The primary care practitioner reviews the screenings and refers patients with qualifying scores to the PBH provi… CARE PLANNING & CARE COORDINATION . Find out how local … What does it take to make integrated care work? The Local Government Association - with NHS England and ADASS, ADCS, Monitor, NHS Confederation and Department of Health - has developed an 'integrated care value case toolkit', which we hope will enable Health and Wellbeing Boards and local partners to understand the evidence and impact of different integrated care models on service users, as well as the associated impact on activity and cost to different parts of the health and care system. This worksheet (ARIES Master Data Collection Form) can be used to remind Medical Case Managers of the data elements required for the creation of a care plan in ARIES. For this to occur, they will have to be convinced of the need for integrated care and accept responsibility for seeing that the necessary changes are implemented. Kaiser Permanente has taken advantage of its integrated payor and provider functions to provide better care for patients who have suffered an acute coronary event. Practice examples of good practice in integrated care. IBHP-funded projects have showed statistically significant improvements in patient physical, mental, and general health, … on 20 January 2014. They needed to adjust, for example, to working on interdisciplinary care … People create and sustain change. For a closer look at the outcomes the VHA achieves, see “, For more information about how to encourage self-care, see “. United Nations, “World population aging 2007,” August 2007. phics. Integrated care brings together the different groups involved in patient care so that, from the patient’s perspective, the services delivered are consistent and coordinated. Our flagship business publication has been defining and informing the senior-management agenda since 1964. This was the case when Bolton Primary Care Trust in the United Kingdom decided to build a diabetes network to address the region’s high prevalence of that disease. To lead and manage integrated care across sectors and posted on our use of cookies, and Change often causes discomfort and confusion, and those reactions can hinder a pilot project’s success. Payor participation is not a requirement, but it can help ensure that all incentives are appropriately aligned. As the decision about which services to include is made, a key consideration is whether payors should also be involved. Having patients take responsibility for their own care helps ensure that they do not inadvertently undermine the efforts of the integrated-care team. Presentation Overview The biomedical model and its legacy • Increased life expectancy • Mind-body dualism • Rise of the pharmaceutical industry • Rise in … For example, in a systematic review of ACO outcomes, Kaufman et al. We have since been contacted by colleagues keen to share further examples of innovative work. [2] The core of the Dutch model are so-called “care groups”, legal entities that act as intermediaries between health insurers and healthcare professionals. Flip the odds. 3 2 Integrated Health Care Study” (August 2015) commissioned by Anthem Blue Cross and Blue Shield and conducted by SourceMedia Research/Employee Benefit News. A really powerful area in moving forward in the health and social care field, and beyond too. Kristian Hibberd (Comms Manager, LGA) If possible, a single person should have ultimate accountability for each patient; this helps ensure that all appropriate services are delivered but no duplicate or unnecessary services are ordered. Everyone involved in the project must understand that their responsibilities will be defined and their performance—as well as the success of the overall effort—will be monitored and measured. “Die Optimierer” (an interview with Wolfram Otto), McKinsey Wissen, 2008, Volume 19, pp. I was also interested to hear about LifeLines. These efforts are usually designed to provide “one stop shop” services for patients; to improve care coordination, especially for people requiring long-term care (who, by definition, include chronically ill and elderly patients); or to ensure more appropriate use of health care resources. We strive to provide individuals with disabilities equal access to our website. Learn about Secondly, the primary care networks ensure that the number of primary care beneficiaries increases. Something went wrong. Inevitably, there will be enormous amounts of activity taking place locally as people share, refine and agree their integration plans. Health and Care Integration – making the case from a public health perspective, Flooding and the public's health: looking beyond the short-term, Understanding alcohol-related hospital admissions. Background. The point on "ocus on people’s wants and needs rather than the organisations and structures that deliver care" is also extremely powerful. PHE is committed to supporting local areas to develop and implement their integrated approaches. Integrated care pathways The literature offers several examples of integrated care pathways designed to improve care of dying patients and their families in the hospital setting. Practice examples of good practice in integrated care. Virtual integration requires only that the organizations work closely together. IV/A/2 . In some countries, physicians in private practice have banded together to form independent practice associations (IPAs). Polikum, the largest provider of integrated outpatient health services in Germany, exemplifies this approach. For example, integrated care … We have spoken with these organizations (individually and in panels) to learn from their experience and identify best practices. While primary care physicians (PCPs) are often bound to their 15- to 20-minute visits with a patient, innovative healthcare systems like Memorial Hermann have an in-house psychologist within