Integrated Healthcare Models: Benefits, Strategies and Importance

Introduction

There is little incentive for different healthcare providers to work together towards a common goal in the current healthcare setup. The ineffective use of information communication technology in healthcare is a further barrier to integrated care, with inadequate information sharing between providers and between different health settings.

These, and other factors, contribute to the inefficient use of health resources, which results in an increasing number of hospital admissions and readmissions that can be prevented with effective care in the community.

Coordinated care initiatives have typically relied on case management/care coordination roles and disease-specific funding for small-scale projects. This has resulted in fragmented funding that does not address the lack of integration between different healthcare providers and health settings.

The expansion of the aged care and disability sectors, along with initiatives such as Health Care Homes and the National Disability Insurance Scheme, will further increase the complexity of healthcare funding and service delivery. Now more than ever, there is an urgent need for a system-wide approach to funding and delivering coordinated care.

The challenge of chronic disease, with the aging population and increasing incidence of conditions such as diabetes and heart disease, has led to the recognition that our health system must be more effective in managing patient care across the continuum of health settings.

Coordinated care is the key to managing patients with complex healthcare needs, and yet our current health system struggles to deliver this effectively. Primary and secondary care are often poorly integrated, with ineffective communication between providers.

Benefits of Integrated Healthcare Models

Access to care is a valued attribute of integrated healthcare models. First, it is widely considered that integrated healthcare systems produce greater access to healthcare. With many programs, there are specific vulnerable groups the integrated model aims to target, such as low-income, elderly populations or people with chronic conditions.

What is integral to this strategy is using tailored interventions to help these groups get access to care. Tailored interventions can include educating clients on the availability of specific services in the community and using a case manager to act as a facilitator in getting clients the care they need.

Some of the benefits of using an integrated healthcare model include::

• Holistic Patient Care: Integrated healthcare models facilitate a comprehensive approach to patient care by connecting different healthcare providers and services. This coordination ensures that all aspects of a patient’s health—physical, mental, and social—are addressed efficiently. For example, a primary care physician can easily collaborate with specialists, nurses, home health aides, therapists, and social workers to create a unified care plan tailored to the patient’s needs.
• Improved Care Coordination: Integration promotes better communication and collaboration among healthcare providers, reducing duplication of services and minimizing gaps in care. For patients with complex conditions or multiple chronic illnesses, streamlined care coordination ensures that they receive the right services at the right time from the right providers, leading to more effective treatment and management.
• Enhanced Patient Experience: Integrated healthcare models often result in a smoother, more seamless patient experience. Patients benefit from simplified appointment scheduling, centralized medical records, and shared decision-making among their healthcare team.
• Cost Savings: By reducing unnecessary tests, visits, and procedures, integrated healthcare models can help control healthcare costs. Additionally, preventive services and early interventions can reduce long-term healthcare expenses.
• Better Population Health Management: Integrated models support population health management strategies by enabling healthcare providers to analyze and address health trends and outcomes across a defined group of patients. With integrated data systems, providers can identify at-risk populations, implement targeted interventions, and measure the effectiveness of public health initiatives.
• Support for Value-Based Care: Value-based care models, which emphasize patient outcomes rather than the volume of services provided, align well with integrated healthcare approaches. Integrated models encourage a focus on quality, efficiency, and patient-centeredness, which are key principles of value-based care.

Strategies for Strengthening Integrated Healthcare Models

• Interprofessional Collaboration

It is becoming increasingly more important for healthcare professionals to work as a team to improve patient outcomes. Healthcare is continuously becoming more complex, costly and dynamic because of advances in technology, new emerging diseases, drug treatments, and research. It is nearly impossible for a healthcare professional to keep updated on all the new information, and therefore working in isolation from other professional groups is no longer feasible if quality patient care is the goal.

