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One of the objectives of the DRIS Initiative is for each site to choose and implement one or more functions that allow the rural community to impact health care cost, quality, or access as it interacts with managed care. Responsibility for implementing the functions is entrusted to a local single accountable entity. The DRIS Initiative established three criterion to guide each community in the selection of their function:
Is it informed by Data?
DRIS is unique in that it is designed to be a data-driven process. So it follows, that the functions chosen by each community be supported by data findings which flow out of their quantitative and qualitative community assessment. When choosing a function, the Community Health Councils asked itself:
If the community assessment data demonstrated a clear need for the proposed functions, due to economic, epidemiological or demographic findings?;
If the community assessment data demonstrated community demand by way of market shares or interested purchases and consumers;
Does the financial feasibility analysis suggest that the proposed functions, if implemented, have a reasonable chance of succeeding in the long run?; and
Can any legal barriers be overcome?
Is there community Buy-In?
As DRIS is a community process, it is essential that the chosen functions reflect the wishes, as best as possible, of the community who are represented by the Community Health Council members. When gauging community support, the following questions were presented as a guideline:
Does the proposed functions and governance structure of the accountable entity responsible for implementation, match the values of the local community?
Has the Community Health Council come to an agreement regarding which essential services should be contracted out for and which should be provided at the local level? and
Is the Community Health Council in agreement that the proposed functions should be managed by a locally controlled single accountable entity?.
Does it better prepare the community for managed care?
It is the goal of DRIS to help prepare rural communities to retain local control of clinical decisions, continue to provide high quality health care, as well as, survive financially as they transition to managed care. Hence the chosen function(s) should serve as a segue way into preparing the community as a whole for the eventual adaptation to the reality of Managed Care. The following guidelines have been presented to the communities to help answer this question:
Do the proposed functions support and further the integration of the local rural health care system?
Will the proposed functions be implemented through an integrated network of providers and community resources?
Will the proposed functions either control costs, ensure quality or assure local access to essential services on an ongoing basis? and
Do the proposed functions focus on disease prevention and health promotion?
© CIRHM