If you search for the term “healthcare delivery models,” you’ll find a smattering of results ranging from healthcare insurance payment categories to national healthcare system models (trust us on this).
That’s because the term is one of those phrases that are commonly used but rarely clearly defined.
We’re here to look at models that apply to the day-to-day operations of a healthcare facility, clarify how they differ from payment models, staffing, and care settings, and how they impact the way your facility delivers care.
What are healthcare delivery models?
We can define healthcare delivery models as frameworks for how care is organized, coordinated, and delivered within a facility.
These models directly influence patient care, cost, and workforce performance. And that influence is an important distinction. Why? Because:
- Hospitals and healthcare facilities can deliver care the same way under different payment models.
- Any 2 facilities of the same setting can use different delivery models.
Healthcare delivery models vs payment models vs care settings
What is care delivery?
Healthcare delivery models provide the framework for answering:
- How care is organized
- How teams are structured
- How patients move through the care journey
Payment models describe how providers are paid. They may incentivize certain behaviors for care, but they don’t dictate team structures, unit workflow, or the patient care experience.
Care settings define where care is provided: the physical environment.
In short:
- Payment models answer how the money flows.
- Care settings answer where care is provided.
- Healthcare delivery models answer how the work is implemented.
Healthcare delivery models vs nursing care models
The confusion between healthcare delivery models and nursing care models is understandable. They are closely related and need to be aligned for success. The best way to separate the 2 is to view delivery models as frameworks that function across multiple layers.
1. System level
How is care organized across an organization or facility network?
At this level, healthcare delivery models will influence the system in contract strategies, care coordination across care settings, data sharing, and population health programs.
2. Service lines
How is care organized within a specialty or specific population group?
At this level, delivery models will dictate care transitions, shift handoffs, staffing ratios, patient flow, and clinical accountability.
3. Unit level
How is care organized shift by shift?
At the bedside level, your facility’s delivery model impacts nurse workload, safety events, missed care, staff satisfaction, use of overtime, and turnover rates.
Here’s where we often see overlap in terminology with nursing care models.
- Macro-level: The delivery model provides structure across the organization.
- Micro-level: Nursing care models are specific frameworks for care assignment and coordination within the unit.
The most common healthcare delivery models
So what counts as a delivery model? Remember:
- Payment models explain incentives.
- Delivery models explain operations.
- Settings explain physical location.
This means they are often intertwined. Let’s take a look at a few of the types of healthcare delivery models.
Traditional healthcare delivery models
Thinking fee-for-service (FFS) fits here? This is a common misconception. FFS is a payment model.
Why shouldn’t we call it a type of healthcare delivery model? Because it defines reimbursement mechanics but does not determine team structure, care coordination, or workflows. In fact, it’s often criticized as contributing to fragmented patient care.
Traditional healthcare delivery models include:
- Managed care and HMOs
- Value-based care
- Integrated delivery
Managed care
Managed care delivery models all incorporate a few key characteristics: a limited provider network, an emphasis on preventive care, explicitly defined referral pathways, and a reduction in fragmented care. Common managed care models include:
- Health Maintenance Organizations (HMOs)
- Preferred Provider Organizations (PPOs)
- Point of Service (POS) Plans
Value-based care
The value-based care delivery model focuses on coordinated care and interdisciplinary teams, relies on data to drive decision-making to improve healthcare outcomes, expands healthcare access, and promotes clinical accountability.
Integrated delivery models
Integrated care models vary widely, but what really sets them apart is their alignment throughout the organization across care settings. These models share key components that are interdependent:
- Cross-care responsibility: Joint assessments, reviews, and discharges
- Care continuity beyond a single unit: Clinical road map for each patient (care pathways or packages of care)
- Structured care coordination: Multidisciplinary teams include clinicians across settings and sectors
- Shared infrastructure: Information sharing and collection to support population health and chronic disease management
Nursing care models (micro-level)
When we zoom in to micro-level bedside care, there are 4 types of nursing models commonly deployed: primary care nursing, team nursing, functional nursing, and total patient care.
Primary care nursing
Under this model, nurses are a patient’s primary point of contact from the beginning to the end of their care journey. It places the burden of care coordination on the nurse and requires strong delegation skills.
Pros:
- Strong nurse-patient relationship
- Patient-centered care
Cons:
- High requirements for nursing skills, knowledge, and capability
- Overwhelm and burnout risks for inexperienced nurses
Total patient care
The total patient care delivery model is a tweak to the primary care model. One nurse is assigned responsibility for patient care from the beginning to the end of their shift.
Pros:
- Strong nurse-patient relationships
- Care continuity
Cons:
- Higher requirements for licensed nurses
- Difficult to sustain
Functional nursing
This model is a strong departure from the emphasis on patient relationships in the primary care model. Functional nursing focuses on task completion and efficiency.
Pros:
- Efficiency
- Clinician skills optimization
Cons:
- Nurse-patient relationship almost non-existent
- Fragmented care
Team nursing
The team-based nursing care model is a hybrid of the primary care and functional models. Delegation is an essential component to leverage the skills of other clinicians within their practice scope, and a single nurse is identified as the team leader.
Pros:
- Supports growth of nurse leaders
- Encourages knowledge and skills growth of inexperienced clinicians
Cons:
- Tendency to prioritize tasks and efficiency over nurse-patient relationships
- Care continuity disruptions at shift change
How to choose the right model for your organization
Simply stated, there is no best model. The first and maybe most important piece of determining the right model for your facility is to look for alignment with your facility’s:
- Structure
- Patient population
- Workforce
- Operational constraints
How do you determine alignment?
Alignment is “the process of aligning a company’s strategy, operations, and goals across all departments and levels.”
The subtext here is that you should assess alignment across all levels of care; it is entirely possible for misalignment to occur in one area and not another.
Consider the following:
- How well would the model support the way day-to-day care is currently being provided?
- Would the model work with the complexities of your facility’s patient population?
- How would the model influence the skill mix and scheduling of your workforce?
- Would the model hold up under your operational and regulatory constraints?
Are your answers revealing inconsistencies, workarounds, or friction? Those are indicators of misalignment. The next move is to look at the data.
Measure the right metrics
Whether you’re evaluating your current delivery model or looking to change it, asking questions will guide you to the points of misalignment. The data is going to help you interpret, confirm, and validate.
- Operational KPIs: Length of stay, throughput, overtime, agency usage, hours per patient/resident day
- Quality and safety metrics: Patient falls, hospital-acquired infection rates, medication errors, readmissions
- Workforce metrics: Turnover, vacancy rates, engagement scores, injury rates, workplace violence incidents
Explore more resources for healthcare facilities
Healthcare facility administration is a career that requires ambition, compassion, managerial skills, and continuous learning.
Explore Nursa’s facility resources for insights on staffing strategies, workforce management, and care delivery.
Sources:
- Managed Care Organization: Complete Guide to MCO Healthcare Systems
- American Medical Association: What is value-based care?
- What is Integrated Care? - Collaborative Family Healthcare Association
- What are Integrated Care Systems? A Simple Guide | Economics by Design
- What is Business Alignment? | DealHub
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