MMHA 6050 Week 9 Sourced Section Drafts Paper Example

Draft Sections: Comparing an Integrated Delivery System, a Federally Qualified Health Center and the Veterans Health Administration

Student Name

Walden University

MMHA 6050: Delivery of Healthcare

Instructor Name

Month Day, Year

Draft Sections: Comparing an Integrated Delivery System, a Federally Qualified Health Center and the Veterans Health Administration

Working Thesis

Working thesis: An integrated delivery system with its own health plan, a federally qualified health center and the Veterans Health Administration each solve a different part of the U.S. delivery problem, and a regional health system can borrow specific features from each, but not the whole model, to improve access, cost and quality for its own population. The final paper will compare the three models on access, cost and quality, and address its recommendations to the chief executive of Riverside Regional Health, an invented regional system.

Background

The U.S. delivery system is often described as a set of partly connected arrangements, with financing, insurance and delivery functions split across many organizations (Shi & Singh, 2022). That fragmentation shows up at the seams: when patients move from hospital to primary care or to post-acute care, information and responsibility are often lost (Kripalani et al., 2007). Spending is high, about $4.9 trillion in 2023 (Martin et al., 2025), and access depends heavily on insurance. Each of the three models examined here addresses fragmentation in a different way: one by owning the whole chain, one by serving those the chain leaves out and one by building a separate national chain for a defined population. Comparing them can show a regional system which features address which problems. The comparison is not meant to crown a best model, since each serves a different population under different rules, but to separate the features that travel from those that depend on a model's particular setting.

Model Profile: Integrated Delivery System

Ownership: a single nonprofit organization owns hospitals, physician groups and a health plan. Financing: most revenue comes from members' premiums, paid by employers, individuals and Medicare Advantage, which the organization uses to pay for all of its members' care; it therefore bears the financial risk for its members' total cost. Workforce: physicians are salaried employees of the medical group, working with nurses, pharmacists and other staff in teams. Population: members who enroll in its health plan, mostly working-age adults and their families, and Medicare beneficiaries in its Medicare Advantage plan, within its service area (Shi & Singh, 2022).

Model Profile: Federally Qualified Health Center

Ownership: a community-based nonprofit governed by a board on which patients of the center must form a majority, as federal law requires for health centers receiving federal grants (42 U.S.C. § 254b). Financing: a mix of Medicaid, Medicare and private insurance payments, federal grants that support care for uninsured patients and sliding-scale fees based on income. Workforce: physicians, nurse practitioners, physician assistants, dentists, behavioral health clinicians and community health workers; a national survey analysis found no significant difference between nurse practitioner, physician assistant and physician care on seven of nine outcomes in health centers (Kurtzman & Barnow, 2017). Population: every resident of its catchment who seeks care, whether or not they can pay, with a high share of low-income, uninsured and Medicaid patients.

Model Profile: Veterans Health Administration

Ownership: the federal government, through the Department of Veterans Affairs, which owns and operates hospitals, clinics and other facilities nationwide. Financing: annual congressional appropriations, supplemented by collections from some veterans' private insurance; most enrolled veterans pay little or nothing for care. Workforce: salaried federal employees, including physicians, nurses and other clinicians, with some care purchased from community providers. Population: veterans who meet eligibility rules, which give priority to those with service-connected disabilities and lower incomes (38 U.S.C. § 1710).

Comparison Framework

For this paper, access means whether the model's population can obtain primary, specialty and hospital care when needed, measured by coverage of its population, cost barriers to care and timeliness. Cost means spending per person served, and the model's ability to manage the total cost of care rather than the cost of each service. Quality means the safety and effectiveness of care, measured where possible by published comparisons with other systems. The VA's quality has been compared with non-VA care in a systematic review, which found the VA often but not always performed better than or similarly to other systems on safety and effectiveness, with too little evidence to judge timeliness, efficiency, equity or patient-centeredness (O'Hanlon et al., 2017). Comparable reviews for the other two models will be located for the final paper. Where none exists, the paper will say so rather than infer quality from reputation, and will rely on the narrower studies available, such as comparisons of clinician types within health centers.

Outline of the Unfinished Analysis

The remaining sections will attach as follows. Comparison by criterion will follow the framework above, with a section each for access, cost and quality, discussing all three models within each section and ending with a summary matrix. Evidence still to be gathered: published cost comparisons for integrated systems and health centers, and a source on VA wait times. Recommendations will address Riverside Regional Health's chief executive and will be tested against Berwick and colleagues' Triple Aim (Berwick et al., 2008). Draft recommendations to test: adopting team-based primary care with nurse practitioners from the health center model; taking on shared-savings risk for a defined population, as the integrated system does; and building a measurement program modeled on the VA's. Limitations will address differences in population that make direct comparison difficult, especially the VA's older, sicker and mostly male population. Conclusion will restate the thesis in light of the evidence, and will say plainly if the evidence supports borrowing fewer features than the thesis now proposes. A thesis that survives the comparison unchanged is possible, but a draft should be written expecting it to change.

Sources Status

All claims in the drafted sections are sourced to current releases or peer-reviewed work, and each source was checked against its abstract or summary rather than cited from secondary accounts. The profiles' financing descriptions should be checked against the most recent federal releases before submission, since health center grant levels and VA appropriations change annually. The background figure on national spending is from the most recent national health expenditure release; if a newer release appears before the final paper, it will be substituted.

References

Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The triple aim: Care, health, and cost. Health Affairs, 27(3), 759-769. https://doi.org/10.1377/hlthaff.27.3.759

Eligibility for hospital, nursing home, and domiciliary care, 38 U.S.C. § 1710 (2023).

Health centers, 42 U.S.C. § 254b (2023).

Kripalani, S., LeFevre, F., Phillips, C. O., Williams, M. V., Basaviah, P., & Baker, D. W. (2007). Deficits in communication and information transfer between hospital-based and primary care physicians: Implications for patient safety and continuity of care. JAMA, 297(8), 831-841. https://doi.org/10.1001/jama.297.8.831

Kurtzman, E. T., & Barnow, B. S. (2017). A comparison of nurse practitioners, physician assistants, and primary care physicians' patterns of practice and quality of care in health centers. Medical Care, 55(6), 615-622. https://doi.org/10.1097/MLR.0000000000000689

Martin, A. B., Hartman, M., Washington, B., Catlin, A., & National Health Expenditure Accounts Team. (2025). National health expenditures in 2023: Faster growth as insurance coverage and utilization increased. Health Affairs, 44(1), 12-22. https://doi.org/10.1377/hlthaff.2024.01375

O'Hanlon, C., Huang, C., Sloss, E., Anhang Price, R., Hussey, P., Farmer, C., & Gidengil, C. (2017). Comparing VA and non-VA quality of care: A systematic review. Journal of General Internal Medicine, 32(1), 105-121. https://doi.org/10.1007/s11606-016-3775-2

Shi, L., & Singh, D. A. (2022). Delivering health care in America: A systems approach (8th ed.). Jones & Bartlett Learning.