Design Care Delivery Transformation
What does it mean to design a care delivery transformation, and why is it important?
Designing a care delivery transformation means creating an intervention that directly addresses the root causes of health inequities that you identified and prioritized for intervention.
A strong design improves outcomes, centers the input of patients living with the inequities, supports sustainability, and stays aligned with your equity goals. This step turns insights into action, restructuring healthcare systems to eliminate disparities and improve outcomes for all.
By this stage, your team has already:
- Started building a culture of equity
- Identified a health equity focus
- Diagnosed the root causes behind that focus
- Prioritized which root causes to address
The chart below details the steps as well as the approximate number of meetings for which to plan, while recognizing that the estimates will vary from team to team.
| Key Activities | Time Estimate: ~13+ Hours |
|---|---|
| Review the results of your root cause analysis and priority matrix | 1 one-hour meeting |
| Map the prioritized root causes to the levels of the care delivery system to determine which level(s) your care transformation will prioritize | 1 one-hour meeting |
| Identify/build interventions for each of the levels * Identify the ideal strategies and how the strategies will be employed (i.e., mode of intervention). | 1-3 one-hour meetings |
| Explore the roles of different stakeholders in interventions and how to earn their buy-in * Consider using the Stakeholder Identification and Action Planning Tool | 1-3 one-hour meetings |
| Present your proposed care delivery transformation to leadership, staff, and patients living with the inequities and get their feedback before your design is final. * Attempt to include at least some root cause analysis participants | 3-5 one-hour meetings |
| Present plan to each implementation stakeholder group for review and approval * Ask them to identify potential implementation challenges. | 3-5 one-hour meetings |
| Anticipate and plan for unexpected implementation challenges and opportunities * Consider using scenario planning resources | 3-4 hours total (one or more meetings) |
How and when should I design a care delivery transformation?
Designing care transformations to eliminate inequities is a multi-step process that requires structured planning and input from diverse voices.
Start by carefully reviewing the Design Care Delivery Transformation presentation below with your team. Allow plenty of time to review and discuss the information.
Next, begin designing your care delivery transformation by reviewing the Recommendations for Designing Equity-Focused Care Delivery Transformations tool as a team and use it to guide your work.
Review the report Designing and Implementing Integrated Care and Payment Transformation Initiatives to Advance Health Equity: Lessons Learned from Three Pioneering Health Care Provider and Health Plan Partnerships to see examples of care transformation models designed and implemented by others. Page 13 outlines the lessons that they learned about this process.
Do not forget to use your priority matrix to align your care transformation with the identified root causes. It is easy to fall into a trap of reverting to care models that you are familiar with or which are easier to implement. While this may be easier and faster than designing a care model tailored to the results of your root cause analysis, it will significantly decrease your chances of success.
Engage frontline staff, patients, and community partners throughout the process to ensure the design stays relevant and sustainable. Create logic models and map patient journeys and care delivery processes to anticipate barriers and leverage existing systems to create changes that are both impactful and achievable.
Resources to Design a Care Delivery Transformation:
Design Care Delivery Transformation
This presentation introduces teams to the process of translating prioritized root causes into care transformation interventions by applying a levels, strategies, and modes framework. This framework helps identify who is impacted by the care transformation, what strategies to use, and how to implement them. It also addresses common implementation barriers such as limited resources, organizational culture, and stakeholder buy-in, and offers practical strategies for navigating them.
Breathe Easy Narratives
The Breathe Easy Narratives document contains three fictional, character-driven vignettes grounded in real health disparity data, designed to support small group discussion and applied learning. Each story invites participants to explore root causes of health inequity and practice designing equity-focused care delivery transformations.
Recommendations for Designing Equity-Focused Care Delivery Transformations
This resource provides recommendations and outlines activities that organizations can implement to design their own equity-focused care delivery transformations.
Designing and Implementing Integrated Care and Payment Transformation Initiatives to Advance Health Equity: Lessons Learned from Three Pioneering Health Care Provider and Health Plan Partnerships
Sometimes it is helpful to learn from the experiences of others. This report presents case studies of care and payment transformation models designed and implemented by three pairs of health care provider and health plan partnerships to advance health equity. See page 37 for important lessons that they learned about anticipating data challenges.
