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Appendix H Levels of Care Level A Experience of the patient (e.g., evidence-based treatments, patient-centered approaches, patient-provider relationship [therapeutic alliance, treatment environment]) environment]) Level B Functioning of small units of care delivery, referred to as “microsystems” (e.g., intensive outpatient [IOP] unit, outpatient clinic, inpatient unit) Level C Functioning of organizations that house or support microsystems, referred to as the “macrosystem” (e.g., comprehensive care delivery systems, large multiple-site hospital systems, health plans, managed care organizations [MCOs], managed behavioral health care organizations [MBHOs]) Level D Environment of policy, payment, regulation, accreditation and other factors that influence the organization at Level C (e.g., federal policies, state policies, health care benefit structure, National Committee for Quality Assurance [NCQA], Utilization Review Accreditation Commission [URAC], health plan policies, subspecialty/trade organizations) FIGURE H-1 Components of health care delivery systems. SOURCE: Adapted from Berwick, 2002. Figure H-1 depicts how the health care environment (i.e., policies, regulation, financing [Level D]), the organizational setting (i.e., health plans 371
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372 SUBSTANCE USE DISORDERS IN THE U.S. ARMED FORCES and health systems [Level C]), and the delivery of care (i.e., clinics [Level B]) combine to affect patient care (i.e., the patient experience [Level A]). The committee suggests that these four levels of care provide a blueprint applicable to the development of a 21st-century system of substance use disorder (SUD) prevention and treatment services within the U.S. military. REFERENCE Berwick, D. M. 2002. A user’s manual for the IOM’s “quality chasm” report. Health Affairs 21(3):80-90.