Effects of Integrated Delivery System on Cost and Quality

The US healthcare system has long been characterized as complex, fragmented, costly, and with significant variation in quality of care. During the health reform debate, many health policy experts have called for the country to reorganize healthcare providers and delivery systems through organizational or virtual integration. The concept of integrated healthcare delivery systems (IDSs) has gained considerable interest. Such systems have been viewed as a better approach to addressing the issues of quality and cost. Indeed, some IDSs are frequently portrayed not just in academic and medical circles but in the popular media as examples of the best, most effective healthcare in this country. However, the evidence used to support such assertions may not have been systematically evaluated. Now that healthcare reform has been enacted and accountable care organizations (ACOs), which have many organizational features similar to those of IDSs, are rapidly being developed and implemented, what do we know about how this approach to organizing healthcare impacts the key factors of quality and cost of care? Do IDSs truly do a better job of providing high-quality care while holding down costs? A comprehensive review of the existing literature that assesses the relationship between IDSs and cost/quality is critically needed.