Capital efficiency and integrated health system designs.

Community health system design plays a role in capital efficiency, including returns on invested capital. This role becomes important in a future healthcare world of pressured payments, increased consolidation, constrained resources, and stretched community service missions and budgets.

Quality, efficiency, and organizational structure.

Physicians and their practice patterns are the largest single determinant of the level of aggregate national health care expenditures. Integrated delivery systems (organizations linking a multispecialty physician groups and acute care hospitals) appear to be more efficient than other organizational structures while providing better clinical outcomes. To determine whether a subset of hospitals was more or less efficient than the national average, we relied on data from the Dartmouth Atlas Project, which included data from 4,346 hospitals.