The integrated care model has been touted as being able to deliver better care for patients and lower costs and improve efficiencies for the healthcare system. A recent study of the model in the United Kingdom by RAND Europe suggests that it does indeed provide benefits, but those benefits are most likely perceived by healthcare professionals rather than by their patients, and cost savings were minimal.
RAND Europe conducted a two-year study of 16 integrated care pilot programs in England to get a sense of how well the model is working. The pilots represented a mix of target populations, interventions and care providers, and had a particular focus on elderly care and management of complex long-term conditions. They did not adhere to a particular definition of integrated care, but most concentrated on horizontal integration between local services. Six projects focused on case management of patients at high risk of emergency hospital admission.
Seventy-two percent of surveyed healthcare staff said they were working better with other organizations under an integrated care model; 64 percent said they had more interesting jobs; and 60 percent said they were working more closely with team members, the study reported.
In contrast, patients had lukewarm responses regarding their perceptions of the care received under integrated care. Patients said they were less likely to see the general practitioner or nurse of their choice, or to be involved in decisions about their care, the study revealed.
The results were mixed on hospital use and cost reductions. RAND researchers found elective admissions went down by 4 percent (21 percent for the case management sites) and outpatient visits went down by 20 percent (22 percent for the case management sites). But, emergency admissions increased by 2 percent (9 percent for the case management sites) and no significant overall reductions in costs were found, although hospital costs were reduced by 9 percent for the case management sites.
The lukewarm findings in the United Kingdom don’t mean integrated care is a bust in the United States.
One organization that is excited about integrated care is the American Psychological Association. It hopes that the model will result in better screenings and referrals for patients.
[See also: Colorado pilot tests payment model to make behavioral health-primary care integration financially viable.]
“The majority of individuals referred to mental health care never make it there,” noted Katherine Nordal, executive director of the professional practice at the APA. “(Integrated care) would provide the same level of care as the primary care environment.”
Most of the gains from integrated care come from reducing the amount of time a patient needs to be hospitalized or using emergency room services, pointed out Tricia Barrett, vice president at the National Committee for Quality Assurance (NCQA) in Washington D.C., a nonprofit organization dedicated to improving healthcare quality.
But for integrated care to truly work – to be cost effective and provide patients better care – changes to the payment reimbursement system are required, she said.