• Technology Integration

Integration of health IT systems across integrated organizations is essential to the efficient working of organizations. The ability to access the same information at the same time is a fundamental benefit IT can bring to integrated care. EHR systems, if utilized effectively, could ease this process, with secondary care information made readily available to primary care providers. Immediate access to accurate patient information, with systems such as single patient identifiers, could also improve the safety and quality of transitions between care settings.

• Standardization of Protocols and Procedures

A protocol is a design or plan for a system of making or doing something, whereas a procedure is a particular way of accomplishing something. Protocols and procedures are integral parts of the health system that have a direct impact on the goal of improved health.

Most of the time, healthcare providers are faced with the divergence between two things: following evidence-based optimal protocols and procedures, and what is feasible in the real world.

Most health systems today have homegrown and disparate sets of protocols and procedures, including the use of diaphragm valves to ensure that medications are produced in a sterile environment.

The wide variability in protocols and procedures from one health setting to the next is a key driver of higher cost and less-than-optimum health outcomes

• Continual Education and Training

Hospitals and health services cannot expect staff to make the shift from professional isolation to team-based care without providing them with the necessary education and training.

The education for staff needs to include background material that helps them understand what integrated care is and why it is needed. This will require resources in the form of written material, seminars, or professional development days.

Eventual success may be in tailoring the training programs specifically to the different professions in healthcare and providing ongoing feedback and improvement processes.

Challenges in Implementing Integrated Healthcare Models

Fragmented efforts toward integration should be acknowledged and avoided. An especially problematic form of fragmentation occurs with “parallel structures”, where separate units for mental health, general health, and substance abuse treatment, for example, lie next to each other, often with separate administrative staff. When resources are tight, there can be a tendency to siphon human and physical capital from the existing programs to create new ones.

A significant barrier to integrated care lies in the area of financing and cost-shifting. The reality of scarce resources necessitates creative accounting to make ends meet. In the short term, cost savings from integrated care will not materialize until reinvestment is made. For example, a community mental health clinic that does an excellent job in managing and preventing diabetes will not realize the savings of reduced medical care for 5-7 years.

A storm of increased demand and decreased resources leads many safety net providers to engage in harmful cost-shifting practices, whereby services to vulnerable groups are discontinued or diluted as providers compete for more lucrative service contracts.

• Financial Barriers
  Current methods of payment to healthcare organizations and physicians have caused it to be difficult for integrated healthcare organizations to compete with others. Due to global budget restrictions, health organizations are financially capped and have inadequate funding for proper equipment and resources. This can be problematic if one organization within a network is assigned the care of a certain population and has limited resources to achieve this.

• Legal and Regulatory Hurdles
  Healthcare integration efforts are often impeded by the legal and regulatory environment. Inflexible or incompatible regulations and laws can obstruct the formation of integrated programs and can be costly and time-consuming to resolve. For instance, states may have differing scope of practice regulations that disallow clinicians from practicing to the full extent of their training, and Medicare has very strict regulations about the circumstances under which services can be provided on a telehealth basis.
• Resistance to Change
  Healthcare is inherently conservative, particularly in the realm of provider organizations. There is a prioritization of providing the best patient care as it is not only the foundation of a successful health service but is also ethical. Integrated healthcare models can sometimes be seen as disturbing this foundation for many healthcare providers.Change disturbs patterns of practice and many healthcare professionals believe that their existing practices are the best for their patients. Integrated healthcare models often require health provider organizations to change the way they currently do things, be it resource allocation, service provision or retraining of staff, hence this resistance to change.

In Conclusion

Strengthening integrated healthcare models should be the order of the day for those responsible for designing and managing healthcare services. The case for continuing to strengthen integrated systems of the entire health value chain is supported by findings in various health services research.

Potential data sources for testing integration hypotheses include global budgets that expose all forms of patient and population-oriented resource allocation, data on transactions between component services of a system, and comparative data on outcomes and costs of care for defined populations served in different manners by similar or different integrated systems.