Achieving Integrated Care as the Foundation of Population Health Management

My last post outlined some of the key drivers for Integrated Care—healthcare that crosses organisational boundaries and different care settings—globally.

In this post, I'll focus on two drivers that are particularly relevant to this concept; financial and legislative.

Financial Drivers

There are key financial drivers for Integrated Care. Current statistics show that nearly $1.2 trillion of the $2.2 trillion spent globally on healthcare is wasteful. There are different buckets of wasted spending: money spent on preventable conditions related to obesity and weight, unnecessary emergency room visits, duplicate medical testing, and inefficiencies in the system. 

To address this, traditional payment and service models are being deconstructed. Around the world, healthcare delivery models are shifting from a traditional fee-for-service (FFS) model to a value-based care (VBC) model. The focus is moving from volume of services toward delivering improved outcomes. The premise of VBC payments is to align physician and hospital bonuses and penalties with cost, quality, and outcome measures.

The U.S. is leading the charge on VBC initiatives to drive efficiencies into the healthcare system with the objective of achieving the “Triple Aim”: improved healthcare outcomes, improved patient experiences, and overall reduced healthcare costs. They have introduced several significant pieces of legislation—most notably the Patient Protection and Affordable Care Act of 2010, commonly referred to as the Affordable Care Act or “Obamacare”—to address the financial drivers for Integrated Care.

Legislative Drivers

Governments are recognising that there are multiple health, social and economic implications of fragmented healthcare, and an integrated healthcare system is an integral part of health reform. Evidence suggests that integrated primary healthcare is an effective way to optimise the efficient delivery of services and improve patients’ outcomes and experiences.

Complexity in how healthcare is currently delivered (a complex mix of primary and secondary, public and private) presents challenges in providing integrated pathways for the ongoing care of people with long-term chronic conditions, who require coordinated access to services across primary, community and acute care settings.

It seems that the goal should be putting the patient at the centre of the health system. Only then will individuals and communities have a better experience of care and support, experiencing less inequality and achieving better outcomes. And this is a focus for many government policies, reforms and funding. This shift in policy will see the faster adoption of healthcare system toward integrated care.  

Now that we understand the drivers for integrated care, we need to figure out how healthcare organisations can take on the challenge to deliver it. In many cases, this requires re-architecting care delivery models. One of the most complex and critical aspects of that is building an IT infrastructure that enables all participants in the healthcare system to access and share the information they need, and to streamline and automate their processes to ensure the most efficient clinical and administrative workflows—all with the result of improving outcomes and reducing costs. This will be the subject of my next post.

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For more on integrated care, please download our white paper, "Navigating the Journey to Integrated Care"