the group practice. ARIES Eligibility Programs Medications Care … Thus, considerably more research is needed to determine how integrated care can best be used to improve clinical outcomes and control health care costs. Once this attitudinal shift takes place, the clinicians should be encouraged to act as role models for others. The approaches can be grouped into three broad categories: Integration between primary care and secondary care. In addition, patients must also be given information, support, and tools they can use to manage their condition (for example, visual-management tools that enable them to see their targets and track their progress).8 8. Integrated care has the potential to deliver efficiencies and improvements in patient experiences and health outcomes. The toolkit contains, among other things, a set 11 of case studies describing local examples of whole-system integration. Both the project’s financial viability and its clinical viability must be considered. For example, pregnant women can now access antenatal care outside of standard office hours. However, which of these factors are most important to the success of the effort will depend on the pilot being conducted and the setting in which that pilot takes place. California: The Integrated Behavioral Health Project (IBHP) is an initiative launched in 2006 to accelerate the integration of behavioral health services into primary care settings in California. Examples of IDNs include, Highmark Health, Kaiser Permanente, UPMC, Mayo Clinic, Cleveland Clinic, Geisinger Health System, Jefferson Health, and Intermountain Healthcare. One hundred thirty-three million Americans, 45 percent of the population, have at least one chronic disease. There are great examples of integrated care services here locally and abroad. “Die Optimierer” (an interview with Wolfram Otto), B.G. The Veterans Health Administration (VHA) is a good example of the value of structural integration. For example, integrated care can benefit children with chronic renal failure. In most parts of the world, integrated care is still a new idea, and the number of integrated-care providers is small. In this article, we have summarized our findings as a way to help other groups that want to pilot or improve their integrated-care programs. NSW Health is delivering integrated care strategies and plans to enable transformation of the NSW Health system as part of Australia's long term health plan.. The program has decreased the need for costly emergency interventions and significantly reduced the risk of death.4 4. Integrated Care Plans: Theory & Practice Jessie M. Gaeta, MD Boston Health Care for the Homeless Program May 2015. The trust began by communicating a clear and concise vision to all staff members of how they—and their patients—would benefit from integrated care. cookies, McKinsey_Website_Accessibility@mckinsey.com, Engaging consumers to manage health care demand. Two interrelated factors—the growing prevalence of chronic diseases and population aging—are placing a heavy burden on health systems. Integrated care is a broad concept, used to describe a connected set of clinical, organizational, and policy changes aimed at improving service efficiency, patient experience, and outcomes. In contrast, Geisinger used financial incentives to encourage physicians to implement the practice infrastructure changes that were necessary for the medical home program to get off the ground. For example, integrated care can benefit children with chronic renal failure. They must learn to see themselves not only as the professionals who deliver patient care but also as partners in—and, ideally, leaders of—the change effort. Have you seen #PHEHealthMatters, a resource for professionals providing data, tools and interventions to help you tackle key public health issues. Successful Examples of Integrated Models from Across the Country. Integrated care facilities are often in medical settings such as primary care clinics, but this doesn’t have to be the rule. LifeLines volunteers run free health and wellbeing activities for residents in the extra care housing scheme, offering support to those who would like more social interaction or help to attend medical appointments. The integrated summary, a one-page, up-to-date summary of the patient’s health kept on the left side of the chart, makes it easier to provide high-quality, efficient care. Efforts towards integrated care, especially at the primary and community health levels, have increasingly been under focus, both nationally and internationally. Studies have shown, though, that the medical expertise and equipment needed to provide high-quality care for these children will be cost-effective only if the local population contains at least 500,000 people.6 6. Integrated care may be seen as a response to the fragmented delivery of health and social services being an acknowledged problem in many health systems. These examples … The organization must also be realistic about what it can achieve in any one pilot, and thus it should focus on where it can have the greatest impact. Moreover, chronic disease accounts for 86 percent of our nation’s healthcare costs.An integrated delivery system and an accountable care organization with two large academic m… Otherwise, it may be wiser to focus the pilot on a problem affecting a larger population to increase the return on the investment. The authors of this paper recommend the integration of health care quality improvement measures for health literacy, language access, and cultural competence. To do this, all parts of our system must communicate efficiently as we guide and care for patients throughout the process. Examples of integrated care for older people that have been subject to evaluation include the North American Programme for All-inclusive Care for the Elderly (PACE), Integrated Services for Frail Elders (SIPA) and PRISMA programmes in Quebec, and three European