Are health systems redesigning how health care is delivered?

Objective: To explore why and how health systems are engaging in care delivery redesign (CDR)—defined as the variety of tools and organizational change processes health systems use to pursue the Triple Aim. Study Setting: A purposive sample of 24 health systems across 4 states as part of the Agency for Healthcare Research and Quality's Comparative Health System Performance Initiative. Study Design: An exploratory qualitative study design to gain an “on the ground” understanding of health systems’ motivations for, and approaches to, CDR, with the goals of identifying key dimensions of CDR, and gauging the depth of change that is possible based on the particular approaches to redesign care being adopted by the health systems. Data Collection: Semi-structured telephone interviews with health system executives and physician organization leaders from 24 health systems (n = 162). Principal Findings: We identify and define 13 CDR activities and find that the health systems’ efforts are varied in terms of both the combination of activities they are engaging in and the depth of innovation within each activity. Health system executives who report strong internal motivation for their CDR efforts describe more confidence in their approach to CDR than those who report strong external motivation. Health system leaders face uncertainty when implementing CDR due to a limited evidence base and because of the slower than expected pace of payment change. Conclusions: The ability to validly and reliably measure CDR activities—particularly across varying organizational contexts and markets—is currently limited but is key to better understanding CDR’s impact on intended outcomes, which is important for guiding both health system decision making and policy making.

This is the peer reviewed version of the following article: [Scanlon, D.P., Harvey, J.B., Wolf, L.J., Vanderbrink, J.M., Shaw, B., Shi, Y., Mahmud, Y., Ridgely, M.S., and Damberg, C.L. (2020). Are health systems redesigning how health care is delivered? Health Services Research 55, 1129–1143.], which has been published in final form at This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions:



Work Title Are health systems redesigning how health care is delivered?
Open Access
  1. Dennis P. Scanlon
  2. Jillian B. Harvey
  3. Laura J. Wolf
  4. Jocelyn M. Vanderbrink
  5. Bethany Shaw
  6. Yunfeng Shi
  7. Yasmin Mahmud
  8. M. Susan Ridgely
  9. Cheryl L. Damberg
License In Copyright (Rights Reserved)
Work Type Article
  1. Wiley
Publication Date December 2020
Publisher Identifier (DOI)
  1. 10.1111/1475-6773.13585
  1. Health Services Research
Deposited September 09, 2021




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  • Created
  • Added Are+Health+Systems+Redesigning+How+Health+Care+Is+Delivered_Submitted+to+HSR+2020-1.pdf
  • Added Creator Dennis P. Scanlon
  • Added Creator Jillian B. Harvey
  • Added Creator Laura J. Wolf
  • Added Creator Jocelyn M. Vanderbrink
  • Added Creator Bethany Shaw
  • Added Creator Yunfeng Shi
  • Added Creator Yasmin Mahmud
  • Added Creator M. Susan Ridgely
  • Added Creator Cheryl L. Damberg
  • Published
  • Updated
  • Updated