Researchers have identified seven components that are instrumental in working towards improved systems integration and controlling healthcare costs incurred through chronic disease management.
Depending on what source you review, the precise definition of clinical integration may slightly vary, but the following definition from the American Hospital Association gives a broad enough scope as to what Integration entails:
The definitions [of clinical integration] generally focus on efforts that involve collaboration among different health care providers and site to ensure higher quality, better coordinated, and more efficient services for patients.
The business of healthcare today is working to appropriately manage chronic conditions like asthma, diabetes and heart disease.
It is estimated that up to 75% of healthcare expenditures are consumed in the care of chronic conditions. The care for these individuals tends to be fragmented across multiple providers and specialties.
The transition to value-based payment models is intended to improve care coordination, quality, and efficiency by attaching incentives for improved management of a patient's continuum of care.
Kizer et al, elaborate on the components needed for clinical integration as a cornerstone for population health management. Organizations and health systems will need to integrate clinical services across providers, care settings, conditions, and time.
In their review of integrated health systems, they found the following seven characteristics as necessary components in the achievement of integrated care.
There is no one integration model that has clearly shown to be superior when compared to others. The goal of achieving improvement in the areas of cost and quality rely more so on the strength of clinical leadership and an organization's commitment to continuous improvement.
The organization's culture is the ultimate driver for the achievement of results. Within institutions culture is a dynamic, living, and breathing entity that is continually being sculpted. Thus, it will take patience and years of focused effort.
The Journal of Health Organization and Management has defined sustainable culture as the values, beliefs and assumptions that comprise an organization that are embedded for the long term with members of an organization.
As healthcare is quite complex with challenges that range from the social to the technological. There are many factors that are at play from health IT, clinical complexity, personnel moral, workflow, effective communication or its absence, internal rules, all the way to mounting external regulations that all make it difficult to address.
A look at an outside industry that adheres to high levels of complexity and safety may offer suggestions for health care culture as well.
Research looking at the avalanche professionals that constantly work in high-risk conditions found that,
“[these] workers have a high level of self-efficacy independent of management, indicating that their professional and personal skills can be enhanced where management recognizes and rewards independent behavior…”
This draws quite similar parallels with the environment in which we find ourselves in healthcare, and deservedly has to be taken into account given the high caliber of workers within complex systems. As step six suggests, accountability is what is needed as it supports the necessary level of self-efficacy that translates into sustainable culture.
Sources:Kizer et al, Clinical Integration: A cornerstone for population health management. Journal of Healthcare Management. 2015American Hospital AssociationJournal of Health Organization and Management