Integrated Care

Integrated Care.  Given the complexity of the evolving ‘healthcare economy’ it’s inevitable that some conceptual adjustments will be required from time to time.  Also, given our conviction that US managed care is the lens through which all policy developments must be viewed, the original assessment of integrated care was placed firmly in this context: namely that it will simply come to mean the forms and extent of integration between hospital chains, physician groups, and insurers.  However while it’s more than likely this will happen it would appear there are some stages in between.

As previously mentioned, integration is being sold as a means of ensuring a more seamless delivery of patient-centred care particularly through the ending of hidebound organisational ‘silos’, primarily those between health and social care, and rewarded by outcomes based financial incentives and other payment structures. As such during this phase it’s about changing the forms and relationships between providers of care. And what we’re talking about appears to be nothing other than good old public private partnerships but this time for the full gamut of clinical services and with the likelihood of the private sector holding the whip hand in terms of, for example, accountability, contractual leads and supply chain management. Certainly many of the proposals for alliance, accountable lead contractor, and Cobic modelling anticipate this form of ‘integration’ with NHS Trusts and GP groups in sub-contractual roles.

Contracts currently on offer certainly give the private sector access to avenues previously unheard of. For example, Care UK and the BMI hospital group recently secured a £110m contract to provide a range of acute medical services in partnership with Pennine Acute NHS Hospital Trust. Also are a local private GP federation, GP Care Services Ltd, and it has to be said this roster is really not that far from our original assessment of managed care relationships, with only the controlling insurer function absent. But give it time. The services on offer will include ENT, gynaecology, orthopaedics, urology and gastrointestinal and endoscopy and rewards Care UK’s diversification over the past few years. Simon Wooton, CCG chief operating officer, who’s obviously completed at least his first module in clinical leadership, said, “we were attracted to the provider partnership bid because of the potential for a seamless patient pathway in these specialty areas”, and that “this will mean a better experience for patients and less duplication in the system, which will also mean a better use of resources”. He also added that “it will also mean a joint governance structure and over arching management board with representation from each organisation”.

Having so many organisations on board does beg a few questions in terms of integrated delivery and a dog’s dinner sounds closer to the mark. But no matter as far as the private sector is concerned: the term integrated care is both suitably progressive and flexible enough to allow any number of entry points, contractual permutations and private forms of ownership. As with the majority of such concepts the key is who’s endorsing it and who’s benefiting most from the new contracts.