Structure and Function

Providers of medical care in the United States are consolidating. Hospitals are merging into “systems” and physicians are joining large physician groups, many of which are part of “vertically integrated” delivery networks that include hospitals.

Many forces are driving this consolidation, including the high capital requirements technologically advanced care, the challenge of meeting government regulations, the “arms race” consolidation of the commercial insurance industry, and the drive toward accountable care, in which providers take on some or all of the financial risk associated with the health outcomes of a population, and therefore need to work closely together to manage care delivery.

A recent paper in Health Affairs points out that structural integration does not necessarily translate into functional integration from the perspective of those who ought to matter the most – patients.

The authors compared the findings of a validated survey of integrated care, administered to a sample of about 3,000 Medicare beneficiaries, and assessed the degree to which perceptions of integrated care correlated with structural measures of integration among the medical groups caring for them. The principal findings were: “…patients perceive less integrated care in domains that particularly reflect patient-centeredness… [and] medical groups that are more structurally integrated as defined in this study (those that are large, multispecialty, and owned by a hospital; have technological capabilities, and use care management processes) do not systematically provide care that patients perceive as more integrated.”

Here is my take-away. Integrating the elements of care delivery into one organization is not the same as delivering integrated care. While putting the pieces together may facilitate better, more patient-focused, high-quality care, it does not guarantee it. I think delivering on the promise of coordinated care requires a more fundamental cultural shift among providers to work together and put the patient at the center of processes of care.

What do you think?




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