HRSA - Health Center Controlled Networks

HRSA - U.S Department of Health and Human Services, Health Resources and Service Administration

U.S. Department of Health & Human Services

Health Center Controlled Networks > Matrix for Collaboration/Integration

printer-friendly Matrix for Collaboration/Integration (Acrobat/pdf)

The matrix is designed as a descriptive tool to aid in the growth and development of integrated service networks. A network can be at various stages of collaborating, sharing and integrating within functional areas, which, for the purposes of this matrix are illustrative of some of the functions networks may perform. In different marketplaces, issues such as demand and levels of managed care, composition of collaborators, and/or unique health care delivery characteristics will impact the functions and composition of the network. Networks should assess their respective environment and the infrastructure of their constituent members to determine the most appropriate mix of functional activities. The matrix is designed to be a dynamic document that will change as the environment changes and as networks develop further and evolves.

Use of the Matrix

Use the matrix in the following manner:

Discussion tool for Boards and staff to begin the discussion of areas where collaboration may be possible;
Strategic planning guide to help refine the types of integration contemplated;
Framework for technical assistance;
Planning and/or self-assessment tool.

A number of networks have reported use of the matrix and found it to be a positive experience. Examples include the following:

Measure a network’s progress against the business plan.
Facilitate discussion among collaborators in terms of where they were and where they would like to be, analyzing issues of convergence, divergence and differences.
Generate discussion among Board members for strategic planning purposes.
Define the goals of a network’s integrated activities.

Definitions

Collaborating, Collaborative: To work together, especially in a joint intellectual effort

Sharing, Shared: A part or portion belonging to, distributed to, contributed by or owned by a person or group

Integrating, Integrated: To make into a whole by bringing all parts together; to join with something else

Core Area: For this purpose, core area encompasses one of the following: administrative, clinical, managed care, financial, and information systems/information technology (IS/IT). Networks can be engaged in activities around all of the core areas as long as they are appropriate to the respective marketplaces and the available infrastructure and resources.

Functions: For the purposes of the ISDI, a function is identified as a specific activity within one of the core areas as defined above. For example, within the core area of clinical activities, a function may include the sharing of common clinical protocols and guidelines among collaborators; within the core area of administration, a function may include centralization of human resources across the network. Networks can be engaged in a number of functions within a core area(s) as long as they are appropriate to the respective marketplaces and the available infrastructure and resources.

Assumptions

The functions and levels of integration described are meant to be illustrative, not exhaustive. Different marketplaces will offer different opportunities; therefore, collaborators may participate in other functions or combinations of functions. At any given time, networks may be carrying out different functions or activities in collaborative, sharing and integrated phases.
Networks will be at different stages of development for different functions. Variables within and beyond the control of the network will affect its ability to achieve levels of integration (e.g., available resources, size, and long term plan of the network, geography).
Centralized management denotes that a function is standardized and/or centralized and/or outsourced. It does not mean that the function has to be located at the network physically, but has to be controlled centrally on behalf of all parties.
Some functions are much more complex than others and may require more time, resources and development (technical assistance, capital, infusion of new collaborators, etc.).

