Beyond integrated care: challenges on the way towards population health management.

Abstract

Integrated care has long emerged as a viable approach to overcome deficiencies in the care management for people with complex health care needs such as chronic diseases, disabling conditions, serious mental illness, and medically fragile children and the frail elderly, while at the same time improving efficiency, quality and effectiveness of the health services provided. The focus thus has been on better coordination and integration among health care sectors to manage specific (chronic) diseases. However, it has become evident that in order to provide truly populationcentred services that improve population health, the scope of integrated care needs to be expanded to bridge the gaps not only within the health system, but also between the health and social systems, among others. Consequently, initiatives are emerging internationally that have a broader focus than integrating health care. These initiatives aim to integrate services across health care, prevention, social care and welfare, and are often labelled as population (health) management [1]. For instance, in the Netherlands, several regional partnerships originated in which care providers, insurers and stakeholders like municipalities and representatives of citizens participate [2]. Similar trends can be observed in other countries, like Germany (e.g. Gesundes Kinzigthal [3]), England (e.g. Torbay [4]) and the USA (e.g. Accountable Community Organization [5]), where initiatives have developed, which all take a population health management focus. The scope of these initiatives reflects a wide array of integrated care concepts. All concepts need to overcome common barriers and challenges in order to be successful.