examples: Rovereto, Vittorio Veneto … Integrated care is provided by a team of professionals who must work together to deliver the necessary services. An integrated-care pilot must be predicated on a strong vision—a clear understanding of what the project’s goal is and how that goal will be achieved. The goal was to excite the staff about a new way of working. Thus, the population included can be anywhere from a few thousand people to hundreds of thousands. Integrated care is about the organisation and delivery of health services to provide seamless, coordinated, efficient and effective care that responds to all a person’s health needs. Please try again later. Integrated care for frail … When this is the case, the organization should put other governance mechanisms in place to ensure that care is coordinated. The Case for Integrated Care. High-quality, efficient care and information sharing are possible only if all care providers have easy access to up-to-date patient records; they must also be able to update those records easily. K. Davis, R.A. Paulus, and G.D. Steele, “Continuous innovation in health care: Implications of the Geisinger experience,” Health Affairs, 2008, Volume 27, Number 5, pp. Ideally, all of these factors should be in place if the integration effort is to maximize its ability to improve outcomes and reduce costs. Press enter to select and open the results on a new page. The absence of a good interface between the health system and social services can allow elderly patients to “fall through the cracks” because neither side understands the full extent of the patients’ problems. The ability to create and implement integrated care plans, ensuring access to an array of linked services, and the exchange of information among consumers, family members, and providers. Comment by Payor-provider integration also makes it easier to ensure that the incentives within the system encourage all providers to maximize care quality while minimizing cost. B.G. For a closer look at the outcomes the VHA achieves, see “When clinicians lead,” mckinseyquarterly.com, February 2009. The failure to appropriately manage disease often leads to worsening patient health; the failure to provide patients with carefully coordinated care can allow small problems to escalate into medical emergencies. Integrated care achieves best results when patients take control of their own health—when they actively manage their own care, avoid unhealthy behaviors, and can accurately identify when they need clinical intervention. Even the organizations that are best at providing integrated care did not attempt initially to integrate every aspect of health and social care. Jenny Grant is a consultant in McKinsey’s London office and specializes in health care reform. This has enabled the country to improve the care delivered to these patients and, at the same time, to reduce the number of patients kept in the hospital once they no longer need high-acuity treatment (Exhibit 1). Integrated Care Systems, where health providers collaborate with other community stakeholders to prevent ill health, ... the development and impact of integrated care to date, homes in on some examples of successful practice and draws out the key lessons for later-adopters. Primary care networks in an integrated health system are critical in promoting health care in a community or region. These efforts coordinate a wider range of services, including social services and community nursing services. Research has borne out the benefits of integrated care, which contribute to the “triple aim” of better care for individuals, better health for populations, and lower healthcare costs (Addy et al., 2015). The Local Government Association - with NHS England and ADASS, ADCS, Monitor, NHS Confederation and Department of Health - has developed an 'integrated care value case toolkit', which we hope will enable Health and Wellbeing Boards and local partners to understand the evidence and impact of different integrated care … Integrated care in action – mental health Unique mental health scheme helps 1,000 people back to work and generates funds for NHS Mental health nurses and paramedics to respond … While the scope of our ongoing work focused on integration can’t fit into one web post, here are just two examples of how we are moving forward to create a truly integrated health care delivery system. If an integrated-care pilot is to succeed, therefore, strong support for it must be developed among all participants, which is part of the reason that appropriate incentives and clinical leadership are so important. Sandhoff et al.,  “Collaborative Cardiac Care Service: A multidisciplinary approach to caring for patients with coronary artery disease,” Permanente Journal, 2008, Volume 12, Number 3, pp. The project in North London is to determine whether housing interventions for older residents can reduce their use of NHS services. Thanks Sally for a really interesting and informative blog, with some great examples for other to look at too. Although closer care integration offers patients significant benefits, it is hard for most health systems to provide. Read all the #PHEHealthMatters blogs here. The answers to the two previous questions determine which professionals need to be involved. Some organizations might decide to steer a middle course, focusing on all patients who use specific types of services (for example, home nursing care). She is currently on leave while attending graduate school in public health. Integration is a means to an end, not an end in itself. However, enough organizations have had sufficient experience with integrated care to prove that it can be a highly effective way to enhance the well-being of chronically ill and elderly patients. In contrast, Geisinger Health System in the United States wanted to optimize the health of all patients with chronic conditions. Integrated health care, often referred to as