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Full reference:

Moses, H., Matheson, D. H. M., & Poste, G. (2019). Serving Individuals and Populations Within Integrated Health Systems. JAMA.



 This week’s blog is brought to you by: Dr Tim Wilson

Authors conclusion

“Despite their successes, a central question is whether the IHS model can meet the needs of all patients, particularly the aging population or patients with chronic illnesses who now account for 84% of health care spending and whose numbers are projected to triple by 2040”

3VH – Implications for value

This article takes a look at integrated care in the US and contains many lessons for health services internationally.

The first, unintended, lesson is that when communicating about complex health issues, it is critical to be clear precisely what is being discussed. The meaning of Integrated Care means many things to many people, so it is worth having a shared glossary. It could mean how care is delivered (integrated care delivery); or describe an organisation that is structurally integrated (integrated care organisations- ICS); or it could mean a set of connected activities that work in an integrated manner towards a common goal (an integrated care system). In this paper, the authors talk about integrated health systems, but are probably talking about integrated health organisations. The difference is important as structural change leading to integrated organisations are far less likely to lead to value improvements than integrated systems.

Second, the paper implies that there are for different types of care for primary through to quaternary care- the classic levels of care- and wonders whether integrated care organisations can cater for all of them? This misses the role of self and informal care, and from the perspective of the people with a condition, the likely need for care from multiple levels within a system. So, whilst market forces may have driven a form integration focussing on levels of care in the US, from the perspective of a people with a common need within a population, integration of levels of care, including self and informal, would seem a prerequisite.

Third, the authors highlight that integration is up against considerable forces that need to be overcome- chiefly culture and values.

“To be successful, an IHS model must address factors that have been overlooked or for which their importance has been minimized. In particular, using financial incentives and disincentives and control of information to change attitudes and culture have not proved to be effective because of attitudes deeply embedded in institutional cultures and professional norms. Consequently, those values must be accorded higher importance, changes for which there is no single formula.”



Integrated care – System, Network and Pathway