Making Integrated Health Care Work

Abstract

Making Integrated Health Care Work, by Dean C. Coddington, Keith D. Moore, and Elizabeth A. Fischer (Center for Research in Ambulatory Health Care Administration, 1996). Integrated health care systems (IHC's) have grown in importance since this book was written in 1996. This growth has been marked by a large increase in provider-owned HMO's. As John Koster of VHA, Inc. remarked in his forward this book, IHC's have grown out of the need improve clinical effectiveness within a setting of cost constraints. In 1999 this need for improvement is even greater due to: (1) three years of flat or declining premium rates; (2) the consolidation of publicly-owned health care plans; (3) government push of Medicare and Medicaid enrollees into managed care; and (4) the budget squeeze on providers induced by the Balanced Budget Act of 1997. Despite its title, Making Integrated Health Care Work is not a to book. The aim of the book is describe the characteristics of mature IHC's that permit them add value the health care marketplace. The ultimate goal of a successful health care system is like that of any other successful business: deliver what the customer wants by providing high quality care at an affordable cost with outstanding service. The book has the same structure as the authors' last text entitled Integrated Health Care, which was published in 1994. Both books are based on the authors' research (in the year prior publication) of ten different health systems with varying maturity levels of integrated care. Unfortunately, the reader does not learn much about these health systems from this book. Nor does the reader get a sense as whether the success or lack of same is a result of the health system's maturity as an IHC. Case studies for each of the organizations were published in a separate volume available through the Center for Research in Ambulatory Health Care Administration. What the reader does obtain are useful checklists of the characteristics necessary become a mature IHC and the various strategies taken by the IHC's achieve value added. An integrated health care system is defined as: [A system combining] physicians, hospital, and other medical services with a health plan (or the ability of the system enter into risk contracts) provide the complete spectrum of medical care for its customers. In a fully-integrated system, the three key elements---physicians, hospital(s) and health plan membership---are in balance in terms of matching medical resources with the needs of purchasers and patients. The characteristics of a mature integrated system are: (1) physicians play a key leadership role; (2) the organizational structure promotes coordination; (3) primary care physicians are economically integrated; (4) practice sites provide geographic coverage; (5) the system is appropriately sized; (6) physicians are organized; (7) health plans and partners are owned by the system; (8) financial incentives are aligned; (9) clinical and management information systems tie together the elements of the system; and (10) the system has access and the ability shift financial resources. The heart of the book focuses on how IHC's develop and implement critical strategies gain competitive advantage and improve value added. Value is added by: (1) improving quality of care; (2) improving service; (3) improving accessibility; (4) reducing unit costs; (5) increasing operating efficiency; (6) strengthening customer ties; and (7) enhancing product offerings. In the authors' view the two most important decisions are developing a primary care network and starting/growing a health plan. The key ingredients for starting an IHC are obtaining physician buy-in and developing physician leadership in all aspects of clinical and administrative functions. Also required are a commitment a common vision, respect for primary care, and sufficient funding. …