Around the world, only a few health care providers deliver integrated care effectively. Their experiences offer useful lessons for organizations that want to pilot integratedcare programs.
What does it take to make integrated care work?
Two interrelated factors—the growing prevalence of chronic diseases and population aging—are placing a heavy burden on health systems. In all parts of the world except Africa, chronic diseases are by far the leading cause of death and disability, and they now account for 75 percent of global health care spend (an amount that is likely to increase in coming years).1 Furthermore, in almost every country, the proportion of people age 60 or older is growing far faster than any other age group, a result of both longer life expectancy and declining fertility rates.2 As people grow older, they are more apt to suffer from chronic diseases, but aging alone can increase their frailty—and their need for health care. If the health care needs of the chronically ill and elderly are not adequately addressed, the consequences for both patients and health systems could be severe. The failure to appropriately manage disease often leads to worsening patient health; the failure to provide patients with carefully coordinated care can allow small problems to escalate into medical emergencies. Both scenarios can result in unnecessary hospitalizations, increased mortality, and higher health system costs.
system and social services can allow elderly patients to “fall through the cracks” because neither side understands the full extent of the patients’ problems. Care fragmentation also frustrates patients, who find it difficult to navigate among the various providers and often feel that there is no one person who can help them get all essential services. Although closer care integration offers patients significant benefits, it is hard for most health systems to provide. To date, only a few organizations around the world have found ways to integrate care effectively and thereby offer the coordinated management that chronically ill and elderly patients require. We have spoken with these organizations (individually and in panels) to learn from their experience and identify best practices. In this article, we have summarized our findings as a way to help other groups that want to pilot or improve their integrated-care programs. What integrated care is—and is not Integrated care brings together the different groups involved in patient care so that, from the patient’s perspective, the services delivered are consistent and coordinated. Too often, providers focus on single episodes of treatment, rather than the patient’s overall well-being. By taking a more comprehensive approach, integrated care offers patients higher-quality, more efficient care that better meets their needs. In many cases, the increased efficiency also helps control costs. Different approaches have been used to integrate care, but they share this trait: they design all stages of care delivery around what is best for patients. The approaches can be grouped into three broad categories:
1Even within Africa, chronic
diseases are becoming an increasingly common cause of death and disability, but they still rank second to the acute health problems of the poor, such as communicable diseases, maternal and perinatal conditions, and nutritional deficiencies. (Source: World Health Organization, “Preventing chronic diseases: A vital investment: WHO global report,” 2005.) 2United Nations, “World
Although the consequences of providing inadequate care to these groups are well known, most health systems have found it difficult to address their needs appropriately, in part because care delivery is often fragmented. Poor communication between general practitioners and specialists, for example, can hinder effective chronic disease management; some components of care may be duplicated,...