Integrated care goes by many names, but the definition is always the same.
Integrated care is healthcare that crosses the boundaries of care settings, organizations, and specialty practices to provide comprehensive care to patients. The World Health Organization defines integrated care as, “a concept bringing together inputs, delivery, management and organization of services related to diagnosis, treatment, care, rehabilitation and health promotion. Integration is a means to improve services in relation to access, quality, user satisfaction and efficiency.”
Integrated care is more than a trendy backlash against the global problem of care fragmentation, it’s a worldwide approach to care that will permanently shape the industry moving forward. Integrated care is now a goal for most healthcare organizations, and there are numerous drivers for this, most associated with rising costs and a need for health systems to save money. Below are six of the largest drivers for the global adoption of integrated care.
1. Per capita healthcare costs. Globally, health systems are beginning to strain because of rising costs. Per-capita healthcare expenditures are skyrocketing everywhere, with the United States topping the charts at a staggering $9,146 per person. That simply isn’t sustainable. By shifting from reactive care to proactive, comprehensive integrated care, health systems hope to control costs by eliminating redundancy and focusing on patient health and the prevention of disease.
2. Aging population. As baby boomers enter retirement, the patient pool starts to become older. Population aging is accelerating worldwide, driven by increased life expectancy. An aging population places a burden on healthcare systems because of the increased demand for service. Even with increased efficiency brought by new workflow technologies, the demand in this case is still rising too quickly to control through standard healthcare practices.
3. Increase in chronic conditions/disease. Obesity, hypertension, and dementia are becoming persistent, widespread public health concerns, and unfortunately these problems bring with them an increased demand for medication and long-term treatment. Chronic illness is the leading causes of death and disability in the U.S., accounting for most healthcare expenditures. Perhaps most unfortunate, the most prolific chronic conditions in the U.S. – heart disease, stroke, cancer, Type 2 diabetes, obesity, and arthritis – are the most costly, despite being among the most preventable of all health problems. Worse yet, if statistics from the Centers for Disease Control and Prevention hold true, chronic conditions are only going to become more prevalent and more expensive to manage as time moves on.
4. Growing consumer demands. Consumers also have a big part to play in the drive toward integrated care, shaping the healthcare industry into something that resembles an online retailer. The average person today is used to having information available at their fingertips. We live in a connected world of smartphones and tablets, and very few of us are ever more than a few seconds away from a conversation with friends or the wonders of the Internet.
Increasingly, consumers are defining their ideal healthcare experience to be more like what they see from the service industry. They want more than a traditional patient-doctor interaction; they expect convenient, quick, efficient care and easy access to their healthcare data from any device. In response to this, many payers and healthcare providers are evolving their offerings, focusing on consumer engagement, cost transparency, and improved service flexibility. These alterations are a must if they want to stay competitive, but unfortunately these modern amenities carry with them a hefty price tag and can cause stress for less-than-tech-savvy staff.
5. Wasteful spending. Current statistics show that nearly $1.2 trillion of the $2.2 trillion spent globally on healthcare is wasteful or unnecessary. This “bad” spending comes in a few different forms: Money spent on preventable conditions, such as those related to obesity and weight; unnecessary emergency room visits; duplicate medical testing; and wasted time due to inefficiency. To address all of the above, traditional payment and service models are being transformed. Around the world, healthcare delivery models are shifting from a traditional fee-for-service model to a value-based care model. The focus is moving into a model that sees reimbursement linked to care outcomes. Further, unnecessary testing and redundant care are being treated as a loss, forcing honesty and efficiency from healthcare organizations that only integrated care can provide.
6. Legislative Initiatives. There are legislative factors that may accelerate provider consolidation in the U.S. healthcare industry, propelling the healthcare system toward integrated care. Among them is the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA establishes a new way to pay physicians who treat Medicare patients; it’s the largest-scale reform in the U.S. since the Affordable Care Act went into effect. Among other things, MACRA changes the way Medicare doctors are reimbursed. Under MACRA, physicians can choose a Merit-based Incentive Payment System (MIPS) or an Advanced Alternative Payment Model (APM), both aimed at controlling costs by mandating improved care outcomes and efficiency.
These major drivers for integrated care leave us with only one question: how can healthcare organizations take on these challenges to deliver integrated health services to their patients? In many cases, this requires completely re-shaping care delivery models and foundational business practices, and for most, that means building an IT infrastructure that enables everyone in a health system to access and share the information they need to streamline operations. By simplifying the sharing of information and leveraging patient data, health systems can begin to take the steps necessary to provide more efficient care that will improve outcomes through better treatment and prevention, reduce costs, and end the fragmented care process that spurred a shift to integrated care in the first place.
By Pam Stout, MHA, RN-BC, CNOR, Nurse Executive, Orion Health
The original article can be found at the Becker’s Hospital Review site here.