Assessing the Process of Designing a Care Delivery Transformation
Utilize the prompts to discuss the following topics and identify next steps.
| Aligning the Care Transformation with Root Causes |
|---|
| Is the team regularly reviewing and emphasizing the prioritized root causes as it designs the care delivery intervention? If not, discuss as a team the reasons for this difficulty and identify potential solutions. Potential challenges include, but are not limited to: A lack of trust in the results of the root cause analysis Believing the wrong root causes were prioritized Lack of buy-in from key stakeholders (e.g., to utilize one or more care models that do not address the prioritized root causes) Time constraints imposed by contracted deliverables or pressure from organization leadership Conflicting organization-level priorities Does the care model “connect the dots” from the prioritized root causes to the necessary behavioral or process changes that are needed to reduce and eliminate the identified inequities? What is the logic model for the care transformation? Can you present a rational case for how and why the care will change, how those changes will address the root cause(s), and how the measured disparity will decrease as a result? Describe each step of the process of change and how your model supports each step. Consider potential process and work flow changes at all levels and functions of the healthcare system that might address the root causes identified by your team (e.g., policy, organization, care team, individual providers and care team members, patients/members, community-based organizations). Has the team drifted toward familiar or comfortable care models rather than those that most directly address the prioritized root causes? If yes, discuss as a team the reasons for this difficulty and identify potential solutions. Potential challenges include, but are not limited to: Feeling unsure about the ability to design something new “from scratch”. Time constraints imposed upon the design process (e.g., pressure from leadership to show progress at a faster rate) Following the path of least resistance or succumbing to inertia (doing what we always do). Failure to partner with patients living with inequities in the design process Has the team successfully implemented a care transformation model? If yes, consider creating new or revised immediate, mid-, and long-term goals based on experiences to date. Can the care model be revised to address additional root causes? Can the team plan out a longer-term time horizon to begin tackling highly important, but less feasible, root causes? |
| Improving Participation in Designing the Care Transformation |
|---|
| Instructions: Review and discuss the following prompts and use what is uncovered to identify next steps. Consider if any of the following key stakeholders were left out of the care transformation design process or had less influence than others. First, describe the level and manner of participation for each group. Second, identify ways that stakeholder groups with comparatively lower involvement could provide their feedback and expertise to review and provide feedback on the care transformation model. Third, as the team updates and revises the healthcare transformation, partner with stakeholders who were left out of the initial design process and increase the involvement of stakeholders who had less influence compared to others in earlier stages of the work. |
| Patients and Community Based Organizations Patients living with the health equity focus Representatives from community based organizations serving patients living with the health equity focus Healthcare Provider Organizations Care team members serving patients living with the health equity focus; including but not limited to behavioral health specialists, care/case managers, community health workers, medical assistants, nurses/population health nurses, patient service representatives, call center staff pharmacists, and social workers. Quality improvement specialists Administrative staff; including finance, coding, and billing team members. Health Plans / Medicaid Managed Care Organizations Population Health Finance Contracting Health Equity and/or Social Drivers of Health Underwriting/actuarial/compliance Provider/Hospital Network Management Senior Leadership (e.g., medical director) Data analytics State/District Medicaid Agency Value-based payment division Data Analytics Managed Care Contracting and Oversight Quality Improvement Population Health Health Equity and/or Social Drivers of Health Team focused on applicable health conditions or issues 1115 waiver/SPA/other waiver teams Senior Leaders (e.g., medical director) Answer the following questions from the perspectives of each key stakeholder/organization/team member. Are all key stakeholders aligned on the answers? What are the goals/objectives of the care transformation? How has success been defined? How will you know if the care transformation is working? Who will be given credit if the care transformation succeeds? Whose job performance will be formally evaluated on whether or not the care transformation succeeds? Informally? Who holds the most influence or power over the final design and implementation of the care transformation? If the individuals who hold the most power for design are different from those for implementation, how will each of them assess whether or not the care transformation is working? What variables or factors will they utilize to evaluate the care transformation? Has the team accounted for the variables/factors? |
| Health plans / Medicaid Managed Care Organizations |
About the Roadmap Goal and Objective Setting Tool
This tool helps your team realize your vision to reduce and eliminate health and healthcare inequities by providing a centralized resource to:
- Establish process goals that align with each Roadmap component;
- Document task status, champions, and detailed notes;
- Monitor progress across multiple Roadmap components simultaneously; and
- Promote consistent team communication, accountability, and progress.
Use this tool to facilitate and document the development, implementation, and evaluation phases of your health equity initiative.