple Aim and to succeed in multiple payment models.

Stratis Health health reform model Establish an Enabling IT Platform with Interoperable EHR and Effective HIE Redesign Care to Consistently Use Evidence-based or Best Practices Embed Strong Organizational Change Skills Supported by Quality Improvement Methods Provide Visionary Leadership and Promote a Learning Culture Engage and Activate Patients Use Robust Data Analytics and Measurement Systems Develop Meaningful Collaborations and Parternships Extend Care Coordination for Complex Patients into the Community

Provide Visionary Leadership and Promote a Learning Culture
TODAY
Acknowledging the status quo won't work and there will be financial implications.
TOMORROW (3 - 5 YEARS)
A vision exists for the new marketplace including the interdependent actions and cultural learning that is required to transform care.
WHAT YOU CAN DO NOW
1. Articulate a vision for improving value (outcomes and costs) for patients, and your organization's overarching strategy to get there.
2. Develop innovative approaches to improve care.
3. Align organizational success metrics with the Triple Aim.
4. Provide ongoing learning for board, senior leaders and staff on ever changing payment models.
Embed Strong Organizational Change Skills Supported by QI Methods
TODAY
Working on a variety of independent improvement projects.
TOMORROW (3 - 5 YEARS)
A culture of continuous improvement enables small and large scale change in response to the rapidly evolving market.
WHAT YOU CAN DO NOW
1. Understand your organization's current performance on the Triple Aim.
2. Assess organizational readiness and capacity for change.
3. Embed quality improvement methods and skills at all levels of the organization.
4. Utilize change management tools.
Redesign Care to Consistently Use Evidence-based or Best Practices
TODAY
Attempting to use existing evidence with variable impact on care and cost.
TOMORROW (3 - 5 YEARS)
Providers are accountable for care and rewarded across payers based on quality, patient experience, and cost performance.
WHAT YOU CAN DO NOW
1. Organize personnel into multidisciplinary teams based on acute and/or chronic medical conditions and use research-based practice guidelines, or best practices.
2. Take responsibility for integrating the full scope of care to maximize patient outcomes as efficiently as possible.
3. Measure quality outcomes and processes, the patient experience, and costs for each patient to prepare for new payment methods based on delivering value vs. volume.
Establish an Enabling IT Platform with Interoperable EHR and Effective HIE
TODAY
Implementing and utilizing EHR and HIE with wide variation across settings.
TOMORROW (3 - 5 YEARS)
HIT is fully utilized for population management with a real ability to exchange information with multiple applications and the full array of care partners.
WHAT YOU CAN DO NOW
1. Establish a HIT strategy and define functional requirements including both infrastructure and systems.
2. Acquire and implement HIT systems (PMS, EHR, HIE, e-registry, CDS).
3. Integrate and optimize systems and/or data sources as appropriate to get complete and up-to-date information.
Activate Patients and Engage Caregivers
TODAY
Demonstrating significant variability in the level of patient engagement.
TOMORROW (3 - 5 YEARS)
Patients and families are engaged partners in their care, with preferences and values honored.
WHAT YOU CAN DO NOW
1. Provide patients with electronic portals to their health information and use the EHR to identify and provide patient-specific educational resources.
2. Support the use of decision aids and shared decision making so treatment decisions are made based on patient preferences, medical evidence, and clinical judgment.
3. Implement measures that assess and reward patient engagement.
Focus on the Health and Wellbeing of Populations
TODAY
Community health needs not driving strategic planning.
TOMORROW (3 - 5 YEARS)
Prevention is a primary focus. Needs of populations (linguistic, cultural, socioeconomic) are understood and guide service development.
WHAT YOU CAN DO NOW
1. Complete and/or review your community's health needs assessment to understand the unique characteristics and needs and of your population.
2. Identify programs and services to be developed or refined to address needs of the population served, and coordinate with public health and health plans.
3. Align preventative activities with all major services.
Use Data to Drive Quality and Financial Performance
TODAY
Growing expectation for quality measures and reporting.
TOMORROW (3 - 5 YEARS)
Data is used to drive decisions at the patient/population level and includes outcomes, social determinants of health, and resource utilization.
WHAT YOU CAN DO NOW
1. Identify and measure outcomes based on what matters to patients, such as functional level and time to recovery.
2. Begin to track total expenses and resource utilization for populations and by condition.
3. Connect expenses to clinical outcomes to determine relative value.
Create Intentional Collaborations
TODAY
Responding with affiliations that are imbalanced, limited in scope, and sporadic.
TOMORROW (3 - 5 YEARS)
Extensive mutually beneficial relationships are used to leverage and share resources across care settings and in the community .
WHAT YOU CAN DO NOW
1. Evaluate the value of current referral patterns.
2. Determine gaps and opportunities, and extend your service portfolio.
3. Inventory the full extent of community resources available to patients.
4. Evaluate developing partnerships within and outside health care to fill gaps and meet opportunities vs. build.
Integrate Care Delivery Across Settings and into the Community
TODAY
Beginning to work on better care coordination to reduce hospital readmissions.
TOMORROW (3 - 5 YEARS)
Communication and hand-offs across settings appear seamless and are highly coordinated by a care team integrated with community resources.
WHAT YOU CAN DO NOW
1. Move from individual-focus to team-based care.
2. Incorporate care coordination principles that support complex populations and build towards community care team models.
3. Identify opportunities to improve integration between settings and community partners.
4. Support workforce development that complements emerging care models.

Transforming Care Framework printable file includes what needs to happen, what is happening today, and the vision for the future (2-page PDF)

How Stratis Health can help prepare you for the uncertainty and complexity of health care >