1. Lerner, Jeffrey C. PhD
  2. President and Chief Executive Officer

Article Content

Three articles in this issue build on presentations made by Mehler, Fogarty, and Timimi at a conference exploring "systemness" in health care systems. So, first, a definition of systemness, offered at the conference by Dr Kenneth W. Kizer, who served as Under Secretary for Health, US Department of Veterans Affairs, and chief executive officer of the nation's largest health care system, and is largely credited with initiating the transformation of the Veterans Health Administration into a high-performing system: "Systemness refers to a functional state of diverse, interconnected, discrete parts that behave predictably and consistently as a coherent whole in ways that are distinct from and superior to the sum of the parts."


Systemness, or at least the drive to achieve it, is stimulated by broad changes in health care delivery, many of which are reinforced by health reform policies deployed in the public and private sectors. Since the passing of the Affordable Care Act, models of Accountable Care Organizations, physician practice acquisitions, payer-provider partnerships, and patient-centered (or primary care) medical home models are increasing, but they vary in form and geographically. The speakers at ECRI Institute's conference, titled "Creating Systemness Within Healthcare Delivery: Can Success Be Proven and Shared?" came from integrated delivery systems, military health care systems, government agencies, payers, universities, companies, and other stakeholder organizations, including patient advocacy, to discuss these trends in terms of microcosmic systems within a macrocosmic system. They addressed themes such as "team structures," "governance," "population health," "culture," "patient-centered care," and "costs and reimbursement."


This is the context for the 3 articles in this issue of Journal of Ambulatory Care Management. They focus on disparate topics, but ones that are important for ambulatory care managers. Although the articles are built on presentations at the conference, they are written more expansively and do not focus on "systemness" per se. Instead, they are extensions of the authors' perspectives.


Fogarty and colleagues explain aspects of Oklahoma Medicaid's SoonerCare program, explaining, for example, the use of the patient-centered medical home. If states are the laboratories of experimentation for broader federal policies, then SoonerCare is a program to watch. Oklahoma is considered a "purple" state, neither a red state nor a blue state in its political leanings.


In their article, Mehler et al explain the workings and progress of Denver Health, a high-performing safety-net health system considered widely as a model well worth emulating. The authors hold the belief that a safety-net system can be an important partner with better-resourced systems serving wealthier segments of the population-an important perspective.


Dr Timimi takes another tack, illustrating how new social media, as deployed by the Mayo Clinic, meets patients where they spend the majority of their time seeking health information-interacting electronically among themselves and with health care professionals. His perspectives are particularly significant for ambulatory care managers as these managers seek to understand and create the future of a much more broadly defined practice of ambulatory care.


Ambulatory care management, in its many forms, is a vibrant part of the changing health care system. The 3 articles may help us evaluate whether lessons learned by one organization can be transferred to or inspire others.


-Jeffrey C. Lerner, PhD


President and Chief Executive Officer


ECRI Institute Headquarters,


Plymouth Meeting, Pennsylvania


E-mail: [email protected]


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