Are we building integrated care, or just integrating the status quo?

Integrated care is often touted as the remedy for fragmented health systems. Yet, after decades of reform, it remains vital to ask: Are we truly connecting care around the person, or simply repackaging old, fragmented systems under a new label?

The promise and paradox of integrated care

For more than two decades, health systems around the world have chased the promise of integrated care. It has been promoted as the solution to rising multimorbidity, ageing populations, and unsustainable costs.

From the Chronic Care Model to Integrated Care Systems (ICSs), the language has evolved, yet the challenges remain stubbornly familiar.

Integrated care is not a unified concept, but an emergent set of practices shaped by context. Despite strong policy enthusiasm, consistent benefits such as improved outcomes, lower costs, and better patient experiences remain elusive. In many cases, reforms have altered governance structures without significantly impacting the lived experience of care.

Integration beyond structures and systems

At its core, integration is a philosophy, a coherent set of methods and models designed to create connectivity, alignment, and collaboration within and between the cure and care sectors.

Yet, as a Frontiers in Public Health review revealed, many systems have prioritised structural and financial alignment over cultural and relational integration. England’s Integrated Care Systems exemplify this tension: while designed to bridge the divide between health and social care, evidence shows uneven progress and persistent fragmentation.

Barriers such as unclear accountability, inconsistent funding, and limited evaluation continue to undermine intent. Similar lessons have emerged in Wales, Scotland, and Northern Ireland, where integration has been legislated for years but still depends on local leadership rather than system design.

In Australia, a Nous Group review found the same pattern: pilot success followed by systemic inertia. Their report noted that scaling integration remains a “considerable challenge,” largely because systems attempt to standardise complex, person-specific interventions. The result? We codify and replicate complexity rather than simplify and connect.

Integration is relational, not just organisational.

True integration cannot be achieved solely by merging institutions. Integrated care is holistic care, encompassing physical, emotional, social, and spiritual well-being, anchored in communication and self-care.

The Development Model for Integrated Care (DMIC) highlights five critical shifts required to achieve this transformation:

1. Involving clients and families as equal partners
2. Broadening the scope beyond treatment to include prevention
3. Embedding digital care into everyday practice
4. Embracing ethics and shared values
5. Linking networks across health, social, and community sectors

These shifts point to a deeper truth: integration is fundamentally relational. Interpersonal and interprofessional relationships are the heart of transformation. Without shared purpose, aligned values, and team-based learning, integration risks becoming bureaucratic coordination rather than collective care.

Measuring progress: are we integrating care or the status quo?

The core dimensions of integration — person-centredness, clinical coordination, professional partnership, organisational alignment, and shared culture — are well established. The challenge lies in how these are enacted.

Evidence suggests three essential tests to determine whether we are building genuine integrated care or merely integrating the status quo:

1. Do people experience continuity and coherence?
   Integrated care should feel seamless, especially for those with complex needs. Yet many still navigate disjointed systems, repeating their stories and reliving trauma across service boundaries.
2. Are communities co-creators, not just recipients?
   Successful models, from Canterbury’s “one system, one budget” to the Welsh Integrated Care Fund, have embedded co-production with communities, not just professionals.
3. Are relationships valued as infrastructure?
   The UK’s Hewitt Review and multiple systematic reviews highlight that relationships, trust, and shared leadership are the real architecture of integration. Integrated care falters when workers aren’t engaged as partners in change.

From assimilation to transformation

Integrated care should break down silos, not reinforce them. Yet too often, we integrate the existing structures instead of reimagining the system’s purpose.

The literature is clear: integration that fails to be person-centred and values-driven is not transformation, it’s assimilation. The most successful examples, from Canterbury to Copenhagen, begin with a simple yet radical premise: people belong at the centre, not the periphery, of the system that serves them.

Until we embed that truth, we will continue to integrate the status quo and call it progress.

Moving towards true integration

The future of integrated care depends on a cultural shift, from institutional mergers to human connection, from policy to purpose, and from integration by design to integration by relationship.

At Orion Health, we believe connected systems must start with connected people. Our solutions enable health systems worldwide to break down data silos, enhance collaboration, and put individuals at the centre of care.

Authored by Tom Varghese, Global Product Marketing & Growth Manager at Orion Health.

References

• Barr, Hugh, Elizabeth S. Anderson, and Maggie Hutchings. 2024. “Understanding Integrated Care.” Journal of Interprofessional Care 38 (6): 974–984. 
• Burns, Diane. 2023. “Integrated and Coordinated Care: What It Means.” Journal of Community Nursing 37 (4): 60–64.
• González-Ortiz, Laura G., Stefano Calciolari, Nick Goodwin, and Viktoria Stein. 2018. “The Core Dimensions of Integrated Care: A Literature Review to Support the Development of a Comprehensive Framework for Implementing Integrated Care.” International Journal of Integrated Care 18 (3): 10. 
• Hughes, Gemma, Sara E. Shaw, and Trisha Greenhalgh. 2020. “Rethinking Integrated Care: A Systematic Hermeneutic Review of the Literature on Integrated Care Strategies and Concepts.” The Milbank Quarterly 98 (2): 446–492. 
• Minkman, Mirella M. N., Nick Zonneveld, Kirsten Hulsebos, Marloes van der Spoel, and Roelof Ettema. 2025. “The Renewed Development Model for Integrated Care: A Systematic Review and Model Update.” BMC Health Services Research 25 (434). 
• Nous Group. 2024. Integrated Care across Australia: What Lessons Can Be Learned. Melbourne: Nous Group.
• Thomson, Linda J. M., and Helen J. Chatterjee. 2024. “Barriers and Enablers of Integrated Care in the UK: A Rapid Evidence Review of Review Articles and Grey Literature 2018–2022.” Frontiers in Public Health 11: 1286479.