A recent BMJ paper  from Stephen Shortell and collaborators from the King’s Fund discusses the design of models of care to improve integration between hospital and community, and between health and social care – an old chestnut. They have a taxonomy of integrated care models that I represent like this:
Model 1 seems to locate responsibility for integration mostly with community providers, while model 2a evokes a structural solution in which hospital and community providers work in an organisation straddling hospital and community. The article comes down in favour of model 2b and gives successful examples from America (where quality has improved at reduced cost). The article emphasises the importance of integrated computer care records, almost saying this is a necessary ingredient.
On this latter point, the CLAHRC WM Director begs to differ – as argued in a previous post, a patient-held paper record has considerable advantages over ‘all singing and all dancing’ IT systems. He does agree, however, with the idea of an integrated record (not necessarily computer-based), the authors’ emphasis on ‘clinical integration’, and the need to win the hearts and minds of service providers. CLAHRC WM is involved with two grant applications to help develop the tacit skills needed to care for patients with multiple morbidities, and different needs and preferences, across multiple types of care provider in different locations.
— Richard Lilford, CLAHRC WM Director
- Shortell SM, Addicott R, Walsh N, Ham C. The NHS five year forward view: lessons from the United States in developing new care models. BMJ. 2015; 350: h2005.
- Centers for Medicare and Medicaid Services. Factsheet: Medicare ACOs continue to succeed in improving care, lowering cost growth. 2014.
- McWilliams JM, Chernew ME, Landon BE, Schwartz AL. Performance differences in year 1 of pioneer accountable care organizations. N Engl J Med. 2015. [ePub].
- Song Z, Rose S, Safran DG, Landon BE, Day MP, Chernew ME. Changes in healthcare spending and quality four years into global payment. N Engl J Med. 2014; 37: 1704-32.
- Markovich P. A global budget pilot project among provider partners and Blue Shield of California led to savings in first two years. Health Aff. 2012; 31: 1969-76.
- Curry N, Ham C. Clinical and service integration. The route to improved outcomes. London: King’s Fund, 2010.