The Shift to Coordinated Care

May 25, 2018 Dealla Smith

There is a fundamental shift going on in the healthcare industry, from acute in-hospital care to coordinated care in the community. This blog series looks at the factors that influenced this change in approach to healthcare, and how an integrated technology platform can help transform care delivery and health outcomes.

There is a popular saying, “You can’t put a price on good health”. Anyone who has ever had a serious illness compromises their quality of life will tell you that. The reality, however, is that high-quality healthcare costs money. Whether it be the government, the individual or the health insurer, someone at some point must pay for a person’s healthcare costs. 

One would expect, therefore, that the higher the financial wealth of the country, the healthier its population. But what if the root of the problem is not something that can be cured purely with financial investment? The argument that health follows wealth is being challenged and it is becoming clear that a broader definition of a society’s wealth is required in order to understand the link between health and wealth. 

Research shows that although people in countries with higher levels of Gross Domestic Product (GDP) per capita will live longer and enjoy better health outcomes compared to people in countries with a lower GDP per capita, the correlation disappears in comparisons between multiple countries with high GDP per capita. Added to this, countries with higher GDPs still have a ‘health gradient’, meaning those with higher incomes and wealth live longer healthier lives compared to those less well-off.  

Interestingly, more egalitarian, high-income countries achieve better health outcomes compared to those wealthy nations that have high levels of income inequality. For these countries, additional factors have a more dominant influence in the relationship between wealth and health, and our healthcare systems must take these into account. 

The causes of health gradients and health inequalities within countries have been subject to extensive research. It has been proven that the less well-off in society tend to exhibit higher rates of unhealthy lifestyle behaviors such as smoking, poor nutrition, obesity, alcoholism and sedentary lifestyles, which in turn lead to poorer health outcomes and higher rates of cancer, heart disease, COPD, mental illness, and diabetes. This begins to explain the poorer health outcomes experienced by the most disadvantaged in society and provides useful targets for public health interventions. 

Personal lifestyle choices are only part of the equation. There are other social determinants of health, many of which are influenced by national laws, policy, taxation, redistributive policies and education. 

More recent studies show that an increased risk of cancer, cardiovascular disease, diabetes, and depression can also have a more insidious cause. They can be the direct result of chronic stress and heightened social evaluative stress – the stress of being judged by others. Long-term exposure to stress hormones results in inflammation and immunological dysfunction, while psychosocial disruption can upset the behavioral systems. This suggests a whole raft of other support structures are required to bolster good health in affected communities. Population health management becomes a social as well as medical issue. 

To tackle this, the healthcare system needs to provide a more holistic approach to care and move out of the hospital and into the community, linking up with social support groups to address the diverse roots of health issues, be they as straightforward as poor nutrition and smoking addiction, or as complex as inherited stress disorders. This new ‘integrated care’ model creates added complexity and requires the coordination of services across multiple organizations, providers, community and social services so they can collaborate, proactively manage care and take preventative action.

Part two of this blog series will look at the holistic approach to healthcare and how it can transform reactive care into preventative care. To find out more, read our White Paper here.


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