Perspectives on Integrated Care from an Ontario Pilot of Bundled Payments

Abstract

This thesis organizes information that will help to inform bundled payment strategies, programmatic design, and decision making for key stakeholders to improve integrated care in local health systems. We aim to contribute to the advancement of integrated care literature, policy, and practice by clarifying how health system integration unravels in practice when implementing bundled payments. The objective of this study is to understand why and how Bundled Care enabled integrated care in Ontario’s health system. A qualitative, exploratory research design was used to collect data, guided by the Quadruple Aim framework and the Rainbow Model of Integrated Care. Data were collected through semi-structured interviews with health system quality improvement experts in Ontario, Canada. Deductive and inductive data analysis methods, as informed by Hennick et al. (2011), were used. Results identified the need for Bundled Care, the outcomes of Bundled Care across macro, meso, and micro levels of the health system, and key factors of how Bundled Care processes contributed to health system integration. Study findings indicate that significant upfront investments and alignment across the health system is necessary when designing and implementing bundled payments. This study demonstrates how adapting one component within a health system (financing) influences other sub-systems in pursuit of the Quadruple Aim. The results can be used by individuals and organizations accountable for driving more integrated services in their local health system through the design and implementation of bundled payments.