Project INTEGRATE was established to develop managerial recommendations and a managerial toolkit to allow health care leaders to realise the full potential of the integration of care. Evidence has shown that integration will lead to better outcomes in terms of population health, efficient use of resources and patient experience (Triple Aim) . In a review of the literature, managerial frameworks were contrasted with the compelling results of Project INTEGRATE. The insights and learnings were presented at the Final Project INTEGRATE Conference, held in the context of the International Foundation for Integrated Care Conference, on 24 May in Barcelona.
A focus on the implementation of integrated care – As initiating the implementation of integrated care can present challenges, the preliminary phase is considered crucial for successful implementation, particularly in ensuring the continuum of care. To facilitate this, the processes have a straightforward, clear design, so that health professionals are more likely to adopt and adhere to change. In the design of services, the involvement of all stakeholders – especially patients and families/informal care givers – is paramount. Ideally, health and care systems work reciprocally with the patient and communities.
Education activities increase patients’ health literacy and act as a vehicle for patient empowerment, co-decision taking and self-management. Evidence from Project INTEGRATE shows that physicians have a particular responsibility here. Education is also an important tool for supporting care professionals in fostering their managerial skills in the implementation and realisation of integrated care. Health professionals who have benefited from training in new roles and responsibilities are able to provide higher quality care, thus realising the full potential of integrated care in the sense of the Triple Aim. Team building exercises also help to develop a greater level of interaction between care professions, while multidisciplinary teams facilitate the management of integrated care.
ICT systems are an essential ingredient of integrated care. Health IT departments are often under-resourced, which limits the functions of tools. Ideally, ICT systems are professionally built from the ground up and designed to accommodate all care processes and services. For example, electronic health records can be shared among care professionals in order to improve information distribution and develop patient profiles from different perspectives. Patients able to access their health records are better engaged in their health and care, leading to increased empowerment and self-management.
The Three Circles of Excellence are extracted from the Triple Aim, and are an excellent way of framing aspects of managing integrated services: Technological Excellence is about superior technology and knowledge management; Operational Excellence concerns bringing all the different resources together in the most efficient way, while all of this contributes to an enhanced Patient Experience. As such, it is a very useful tool for managers of integrated care.
Expert panel discussion – In-depth discussions with leading experts in the field were held at the Final Conference in May 2016. From these emerged the fundamental importance of clear integrated care models that are more conducive to cohesive and efficient care, and that enable care professionals to quickly assume their new responsibilities, while increasing their knowledge of the development of integrated care.
Experts also agreed on the importance of joining together in order to learn from integrated care experiences, as this is likely to be the future of health care, with the trend being particularly evident in Europe and parts of Asia. Project INTEGRATE’s case studies were highly valued, as there is still not a great deal of evidence on what does or does not work in chronic care management. This will be important for scaling up positive experiences, acquiring the necessary funds for doing so, and at the same time making the best use of resources – so giving full value for patients, citizens and health systems. Integrated care researchers working with advocacy groups (consumers or physicians, for example) will be better placed to change the system, and further economic studies will also allow for the economic case to be made, proving integrated care to be economically effective, and actually cost-saving.
Another aspect has been to respond more explicitly to the increasing expectations of populations, showing how integrated care represents a valid response to the demographic and economic challenges of health care systems. Integrated care will allow professionals to offer solutions, providing high quality care to patients in a less expensive way, thus making systems more sustainable, which is particularly important given current budget constraints. All of this will increase the case for care integration.
A great deal has already been achieved in integrated care – Project INTEGRATE has shown that it does work, and has contributed a set of highly valuable insights. More evidence is needed, and we look forward to increasing our knowledge and understanding of how management in integrated care can respond to today’s economical, societal and health systems challenges, and contributing to the Triple Aim of better health, more efficient use of resources and improved patient experience in Europe, and globally.
Senior lecturer in the Department of Production,
Technology and Operations Management
IESE Business School, Spain