Vertical Integration as a Strategy to Address NCDs May 22, 2018

Vertical Integration as a Strategy to Address NCDs

The rapid increase of non-communicable diseases (NCDs) – including cancer, diabetes and heart disease – is a new and formidable challenge facing health systems around the world. Driven by aging populations and changing lifestyles, NCDs require health systems to treat patients in a fundamentally different way.

Patients with NCDs need continuous treatment and care management fostered by strong provider integration. Yet most health systems are fragmented across hospitals, primary care and community providers. In other words, providers at different care levels often fail to work together to coordinate patient care, instead focusing solely on the care provided within the walls of their respective facilities or organizations.

Current systems are ill-equipped to serve the growing number of NCD patients. Vertical integration – a broader care coordination strategy – aims to enable care models organized around the health care needs of populations, addressing the need for continuous treatment and care management.

Vertical Integration and New Roles for Hospitals
To address these challenges, 15 health systems practitioners from five JLN countries – Indonesia, Malaysia, the Philippines, Sudan and Vietnam – met for the first learning exchange on Vertical Integration and New Roles for Hospitals, facilitated by Aceso Global, in Manila on March 5-8, 2018.

During the workshop, participants developed their understanding of vertical integration and its implementation strategies, explored countries’ experiences with vertical integration initiatives and laid the groundwork for an assessment tool that will support countries in assessing their existing initiatives and level of readiness for deeper vertical integration efforts.

Workshop Highlights
The four-day workshop included interactive presentations, lectures, brainstorming sessions and team exercises. Participants learned about specific strategies to foster vertical integration and new roles for hospitals, including:

  1. Strengthening relationships among providers through fashioning collaborative practice arrangements, technical assistance and skill building
  2. Developing tools to support care coordination between hospitals and ambulatory providers (e.g., standardized protocols, guidelines, care plans, reporting and feedback loops, information systems)
  3. Establishing the financial and information environment needed to enable care coordination
  4. Redefining hospital roles within a vertically-integrated network to provide home outreach, training and technical support to primary care providers and services outside of the hospital walls

An integrated care system is context specific and cannot be built overnight. As a first step, the workshop focused on the more addressable patient care “gaps”, which often develop as patients transition from one provider level to another. Types of transitions discussed included those between hospitals and primary health care providers, specialists and primary health care providers, and hospitals and homes or communities. Participants explored practical strategies to improve care coordination during these transitions.

As part of the workshop, participants also toured a vertical integration initiative in Manila, visiting a private clinic and a referral hospital that are part of an emergency maternal, newborn and child health network linking private and public providers.

What made the workshop a true success was the relentless enthusiasm of the participants, who were eager to both share their experiences and learn from each other. A central part of the workshop involved participants discussing ongoing vertical integration initiatives in their countries, such as cataract mobile units in Malaysia and a telemedicine collaboration between tertiary and secondary hospitals in Indonesia.

All participants agreed on the importance of targeting and empowering existing local initiatives to disseminate lessons learned and scaling up successful efforts. During the latter half of the workshop, participants also proposed nine themes and questions to address in the assessment tool, providing a foundation for its development.

Next Steps
Building off the momentum at this workshop, participants are co-producing a modular diagnostic and readiness assessment tool covering vertical integration and new roles for hospitals.

The tool will evaluate current vertical integration initiatives and assess a country’s broader financial and institutional context to gauge preparedness for new vertical integration initiatives. The final tool will be released in August 2018 and provide an opportunity to health systems practitioners from around the world to learn from the experiences of low- and middle-income countries in pursuit of catalyzing and strengthening scalable vertical integration initiatives.