Intergration Can Control Costs, Improve Outcomes

We write extensively about the trend of integration of care in the second edition of Renegotiating Health Care. We looked at integration at three levels of scale: Kaiser Permanente is the largest private integrated health care system in the country and has been able to attack costs while boosting patient satisfaction; Village Health Partners in Plano, Texas co-locates primary and specialty care and while each practice remains separate, they share a philosophy of care and interoperable electronic health record systems so that they can coordinate care – they achieve superior financial and care outcomes; and the rise of solo medical practitioners – physicians like Dr. Pamela Wible who strip away all of the traditional trappings of a medical practice in order to make it financially sustainable to spend more quality time with a smaller group of patients.

Now new research from a group headed by our colleague Nancy Keating at the Harvard School of Public Health reports that cancer care for men over age 65 delivered through the Veterans Health Administration is generally as good or better than that provided through Medicare’s fee-for-service network. The VHA is the largest integrated health care organization in the United States.

“Care in the VHA is much better coordinated than most other settings,” said Keating, who is also an associate physician at Brigham and Women’s Hospital. “The VHA has a good, integrated medical record. Their doctors all work together and communicate more effectively. There are no incentives for the overuse of cancer treatments because VHA physicians are not rewarded financially for prescribing more drugs or procedures. The VHA also measures quality across a wide range of conditions, so there is a culture of quality improvement.”

Integration is being driven by both the need to control costs and the ability to use data analysis to improve outcomes. Better coordinating care and increasing collaboration among care givers can eliminate gaps in care delivery as well as the need for duplicate tests. Each individual in the care delivery chain has access to a comprehensive view of the patient’s history and treatment program. Kaiser Permanente now has evidence-based default protocols for many common cancers across all of its facilities. Village Health Partners has increased the likelihood that its patients will get the tests they need by making relevant patient information accessible across the independent practices it comprises: the diabetic patient who comes in for a blood test can be reminded that an eye exam is due — and it can be booked while the patient is still in the office.

Integration won’t solve all of the ills of the U.S. health care system but it is a trend that we predict will continue and grow. It will generate its own conflicts — from how independent practices make health records interoperable to how to get more physicians to accept standard protocols for treatment — yet also offers many opportunities for collaboration.

What do you think? Are you experiencing more integration in your health care experience? What are the benefits — and problems — you’ve seen?

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