Confused by all the talk on integrated care? You’re not alone.
So what is integrated care?
Integrated care is any system that seamlessly delivers each person’s health and social support
– Integrated Care Definition
This is in contrast to current segregated systems which encourage individual silo-ed professionals and organisations to work in isolation. Uncoordinated service provision relegates service users to a position of piecing together their care solutions, left to shuffle between referrals as they try to transfer the necessary information for each provider to support them.
The current segregated system in most developed countries is very expensive. It leads to duplication of testing, unnecessary procedures, conflicting advice, reactive response and inefficient process. All of these expenses put added stress on the service user and their family. We pay too much for less than ideal outcomes.
There is substantial interest in integrated care from communities around the globe as the premise of better cooperation between services has the potential to achieve better individual and community outcomes at a lower cost. In his work for the UK, Sir John Oldham described an integrated care system succinctly as the circumstance where one person is supported by people from organisations acting as one team behaving as one system.
Integrated care is often confused with a number of initiatives that seek to facilitate it. This is in part because a number of global accounting firms have built big businesses charging governments advisory fees on this topic and their fees are dependent on prolonging confusion. It is also in part because health & social care organisations are filled with smart, passionate people who are motivated to actively connect their initiatives with the direction of change.
Our integrated care definition is easy to say, but don’t be fooled, it is immensely difficult to achieve. While few will disagree with a system that offers better care at lower cost, many will quarrel over how to design it.
It’s important to maintain a clear line between the vision of an integrated system of care and the specific changes (outcome-based commissioning, accountable care, shared care planning, etc) that are seeking to achieve it. Try not to think of integrated care as a ‘thing’ and more as a state. A number of things can be done to create an integrated system of care, however what those things are will be determined by local circumstances.
Below are some brief examples of initiatives that seek to achieve a more integrated system of care. This should give you an indication how initiatives are distinct from the vision and vice versa:
|Outcome Based Commissioning||A type of contractual arrangement with providers where compensation is based on the achievement of an outcome (rather than the performance of an activity). It seeks to reduce the perverse incentives in current systems by rewarding good care outcomes rather than volume of activity.|
|Care Coordination||Care Coordination adds another player to the team who’s role is to help the rest of the team work together. To this extent it is somewhat of a bandaid solution as it does not address the issues in current systems, but instead seeks to patch up their shortcomings. It’s primary effectiveness is in transferring the responsibility of system navigation from the service user to a professional who has the system knowledge to support a more seamless experience for the user through guided navigation and coordination.|
|Shared Care Planning Tools||Usually software or web application based tools to improve the sharing of information between providers. The premise of shared care planning tools is that they transfer responsibility for sharing information about the service user’s current condition from the service user to a provider platform. This facilitates asynchronous communication of higher quality communication between providers for better informed decision making. Fundamentally, this is a teamwork oriented tool which doesn’t address system issues but does improve providers ability to work in existing systems more effectively.|