Achieving Integrated Care as the Foundation of Population Health Management
We all lead busy lives, with stresses and strains that pepper our days and weeks—some of us are working parents, some have elderly relatives to care for, and all of us have personal challenges to deal with. A conversation with one of my colleagues before the holidays got me thinking about this last point.
She was describing the challenges of working full-time with two young children, but then caveated her complaint as “nothing compared to what my best friend has to deal with.” Her friend has Type 1 diabetes (only developed in her 20s, which is rare). She deals with multiple specialists to help manage her condition—her PCP, endocrinologist, physician, diabetes nurse specialist, cardiologist, podiatrist, eye specialist, and dietician, not to mention the specialist diabetes clinic she visits to check the operation of her insulin pump.
While each of these specialists shares information in the old-fashioned way—by faxing and emailing notes—it’s a very manual process that leaves gaping holes. And at no point is any real-time data captured about my colleague’s friend’s fitness regime or the stresses she faces caring for two young children—without any family support—while managing her condition. “Managing diabetes is a full-time job,” says my colleague.
She was describing a situation that demands the need for Integrated Care. That’s a phrase you would no doubt have routinely encountered – but just what is Integrated Care, and perhaps more importantly, why is it important?
The ‘textbook’ definition of Integrated Care is a more coordinated and integrated form of care provision. What that means in practice is that Integrated Care is information-driven, addressing the needs of the population through innovative solutions. It upends the traditional healthcare delivery model, which centres on individual clinical disciplines performing tasks in isolation, to vertically integrate systems to provide a single, holistic view of the patient to any clinician who treats that person.
The current structure of health care delivery has been sustained for decades by a number of mutually reinforcing factors: siloed primary care practices; measurements of “quality” defined and incentivised as process compliance; care delivery systems with duplicative service lines and little integration; fragmented patient populations; and all underscored by siloed IT systems with little or no sharing of information. These, along with a number of driving factors are creating a shift towards integrated health systems;
Per capita healthcare costs. Globally, health systems are reaching a breaking point because of burgeoning costs. Health expenditure per capita in the U.S. sits at US$9,146, one of the highest in the OECD. This compares with US$5,718 per capita in Canada, US$5,827 in Australia, and US$3,598 in the U.K. In the U.S., as in other parts of the globe, a fundamental shift in emphasis from acute in-hospital care (which is costly and not very efficient) to coordinated care across the community is required. More than this, the focus must shift from reactive to preventative care—identifying signs of chronic conditions well in advance of them developing and putting in place plans for prevention. Yet, to date, health systems globally have been slow at investing in the building blocks to implement transformative change.
Ageing population. Population ageing is accelerating worldwide. On average, life expectancy is projected to increase from 72.3 years in 2014 to 73.3 in 2019, which would bring the number of people over 65 to more than 604 million, or 10.8 percent of the total global population. An ageing population places additional burdens on a country’s healthcare system, but not only due to the increased demand for services that are the result of chronic conditions. Increasingly, active, well-informed, affluent seniors are demanding new healthcare services, drugs, and technologies to prolong their good health.
Increase in chronic conditions/disease. Globally, obesity, cardiovascular diseases, hypertension, mental health, and dementia are becoming persistent, widespread health problems and are challenging public health systems to meet increasing demand for medications and treatments. The Deloitte 2015 healthcare outlook for Australia provides some insightful facts: coronary heart disease (CHD) was the leading underlying cause of death for both males and females in Australia in 2011, accounting for 15 percent of all deaths. Three- quarters of these were deaths in people aged 75 and over; just five percent were deaths of people under the age of 55. Cerebrovascular disease (e.g., stroke) is the second most common underlying cause of death in Australia, accounting for eight percent of all deaths in 2011. Stroke deaths increase greatly with age, with 82 percent of deaths occurring in people aged 75 or over in 2011. Dementia (including Alzheimer disease) and lung cancer were the third and fourth most common underlying causes of death7.
Growing consumer demands. Consumers also have a big part to play in the drive for Integrated Care. Today’s consumers are used to having information at their fingertips. In this connected world and smartphone ecosystem, we’re never more than a few seconds from our banking information, chat conversation with friends, or checking our flight schedule. Increasingly, consumers are defining their ideal healthcare experience to be more like what they experience from other industries. They want more than a traditional patient-doctor experience—they expect convenience, amenities, service, and access to their own healthcare information. They want digitally connected health with access “anytime and anywhere.” Consequently, insurers and healthcare providers are evolving their offerings, and focusing on consumer engagement strategies, cost transparency, and improved service/product quality. Changing consumer attitudes and behaviours are prompting sector stakeholders to invest more in new and expanded customer engagement capabilities.
There are two additional key drivers for integrated care—financial and legislative—which I’ll examine in my next post.