“Integrated” is a word that has lost much of its meaning. Same location? Same clinical team members? Same medical record? Shared medical information? Shared financing? When planning strategy (and doing contract negotiations), you need to ask for a definition if you have any hope of developing something tangible (see What’s In A Word? A Lot, If That Word Is “Integrated”).
That issue of definition of terms has reappeared again—this time the issue is distinguishing between the terms “collaborative care” and “integrated care.” A recent article by the Center for Psychology and Health, and published by the APA Practice Organization (see Collaborative Care And Integrated Care: What’s The Difference?) spells out the problem, noting:
You may have heard or used the phrase “collaborative care” to describe an integrated approach to delivering health care. Payers, insurers and other clinicians, however, may confuse your practice with the American Psychiatric Association’s “Collaborative Care Model” or CoCM. Because the CoCM is a specific framework, the American Psychological Association and the Practice Organization encourage psychologists to use the term “integrated care” to describe how psychologists work in collaborative environments.
The main message here is that “collaborative care” is now being defined by a specific model within the larger set of options for integrated care delivery. The “Collaborative Care Model” from the American Psychiatric Association is defined as a team-based model of care in which a primary care physician leads a team of “care managers, psychiatrists, and frequently other mental health professionals all empowered to work at the top of their license. The team implements a measurement-guided care plan based on evidence-based practice guidelines, and focuses particular attention on patients not meeting their clinical goals” (see What is the Collaborative Care Model?).
What is the range of models that “integrated care” has come to mean? As the saying goes, “when you’ve seen one integrated model, you’ve seen one.” Some are service delivery and some are care coordination; many are variations within that. According to work done by The SAMHSA-HRSA Center for Integrated Health Solutions (see Integrated Service Delivery In One Chart: Six Levels Of Collaboration), there are six levels of integrated service delivery.
- Level 1 — Minimal Collaboration
- Level 2 — Basic Collaboration at a Distance
- Level 3 — Basic Collaboration Onsite
- Level 4 — Close Collaboration with Some System Integration
- Level 5 — Close Collaboration Approaching an Integrated Practice
- Level 6 — Full Collaboration in a Transformed/Merged Practice
And, the World Health Organization also identifies four elements for integration—organizational, functional, service, and clinical (see Integrated Care Models: An Overview). I would add that this framework is missing two other types of integration—consumer-centric information integration and financial/financing integration.
Typologies Of Integration
|Organizational||Integration of organizations are brought together formally by mergers or through ‘collectives’ and/or virtually through coordinated provider networks or via contacts between separate organizations brokered by purchaser|
|Functional||Integration of non-clinical support and back-office functions, such as electronic patient records|
|Service||Integration of different clinical services at an organizational level, such as through teams of multidisciplinary professionals|
|Clinical||Integration of care delivered by professional and providers to patients into a single or coherent process within and/or across professions, such as through use of shared guidelines and protocols|
This framework includes a wide array of integrated care delivery models (from individual care plans to chronic care models) and integrated care coordination models (from case management to patient-centered medical homes).
So what does the future hold for these many models? I think there are a few key developments that we can count on shaping “integration” in the months and years ahead.
- Regardless of the specific model, telehealth technologies will continue to increase for consumer and professional consultation—in both service delivery and care coordination—for reasons of consumer convenience and cost reductions.
- Declining rates for care coordination will force new and innovative uses of both passive data collection and “big data” algorithms to identify early intervention opportunities.
- The expanding footprints of retail clinics will challenge the concept of primary care—in terms of both the desire for service co-location and the loci for care coordination.
The “right solution” might be integrated, or coordinated, or collaborative, or any other number of models—but the key to success in this market won’t lay in picking the “right” care coordination model. It will be in finding innovative ways to coordinate care through new partnerships and new technologies, and building a sustainable business model around that model of integration. For more, check out these resources from the OPEN MINDS Industry Library:
- Whole Person Care Takes Another Step Forward
- Payer, Provider, Partner
- Success With Care Coordination? Bringing Order To Complication
- Planning For Turbulence – A Case Study
- From Specialist To Full-Service Health: A Transmogrification
For more, join us on June 6 in New Orleans for The 2017 OPEN MINDS Strategy & Innovation Institute, where Athena Mandros will present “The Return On Investment Of Health Homes & Medical Homes.”