Function Options	Collaborative	Shared	Integrated
Core Area: Administrative
Human Resources	Joint position descriptions & advertising	Common policies & procedures Joint purchase of fringe benefit either “benefits” or benefit package	Centralized HR staff Centralized management of common fringe benefits
Purchasing	Standard inventory Joint RFP	Joint purchasing	Centralized purchasing department
Corporate Compliance	Sharing of individual self-evaluation compliance assessments	Standardized self-evaluation tool to monitor compliance Some shared staff Common policies and procedures	Centralized compliance unit/internal auditor
Medicare/Medicaid Compliance	Common policies	Shared staff, some same but separate systems	Internal audit function
Program/Services Development	Strategic planning	Shared programs/services	Centralized program development unit
Resource Development	Joint proposal or fund raising effort	Network proposal	Centralized resource development unit
Education Community Patient/Customer Staff Board	Sharing of current educational activities	Using/Publishing standardized materials Shared community outreach staff	Centralized education functions Centralized community promotion/outreach function
Communication Public Relations Marketing	Joint events and materials	Shared staff or contracts Joint ongoing projects	Centralized communication functions
Governance Structure	Statement of intent to participate	Memorandum of Agreement	Formation of a separate corporate entity and/or centralized management
Marketing	Joint marketing assessment	Standardized materials and joint events	Centralized/Standardized marketing approach
Strategic Planning	Review of collaborator strategic plans Agreement on a strategic planning process	Development and endorsement of network strategic plan	Implementation and monitoring of network strategic plan
Quality Improvement: Administrative	Joint education and training Sharing of expertise	Joint projects, e.g., surveys Development of quality guidelines	Standardized CQI plans and implementation at network level Centralized staff resources
Function Options	Collaborative	Shared	Integrated
Core Area: Clinical
Services/Programs	Joint planning at the collaborator level Services available to each collaborators clients	Joint planning at network level, e.g., collaborators develop coordinated programs which still involve participation on individual level Some common internal and external referral guidelines Staff delivering services at more than one of the participating agencies	Joint funding, coordinated services and programs Centers of Excellence Centralized internal and external referral/ consultation program Collapsing existing services into one Services/programs delivered by network level staff Programs offered at the network level are not duplicated at the center level
Health Education	Sharing educational materials/activities Collaborators actively informed about health education programs and activities Health education information available to clients/practitioners across the network	Some shared staff Using/Publishing common materials Collaborators plan some activities in which several collaborators participate – staff and resources are still individual center based, e.g., health fairs, prenatal education classes, educational brochures	Centralized clinical health education function/educator Centralized on-line information resources Centralized promotion/outreach function Health education activities delivered by network staff not duplicated at the individual center level Planning performed at the network level
Clinical Guidelines and Disease Management	Joint clinical staff meetings by discipline Common health maintenance, health education, and disease management guidelines	Shared staff educational materials Common clinical staff development programs Some shared staff Centers discuss and identify some common outcomes measures	Standardized guidelines, including disease management, utilization review, case management and triage Outcome measures adopted and monitored at the network level Centralized disease management function Standard messages/programs Integrated information systems
Staffing	Collaborators share strategies for recruitment Sharing information around retention and benefits packages Collaborators assist each other in times of provider shortages (Locum tenens) Clinical directors meet informally on a regular basis	Joint health professions training program or sponsor joint CME activities Shared vacation coverage Common policies for credentialing, clinical privileges and re-credentialing Clinical directors meet formally on regular basis	Network level (single) Chief Medical Officer Shared hospitalist Common retention and benefits package Network level credentialing and re-credentialing function Network level clinical staff (may be clinical administrative) performing functions not duplicated at the individual center level
Documentation Medical Records Common Forms Policies (e.g., record retention, storage retrieval, standards)	Collaborators assist each other in developing medical records forms/policies	Adoption (sharing )of common forms Some joint policies and procedures Network sponsored education for staff on medical records related issues (e.g., billing and coding, filing systems, confidentiality) Shared information on common forms Sharing of common policies	Common medical records format – electronic or paper Network level health information staff Network level functions such as policy and procedure development, chart review, billing and coding assistance, processing of record requests Electronic medical record Standardized basic forms Uniform policies and procedures
Ancillary Services Laboratory Pharmacy Radiology Other	Joint solicitation of ancillary services contracts Clinical directors share information about services, contractors and utilization Clinicians aware of services available at other centers and how to refer clients	Common vendors Some shared staff Joint solicitation of ancillary services contracts maintained at center level Formal or at least streamlined mechanisms to refer clients for services from one collaborator to the other Clinical directors plan ancillary services delivery based upon knowledge of and taking advantage of among the collaborators	Single outsource contracts or bring expertise in-house Centralized staff Network level services not duplicated at the individual center level Clients access services at any of the participating centers without need for separate registration
CQI/Clinical Systems Improvement	Joint quality committee Joint staff training Collaborators adopt common approach to CQI Collaborators formally discuss development of indicators and share these with each other	Development of materials common indicators and reporting formats Shared staff for CQI Joint education/preparation for individual accreditation Peer review – common format for peer review, clinicians may conduct reviews across collaborators Shared comparative data (collective) Common quality indicators	Centralized support for implementation and monitoring of common quality indicators, e.g., appointment availability and wait times Centralized staff support for education, consultation and coaching of improvement efforts, data analysis and reporting Network level goals and thresholds Joint accreditation
Research	Common data collection Collaborators discuss possible research activities and share information about individual projects	Joint research projects Collaborators participate individually in common research projects	Joint internal review board Network develops and carries out research projects Network level research department or staff
Function Options	Collaborative	Shared	Integrated
Core Area: Managed Care
Credentialing	Common policies and procedures		Centralized/Standardized credentialing
Member Services—Managed Care	Common policies and procedures	Joint enrollment materials Common intake and referral	Centralized/Standardized member services
UM/ UR	Shared planing around UM/ UR	Done individually under common protocols	Centralized UM/ UR
Contracting	Assessment of collaborators’ managed care activities Inventory of collaborator participation agreements within the marketplace	Standard utilization review and risk management program	Contracting authority and monitoring performed at the network level Risk agreement carve outs HMO license
Function Options	Collaborative	Shared	Integrated
Core Area: Fiscal
Grants Management	Review PINS and disseminate information Coordinate common strategy	Joint staff collects information and develops reports Technical assistance	Centralized staff administers and monitors grants
Claims Processing	Common policies and shared staff training	Shared staff, some same but separate systems	Single CFO and/or centralized management approach Centralized network claims processing
Accounting General Ledger A/R A/P Payroll	Common policies Common chart of accounts	Shared staff, some same but separate systems	Single CFO and/or centralized management approach Some central staff Centralized server/systems
Policies and Procedures	Board has approved 25 percent of common policies and procedures	Board has approved 50 percent of common policies and procedures	Board has approved 100 percent of common policies and procedures
External Audit	Different procedures and/or auditors Some sharing of data	Common set of specifications Some sharing of data	Same auditor Full/complete data sharing
Staff Education and Training	Individual training of common subjects	Some shared training by system “experts”	Implementation and monitoring of standard curriculum
Function Options	Collaborative	Shared	Integrated
Core Area: IS/IT
Management of IS Department	Formation of IS Committee	Some shared staff	Single CIO and/or centralized management approach
Data	Common data elements	Data compiled for common management reporting (data warehousing) Roll-up reporting	Centralized database
Communications	Email capacity at collaborator level	Internet email capacity for all appropriate people	Email, intranet, web pages with common links
Staff Education and Training	Individual training of common subjects	Some shared training by system “experts”	Training program at network level
Support	Common support agreement	Sharing staff	Central help desk/support performed at network level
Reporting	Common reports	Roll-up reporting	Reports produced at network level
Infrastructure	Individual assessments at the collaborator level Strategic planning Development of joint RFP	Group purchase of systems Interfaced systems	Central server