What is integrated health care?

Definitions of Integrated Delivery System

First. An organized, coordinated and collaborative network that:

1. links various health care providers, via common ownership or contract, across three domains of integration (economic, noneconomic, and clinical) to provide a coordinated, vertical continuum of services to a particular patient population or community
2. is accountable both clinically and fiscally for the clinical outcomes and health status of the population or community served, and has systems in place to manage and improve

Second. A delivery system which “provides or aims to provide a coordinated continuum of services to a defined population and are willing to be held clinically and fiscally accountable for the outcomes and the health status of the population served

Third. An organization which “uses corporate structure, strategic alliances, governance, management approaches, culture, financial practices, clinical information systems, and other tools to facilitate and insure delivery of this type of care”

Forth. The management and delivery of health services so that the clients receive a continuum of preventive and curative services, according to their needs over time and across different levels of the health system

Fifth. A network of organizations that provides, or arranges to provide, a coordinated continuum of services to a defined population and is willing to be held clinically and fiscally accountable for the health status of the population served

Sixth. An organization that, through ownership or formal agreements, vertically and horizontally aligns health care facilities, programs or services in order to offer a coordinated continuum of health care to a defined geographic population, and that is willing to be held responsible clinically and fiscally for the health status of that population

Characteristics of a Fully Integrated Delivery System

After consolidating the literature on integrated care, America’s Essential Hospitals found seven characteristic domains that encompass a fully integrated health care delivery system.

Components of a Fully Integrated Health System

Domain 1: Value-Driven Governance & Leadership:

• The board is very focused on integration and reflects all relevant stakeholders.
• Administrative leadership is very committed to promoting and implementing integration.
• Physician leaders are very committed to promoting and implementing integration.
• The organizational structure is very favorable to integrated care.
• Strategic, financial and operational planning toward integration is very clear and convincing.
• A culture of safety and teamwork is continuously taught and reinforced.
• Financial, quality and community benefit data are transparent throughout the organization and to the community.

Domain 2: Hospital/Physician Alignment:

• The system has a clear and convincing approach to aligning and integrating clinicians with hospital administration.
• Physician leaders frequently represent the interests of all system physicians.
• Physicians and administrators frequently participate in joint decision making.

Domain 3: Financial Integration:

• The system is well-prepared for assuming risk-based payment and has conducted considerable analysis of the implications.
• The system has a very good ability to manage contractual relationships with payers with sufficient staff/resources and compatible information systems.

Domain 4: Clinical Integration/Care Coordination:

• The system provides or contracts for the full range of services and sites of care needed to meet patient demand for preventive, ambulatory, acute, post-acute and behavioral health care.
• Strong evidence exists of accountability, peer review and teamwork among providers.
• Care is frequently delivered at the most cost-effective and appropriate setting.
• Transitions and handoffs between settings are effectively managed and need little improvement.
• Strong collaboration exists between the hospital system and social services.
• The system has almost fully integrated behavioral health programs into primary care.

Domain 5: Information Continuity:

• Electronic Health Records (EHRs) for each patient are accessible to all providers within the system and most community providers outside of the system.
• The EHR system can track all patient encounters and combine all data to system wide level for evaluation and benchmarking.
• EHRs can track health outcomes of patients with specific conditions within all physicians’ panels.

Domain 6: Patient-Centered & Population Health Focused:

• The system has very good, complete data on sociodemographic, utilization, cost and health status characteristics of the populations it serves.
• The system’s resources and services are well-matched to the needs of the populations served.
• The system provides significant social services to assist patients in accessing needed care.
• The system provides almost full or full, 24/7 access to care via phone, email or in-person visits.
• The system has trained all or nearly all staff in cultural competency skills.
• All providers have been trained in encouraging expanded patient/family/caregiver roles in decision making and self-management.

Domain 7: Continuous Quality Improvement & Innovation:

• The system frequently trains/develops employees to be future leaders.
• The system frequently tests strategic activities through pilot projects.
• Staff feel very empowered to innovate.
• Providers frequently employ evidence-based practices.