Health Policy February 18, 2019
Integrated care

By Dr Anna van Poucke - World Healthcare Journal

Integrated care, with a focus on primary care, is a key component of building sustainable healthcare systems

As the Global Care System Redesign (CSR) network lead, my passion is to promote healthier, longer lives, by working with our clients to improve their services and focus on population health outcomes.

Changing demographics, along with the increased prevalence of complex conditions and multimorbidity, are leading to changing patient profiles, which are putting stress and strain on outdated models of care in many countries across the world.

Our global experience at KPMG has shown us that to create a sustainable health system you need to focus on the triple aim of improved health outcomes for a local population, improved quality of care and lower costs. By doing this you can deliver long-term system sustainability (e.g. financial sustainability and efficient use of resources).

“Too often, providers focus on single episodes of treatment, rather than the patient’s overall well-being”

In our approach, we help our clients to design new integrated networks and models of care that meet the needs of their local population. We also work with our clients to help them understand how these can be implemented pragmatically and affordably to drive improvement goals and achieve better health, better care, and better value.

From my experience, there are nine key traits that describe ‘what good looks like’ for an integrated care network/system. See Figure1.

Figure 1. CSR Integrated care networks (ICN network).
 

Integrated care

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.

Figure 2. King's Fund Integrated care model

Some forms of integrated care involve local authorities (e.g. social care) and the third sector (voluntary and charity sector) in working towards these objectives, alongside healthcare. The most ambitious forms of integrated care networks and models aim to improve population health by tackling the causes of illness and the wider determinants of health.


Evidence supporting the investment in primary care shows that:

  • Treating patients in primary care settings is much cheaper than hospitals.
  • Primary care is better placed to address chronic health problems early and to prevent minor conditions progressing into serious ones (e.g. diabetes, obesity and CHD).

  • Primary care helps to navigate patients through the system, so they are not ‘bounced’ from one service to the next.


The evidence shows that health systems with a high-performing primary care sector achieve better health outcomes, better equity, lower mortality rates, and lower overall costs of health care. There is a consensus internationally that the transformation of health care systems must be built on a foundation of high-performing primary care. A high-performance system is one that is accessible, person-centred, safe, effective, efficient, and equitable. It is also one that is driven by evidence that is coordinated and oriented towards population health.

Currently, there is an urgent need for the renovation of old primary care facilities in the Middle East region. Increasing demand on systems means that redesigning current infrastructure as well as new models of integrated care is a priority to deliver sustainable health systems for local populations.

Primary health care has a role to play in strategically shaping the rest of the healthcare system by establishing the flows to secondary and tertiary care and guiding what these should look like.

A move towards a primary care focussed system requires a corresponding shift in patient behaviours. Empowering citizens both financially and through the provision of relevant information will help shape the demand for primary care services. Achieving equity in provision is an important consideration.

At the same time, the supply side needs to be designed to ensure the right care is provided. Important considerations include aligning provider incentives, looking at partnerships and investing in technology.

Future entry to the system could be enabled through a digital front door (patient apps, telehealth), helping the patient navigate the system and avoiding unnecessary visits. Policy makers play a crucial role in ensuring the demand and supply sides work coherently. This includes establishing the financing flows through different tiers of care, inter-agency dialogue, a clear plan and strategy and regulation and governance in place to ensure the system is functioning as intended.

KPMG has supported and delivered primary care redesign work across the globe, from the Philippines (service delivery reform) to the Bahamas (UHC work to create an integrated benefit package which created demand for primary healthcare), from the United States (State-wide reform) to Europe (whole health system redesign).


E: vanpoucke.anna@kpmg.nl | T: +31650263965


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