DRIS Initiative Update

by Luisa Buada

Do the Selected Finance or Delivery System Function(s) Meet DRIS Criteria?

Humboldt/Del Norte Council Presentation - Annual Conference

In the Winter 1998 issue of the DRIS Newsletter, we discussed the fourth quarter challenge for each of the DRIS sites in choosing an integrated health system delivery and/or finance function(s) to be implemented ultimately through a local Cooperative Vehicle. For functions to be accepted for future implementation funding through the DRIS Initiative, the function(s) must meet the DRIS Criteria for selection. The three critical DRIS Criteria are:

Are the Function(s) Informed by Data?
Is there Community Buy-in?
Does it Better Prepare the Local Health Care System to Survive in Managed Care?

To assist the sites in examining these three criteria in depth, CIRHM has provided a list of related questions for the Community Health Councils to consider as they prioritze and choose their DRIS function(s).

Are the Function(s) Informed by Data?
1. Epidemiologic data
  1. Is there a significant incidence for a condition or illness in the population?
  2. What are the number of lives affected by payor sources over which one can affect change through an integrated provider network?
  3. Is there evidence, for instance, of lost work days related to the condition reported by employers of residents of the service area?
2. Provider supply and utilization data
  1. Are the same services already offered in the service area?
  2. In terms of provider competence and equipment, can the function(s) technically be offered appropriately through primary care and specialist providers in and out of the service area?
  3. Who else is doing it? Does sufficient and available marketshare to implement the function(s) exist?
  4. Why does the Council think they can do a better job? Are the current function(s) being implemented in the community not rural, or market appropriate? What is the basis for thinking that folks can do it better?
  5. Can one assure conformance with HEDIS or other quality assurance guidelines? Can one improve patient outcomes?
3. Economic data
  1. Can one provide the service less expensively, given your PMPM (per member per month) relative cost effectiveness data as a proxy?
  2. Is this an expansion of existing function(s) or a whole new one?
  3. Is there sufficient demand for the service from consumers and health insurance companies?
  4. If one improves patient outcomes (reduced incidence, prevalence of disease, reduced hospitalization, reduced ER crises, improved health function), can lowered costs be measured?
  5. Where will savings be accrued in the health care delivery system? How can benefits realistically be distributed financially?
  6. Are the function(s) sustainable over the long run by selling service to either employers, insurance companies, consumers or funding agencies?
  7. Can one hire locally or garner the support of all the appropriately skilled personnel to carry out the activities of all levels of the venture (function)?
4. Legal Data
  1. Can the proposed function(s) be carried out given the legal structure of the Cooperative Vehicle?
  2. Have the proposed function(s) been designed to reduce antitrust liability risk for all the parties involved?
  3. Are the governance structure and administration of the Cooperative Vehicle designed to comply with all laws and regulations?

Imperial Council Presentation - Annual Conference

Is there Community Buy In?
1. Do the function(s) match with Community Values?
  1. Is it a priority of the Community Health Council?
  2. Was it a Community visioning, focus group or surveyed priority?
2. Did the Community select the function(s) as an Essential Service?
  1. Is essential service better provided locally or through a referral network?
3. Is the Community willing to select and commit to a Cooperative Vehicle to carry out the function(s)?
  1. Is the Community Health Council willing to select an existing corporation/ agency, or create a corporation/agency to carry out the activities of their selected function(s)?
  2. Will the Community Health Council have an ongoing relationship to the Cooperative Vehicle which is defined through a binding agreement?
  3. Is the Community ready to decide, subsidize and carry on the process after the DRIS Initiative ends?
4. Are key community participants involved and willing to cooperate to implement the function(s)? Are Providers? Agencies? Consumers? Employers?
Does it Better Prepare the Local Health Care System to survive in Managed Care?

Do the function(s) promote and strengthen a system of integrated (vs. fragmented) health care service delivery in the local community?
Can one make the service available through a network of providers who are in agreement to work together to reduce duplication and fragmentation of health care delivery to their patients?
What is the added value of the function(s)? Does the Community Health Council think they can do a better job by implementing these function(s) as described above?
1. Does it increase access? (Accessibility)
2. Does it increase quality? (Accountability)
3. Does it decrease cost? (Affordability)
Do the function(s) focus on health promotion and disease prevention?

Lompoc Council Members Deborah Parker & Elizabeth Hatcher - Annual Conference

Some of these questions can only be answered through a financial and market feasibility analysis during Phase II of the DRIS Initiative. However, since there is only one opportunity for each DRIS site to perform a feasibility analysis, the Community Health Councils together with their Community System Consultant need to give priority to the function(s) which appears to have the greatest probability for success across all three DRIS criteria.

Timeline to Phase III Implementation:

Council chooses Function(s) based on potential for meeting DRIS selection Criteria
Council chooses an existing corporation or agency or creates a corporation or agency to be the Cooperative Vehicle to carry out the function
Council decides on the Governance of Cooperative Vehicle and defines the role of the Council vis a vis the Cooperative Vehicle and signs binding agreements
Financial and Market Analysis of proposed Function(s) implemented by CIRHM consultants
Business/Implementation Plan written for Function(s) by CIRHM consultants
Function(s) are Implemented through the local Cooperative Vehicle

go back to the top