In today’s healthcare climate, policy makers are looking for ways to create a more efficient and effective integrated healthcare delivery systems.
We have Accountable Care Organizations that are trying to pull partners together to hold each other accountable for the quality and cost of the healthcare they deliver in return for financial incentives.
We have Health Homes that are working towards providing more comprehensive care management, coordination, transitional care, and follow-up across communities.
At the heart of both these healthcare efforts is the attempt to combat fragmentation, the primary driver of healthcare inefficiency and ineffectiveness. Fragmentation drives cost and ultimately makes it harder for patients to receive the care they deserve.
Consider that the more complicated your health problems, the more fragmented your care will healthcare will be.
And what about the patient? From the British Journal of General Practice: “Elevating the patient to prominence within health care is fraught with complications that often have more to do with the US’ historical healthcare fragmentation than the desire to have patients more involved.”
However, nowhere is there a better possibility to address patient-centeredness, efficiency, effectiveness, and fragmentation than in the separation of the “mental” health system from the “physical” health system.
Creating an integrated healthcare system
Despite decades worth of research showing the inseparability of the two, we continue to think that they are indeed separate.
Consider that “physical health and mental health are inextricably linked. Action is needed to improve the physical health of people with mental health problems, and to make mental health a key public health priority.” The same can be said for individuals who present with physical health problems who have unrecognized and undiagnosed mental health conditions; something must be done to better integrate our thinking around health and the care that we deliver.
Another way to conceptualize integrated healthcare is as follows:
“Integrated health care, often referred to as interdisciplinary health care, is an approach characterized by a high degree of collaboration and communication among health professionals. What makes integrated health care unique is the sharing of information among team members related to patient care and the establishment of a comprehensive treatment plan to address the biological, psychological, and social needs of the patient. The interdisciplinary health care team includes a diverse group of members (e.g., physicians, psychologists, social workers, and occupational and physical therapists), depending on the needs of the patient.”
But no matter how you define it, at the heart of strong integrated healthcare is the need for a good comprehensive team. If we are to start combating fragmentation, we have to start better working together in teams. Nowhere is this more evident than in primary care, where more patients are seen than in any other healthcare setting.
And team-based integrated healthcare works.
So much so that some insurance companies have started adopting models of integrated healthcare that incorporate mental health providers into primary care to create these multidisciplinary teams.
However, “team-based primary care offers the potential to dramatically improve the quality and efficiency of care, but its broader adoption is hindered by an education system that trains health professions in silos. Collaborative models that educate multiple practitioners together are needed to create a new generation of health professionals able to work in efficiently functioning teams. Changes in professional cultures, organizational structures, clinical partnerships, admissions, accreditation, and funding models will be required to support the expansion of collaborative education effectively.”
As we have discussed on this site previously, there are four main points we always must consider to create a more comprehensive integrated healthcare system (clinical, operational, financial, and training and education); these must not be forgotten.
Will we ever achieve a truly integrated healthcare system that pays no attention to the historical separation of things like the mind and the body?
Will we ever achieve a truly integrated healthcare system that places the patient at the center of the team and surrounds that patient with all types of healthcare providers there to work with them on whatever they may need?
Integrated healthcare, in all its various forms, will become reality.
Our system cannot sustain its current trajectory from a cost and effectiveness perspective nor from a patient and provider satisfaction perspective.
One opportunity to learn more about integrated healthcare is from the Collaborative Family Healthcare Association (CFHA). CFHA is a national not for profit association committed to patient and family-centered integrated healthcare.
CFHA “envisions seamless collaboration between psychosocial, biomedical, nursing, and other healthcare providers, and views patient, family, community, and provider systems as equal participants in the healthcare process. This approach is a radical departure from conventional “diagnose and refer” models and is distinctly different from the usual managed care approaches. It recognizes that clinical events always occur at biological, psychological and social levels, and that patient, family, and community levels represent integrated elements of a single ecosystem.”
Their upcoming conference title is “The future of integrated healthcare: Activating clinicians, consumers, researchers, and policy makers”. (disclosure – author is the president of the board this year).
In summary, we do need a radical departure in healthcare that takes us far away from a delivery system of the isolated provider to a more truly integrated healthcare delivery system that works in teams and focuses on the whole person, not just parts.