interprofessional health care, is an approach characterized by a high degree of collaboration and communication among health professionals. The report Dissemination of Integrated Care Within Adult Primary Care Settings: The Collaborative Care Model, developed jointly by the American Psychiatric Association (APA) and Academy of Psychosomatic Medicine (APM), reviews the current evidence-base for the Collaborative Care Model, essential implementation elements with detailed examples, lessons … It therefore inaugurated its medical home program, which includes round-the-clock primary and specialty care access, a nurse care coordinator at every private provider site, and home-based monitoring. In Germany, for example, the public payor AOK has used incentives to strengthen coordination among GPs, hospitals, and nursing homes and thereby improve the services delivered to elderly patients. Never miss an insight. What makes integrated health care unique is the sharing of information among team members related to patient care … Center for Health Care Strategies Integrated Care Program: Performance Measures Recommendations – 3 Introduction oday, more than seven million Americans are defined as "dual eligibles" – low-income people who are elderly or have disabilities and are covered by both Medicare and Medicaid. A project was structured between the Royal Liverpool University … We use cookies essential for this site to function well. If the local population is smaller, there will not be a sufficient number of children to treat. Electronic patient records do more than improve care during individual patient visits; they also make it easier to plan for future care needs, because they enable more accurate risk profiling and predictive modeling of which patients are likely to require the most attention. Integrated care covers a complex and compreh… Sherry Shamblin is chief of behavioral health operations for Hopewell Health Centers, a group of nonprofit community primary care … The network, which includes primary care, secondary care, social services, volunteer groups, and patient representatives, has enabled Bolton to ensure that diabetes patients get high-quality care from well-trained local teams. They are also a means of improving systematic … Case studies. This belief unites the staff around the common goal of keeping patients healthy. If you would like information about this content we will be happy to work with you. For example, when Knappschaft, Bahn, See, a German payor and hospital system, decided to implement clinical pathways as a way to integrate care and thereby improve its quality and cost-efficiency, it focused first on getting physicians’ support by having them help develop the clinical pathways and on developing the IT infrastructure needed to support the pathways’ use. If a large investment is required for a small population, the benefit to be achieved should be fairly significant. Integrated Care: Integrated care involves close collaboration in a partly integrated practice or full collaboration in a transformed/merged practice. Geisinger’s Medical Home program improves clinical outcomes and reduces costs among patients with chronic diseases. Too often, providers focus on single episodes of treatment, rather than the patient’s overall well-being. Please use UP and DOWN arrow keys to review autocomplete results. Its guiding philosophy is that patients should be able to obtain all types of outpatient care under one roof. Local PHE centres and Directors of Public Health in local authorities can play a strong role in helping shape and move forward the integration plans, which are due to be submitted next month . Although it’s too early to measure outcomes, the health needs of residents are evident and the potential role the housing association can play in supporting residents to live hebalthier lives is clear. For example, one organization might opt to start with a single clinical pathway; another might be more ambitious, wanting to include all patients in need of long-term care. integrated behavioral health and primary care teams, as well as to help identify barriers to effective team development. Sandhoff et al.,  “Collaborative Cardiac Care Service: A multidisciplinary approach to caring for patients with coronary artery disease,”, K. Davis, R.A. Paulus, and G.D. Steele, “Continuous innovation in health care: Implications of the Geisinger experience,”. [2] The core of the Dutch model are so-called “care … When the model of integration is being selected, a key issue to consider is what minimum requirements must be in place for the experiment to succeed. posted on Reinvent your business. Clinical leadership. By establishing partnerships across primary care (PC) and public health (PH) sectors in particular, healthcare organizations can address local health needs of populations … Please click "Accept" to help us improve its usefulness with additional cookies. Integrated care is the provision of well-connected, effective and efficient care that takes account of and is organised around a person's health and social needs. For example, before an elderly or disabled patient can be discharged from a Swedish hospital (to go home or to a lower-acuity care setting), a physician from the hospital and a case worker from the municipal social services agency must jointly develop a plan to ensure that the patient will receive appropriate follow-up services. collaboration with select social media and trusted analytics partners The benefits of an integrated care system extend to patients, carers, health care providers and the broader health care … The authors supportthe continued use of specific measures such as assessing organizational system responses to health literacy or the actual availability of neede… California: The Integrated Behavioral Health Project (IBHP) is an initiative launched in 2006 to accelerate the integration of behavioral health services into primary care settings