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Despite Limited Penetration, Integrated Delivery Systems Have Advanced Chronic Care

The 1990’s experiment around development of integrated delivery systems (IDSs) mostly did not take root. This experiment was primarily about financial integration — doctors joining with hospitals so that they could together contract with health insurers for capitated reimbursement, hospitals starting their own health plan, or hospitals buying physician practices as a way of guaranteeing a future base of patients and revenues.

The systems and processes needed jointly to manage financial and clinical risk were an afterthought; information technology was not yet far enough advanced to offer integrated clinical solutions. One of the lessons learned was that financial integration alone was insufficient for success.

There is still a largely unexplored side of integration. Clinical integration refers to doctors, hospitals, health plans and others working together improve clinical care and care management on behalf of patients.

Today I presented my “Chronic Disease Management Megatrends” speech at a conference sponsored by the UPMC Health Plan, which is a part of the University of Pittsburgh Medical Center (an IDS).

The audience was a mixed group of health plan executives, hospital administrators, and physicians. These people were truly interested in chronic disease management, the Chronic Care Model, and clinical integration opportunities; audience questions focused on how the health plan and doctors could work together. It’s great to see places where health plans, hospitals and doctors sit in the same room and talk about ways to improve care and care management.

Today, the IDS is a minority model. Yet, it’s worth noting that some of the most innovative advancements in quality improvement, information technology, and chronic disease management are still being pioneered in IDS models. Some of the best innovations in chronic care have come from Kaiser Care Management Institute (affiliated with Kaiser Permanente) and the MacColl Institute for Healthcare Innovation (affiliated with Group Health Cooperative).

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1 Comment

  1. Catherine Mcnair on April 23, 2007 at 1:33 pm

    The only way chronic disease(s) outcomes will really improve, population wide, is through a variation of the CCM Model. Why? Only a patient and his/her physician(s) have a direct customer relationship to sustain over time. If anything, the insurance/carrier MCO would prefer the chronic disease user to leave the Plan or not join it in the first place. I am not making a moral judgement, but rather merely looking at the ovweall economic drivers of each relationship. Forgive my sarcasm, but I am assuming that chronic disease cannot be entirely self-managed with a long distance nurse call every once and a while.

    Why do we not pay for physicians, in the ambulatory environment, to use information technology to extend chronic disease care beyond office walls? Theoretically, a mixture of IVR, e-mail and WEB would allow proactive, preventive care (badly needed with chronic disease) to take place.

    We are sitting on a “tipping point” in health care delivery. What are the barriers to shifting the WEB based and IT enabled disease management programs of third party payers to physicians?

    Let’s consider e-prescribing (ASP version being given away free by Allscripts and partners). Patient drug noncompliance (especially blood pressure) can be suspected in claims data of members who had the drug paid and then claims for it stopped. But how much better will it be if their physician knows, can ask why they have stopped, maybe prescribe one they will better tolerate and/or address their misconceptions about their need for it?

    I see physician adoption of e-prescribing not as an end in itself just for Formulary compliance on the part of Payers. More importnat is how it can change communications between patients and physicians.

    only retain the patient but bring them in at the optimum time versus reative to patient crisis.
    Pharos and Allscripts (some components) are examples of going beyond the walls and attempts to cause more fruitful, earlier cost effective patient physician interaction. I am sure there are others.
    I would welcome a discussion on ambulatory provider driven chronic care management – especially how to successfuly make a ROI on it – top line growth as well as cost control.