This issue brief from The Commonwealth Fund examines how health care delivery system reforms might be monitoring and evaluated. The authors propose documenting and monitoring changes in delivery system structures, capabilities, incentives, and outcomes:
- Structure: What does it look like? How is the delivery system organized, and how does it change over time?
- Capabilities: What can it do? Does the delivery system have the tools and processes in place that would allow it to manage total spending and health outcomes?
- Incentives: With what incentives is it provided? Do incentives in the external environment encour- age the delivery system to contain costs and improve health outcomes?
- Outcomes: What does it actually do? Does the delivery system succeed at containing costs and improving health outcomes?
The authors conclude: “Without a clear understanding of what is changing in the delivery system, it will be impossible to draw any conclusions about the impact of change on cost, quality, access, and patient experience.”