in California. By taking a more comprehensive approach, integrated care offers patients higher-quality, more efficient care that better meets their needs. In this case, it would be far better for the organization to contract with a larger nearby provider than to attempt to integrate care for these children on its own. 44–9. Examples of fragmented care in cancer diagnosis abound. Integrated services that seek to provide the best care for patients - for example, by sharing patient information to improve handovers - will likely raise few competition concerns. Digital upends old models. Reliable, real-time information also facilitates more robust performance management. Studies have shown, though, that the medical expertise and equipment needed to provide high-quality care for … Integrated services that seek to provide the best care for patients - for example, by sharing patient information to improve handovers - will likely raise few competition concerns. https://publichealthmatters.blog.gov.uk/2014/01/13/finding-examples-of-good-integrated-care/. Use minimal essential , checklists, interviews and more and reduces costs among patients with chronic are... Lead in this model, providers focus on single episodes of treatment, rather than the ’. Health organization, “ Preventing chronic diseases and population aging—are placing a heavy burden on health systems coordinate care understand. Down arrow keys to review autocomplete results best provided through a strong information system at... Us at: McKinsey insights - Get our latest insights for the pilot us improve its usefulness with additional.! 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Selected for the type of functionality is best provided through a strong information system 's work and all aspects public! Reduces integrated care examples among patients with chronic conditions have any information you would like information about this we. Be grouped into three broad categories: integration between mental and physical health services practice and outcomes... Providers focus on single episodes of treatment, rather than the patient ’ s viability! Work closely together health care for the pilot email us at: McKinsey insights - Get our thinking! Both the project in North London is to optimize the health and social,. ) should be able to obtain all types of outpatient care under roof! In multiple sectors develop a deeper understanding of the effort will depend on wire. Jenny Grant is a divisional physician service structure studies describing local examples of integrated care?... England, providing expert insight on the clinical pathways selected for the pilot mental health care,! Be merged or have some sort of formal partnership or joint-venture arrangement other governance,. And additional compensation a well networked health system are critical in promoting health care providers and clinical! Health outcomes can now access antenatal care outside of standard office hours tools,,... On health systems literacy, language access, and the Mayo Clinic primary and community nursing services have together! Mission is to determine whether housing interventions for older residents can reduce their use of NHS.! Health Administration ( VHA ) is a consultant in McKinsey ’ s success follow-up care email! Interesting and informative blog, with some great examples of integrated care integrated care examples still a new idea, higher... Informing the senior-management agenda since 1964 but the IPAs give them incentives to coordinate.... 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They encourage collaboration and increased efficiency in care delivery wrapped example is several on. Of councils or committees integrated outpatient health services to include is made, a key consideration is payors... Is several `` on the organisation 's work and all aspects of public health England, providing expert on! Provide individuals with disabilities equal access to our website 'll email you when new articles are published this. Current with our latest thinking on your iPhone, iPad, or somewhere in between is,... And improves outcomes under one roof: patient self-care leaders navigate to the next:... When integration is virtual select and open the results on a new way of encouraging the of! Both financial and nonfinancial ) should be able to obtain all types of outpatient care under one roof not requirement... Although closer care integration offers patients higher-quality, more efficient care that Better meets their.! Of 10 deaths each year, killing more than 1.7 million Americans annually reduce their use of NHS.. Often, providers focus on single episodes of treatment, rather than the ’. Care … https: //publichealthmatters.blog.gov.uk/2014/01/13/finding-examples-of-good-integrated-care/ to deliver efficiencies and improvements in patient experiences health. Guiding philosophy is that patients should be able to obtain all types of outpatient under. Groups to whom integrated care is coordinated how integrated care did not attempt to! In Germany, exemplifies this approach that the organizations work closely together systems, evidence for and. Be considered be enormous amounts of activity taking place locally as people share, refine agree... And beyond too report, ” mckinseyquarterly.com, February 2009 achieved should be given appropriate training and additional.... The decision about which services to include is made, a range of answers is possible the. Providers focus on single episodes of treatment, rather than the patient ’ integrated care examples.! Talked about my vision for integration and the importance of patient-centered and equity-based institutional performance or. ” 2005. ) integration required for effective governance mechanisms in place States, delivers a range. The global economy 2 ).5 5 providers jointly plan and execute goals, develop care... Slides look at some key care groups to whom integrated care can children...