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The Five DRIS Sites were chosen through an extensive review process of the eligible communities, cumulating with a site visit and face to face interview with community members. The criterion for choosing the sites was a delicate balance of community need, and community readiness. As DRIS is a non-traditional grant supplying technical resources services up-front and only capital upon implementation, it was not practical to base the decision solely on community need, but also on the chance of success in each community. Following are the seven areas communities were evaluated on during the site review process:
Community Leadership
When examining Community Leadership, CIRHM site reviewers were interested in finding out if the community leaders were diverse in representing their community, yet localized into a critical mass; if they were strong in their commitment of time and effort; and if they had a realistic sense of urgency stimulated by market pressures and government reform. The reviewers also looked into the history of the community’s willingness to utilize outside facilitation in achieving results.
Availability of Data
To facilitate the data driven aspect of DRIS, reviewers checked to see if local hospitals, clinics, health and human service providers were willing to share surveys and utilization data that they had developed. In addition to this private data, it was checked to see if recent Medicare and Medicaid data was readily available.
Health Care Providers Involvement, Interest and Commitment
As essential players in DRIS, the review committee looked to see if the local health care providers were interested in the project. This was checked into based on their history of involvement in cooperative ventures, whether they had a sizeable share of both high and low income clients, and whether they were willing to participate in the DRIS Initiative process itself.
Community understanding of the challenge of integration.
The review committee, to the extent possible, assessed the community’s understanding of the challenges of integration. Was the community interviewed, committed to a selecting a single accountable entity to be responsible for managing local health care resources and assuming risk? Again, since DRIS is a non-traditional grant, the product of the Initiative for the first two years would largely be process. It was important to make sure that the community was aware that being named as a site under this grant initiative, would constitute a great deal of work and might be the catalyst for what some would consider unwanted change in their community.
Environment for Success
A key concern of the DRIS Initiative is for the rural community to maintain local control over its health care decisions and resources. Therefore it was necessary to ensure the participation of community leaders, employers as well as social, medical and behavioral health providers. As important an environmental consideration was a community ripe for this change. DRIS reviewers asked if a majority of the health and human services providers had agreed to participate in the Initiative, whether the community had a history of planning for the future and following through with these plans, and if the community had a past history of integrating and/or consolidating services or businesses.
Other factors that should be considered or weighed in each specific community
DRIS reviewers looked for other population characteristics, such as size, age and race, economic conditions and geographic characteristics, such as mountains or deserts (both of which are represented in the DRIS project). Other complementing or contrasting grants were inquired about. And finally, any other characteristic that stood out as able to enhance or support the success of DRIS in the community.
© CIRHM