Barriers to Integrated Care and How to Overcome Them

Around 75% of healthcare spending in Europe is directed towards managing and treating chronic diseases. Looking at different patient groups, around 10% of patients account for almost two-thirds of healthcare expenditure. These patients are to a large extent elderly people with multiple chronic conditions. The figures show clearly why increased effectiveness in preventing, managing and treating chronic diseases is a matter of the highest priority for most health policy makers – and finance ministers.

Chronic diseases pose specific challenges to healthcare systems. Usually, several healthcare providers are involved in care, so for patients, navigating this area is often problematic. Patients with several chronic conditions face greater difficulties where no coordination exists.

Generally, chronic diseases have more complex "care pathways", resulting in a variety of models, sometimes leading to variations in the patient’s health status. Clinical guidelines for major chronic diseases may vary between regions and countries.

"Integrated care", which coordinates all healthcare activities, with a patient-centric approach, has therefore grown in importance. It should provide higher quality care, resulting in better patient-relevant health outcomes, often at the same or even lower cost.

Nevertheless, several complicating factors make integrated care difficult to implement:

• Coordinating different healthcare professionals with different roles is sometimes problematic
• Different healthcare system parts sometimes fall under different organisational and political management, with different budgets.
• Healthcare payment models often discourage coordinated efforts, with most HCPs reimbursed separately
• Health IT systems are often fragmented, making it difficult to collect the required data in one place

Care organisations are experimenting with new, innovative models to provide solutions. One example is the implementation of integrated care for Type 2 Diabetes in the Netherlands – under the EU-funded Project INTEGRATE. This focuses on "care groups" – legal entities that act as intermediaries between health insurers and healthcare professionals. They negotiate the content and price of a comprehensive diabetes care package, allowing health insurers to buy care as a single service.

The case study acknowledged major success but conceded barriers to an integrated care system. One of the barriers was the non-integration of electronic databases used by healthcare stakeholders.

Positive signs included effective cooperation between HCPs – a key relationship in any integrated care model.

Has diabetes care for Dutch patients improved?

If functioning well, integrated care should provide better quality patient care, more efficiently. The study authors suggest integrated care models are difficult to evaluate due to the "lack of comparable outcome measures as well as in-depth, qualitative data". This is also problematic for assessing the real impact of all care pathways. We can usually measure processes effectively, but not really what matters in the end: the patient’s health. Interconnected Health IT systems and their capability to collect data on easily comparable and patient-relevant health outcomes are vital.

Standardised outcomes measures would enable almost real-time analysis of how different organisational changes and the introduction of new methods and technology affect the health outcomes of patients. This could improve quality patient care, and create substantial efficiency gains in health expenditure.