Vertical Integration with Expanded Roles for Hospitals Jan 23, 2018

Vertical Integration with Expanded Roles for Hospitals

For the global UHC community, the idea of people-centered integrated health services has resonated widely as being pivotal to achieving UHC and to truly ensure that no one is left behind.

The entailing shift from health systems designed around diseases and health institutions towards health systems designed around needs of people places a heavy demand on care coordination strategies that cut across all actors in the care continuum – including primary care providers, hospitals, community agencies and home care providers.

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Most countries, however, struggle with fragmented delivery systems, which are increasingly becoming a roadblock in the context of the rise in non-communicable diseases.

Last year, a group of JLN countries prioritized vertical integration with the aim of enabling care models that are organized around the health care needs of populations. With the support of the Bill and Melinda Gates Foundation, the JLN launched the Vertical Integration and New Roles for Hospitals learning exchange in 2017, facilitated by Aceso Global. Under the new JLN learning exchange, Indonesia, Malaysia, Philippines, Sudan and Vietnam have set out to jointly examine existing vertical integration initiatives and potential new roles for hospitals to address the onslaught of non-communicable diseases.

A Broader Care Coordination Strategy
Vertical integration is part and parcel of a broader care coordination strategy that aims to provide support to patients through the “deliberate organization of patient care activities between two or more [providers] involved in a patient’s care to facilitate the appropriate delivery of health care services,” according to McDonald in a 2007 paper on vertical integration.

During the initial scoping phase held between July and September 2017, country participants mentioned several recurring themes, including the lack of care coordination across providers, resulting in poor quality, higher costs and patient dissatisfaction, and patients’ bypassing primary care units to seek care in overcrowded hospitals.

Broadly, vertical integration was widely understood as confined to referral systems which existed on paper but were rarely used. For example, country teams reported that there were no standard procedures to track patients once they were referred to or discharged from hospitals. Also, addressing non-communicable diseases through better care coordination and provider interaction emerged as a major priority, as aging populations, rising incomes and urbanization contribute to its already high burden.

A New Diagnostic Assessment Tool
Participating countries agreed to co-produce a diagnostic and readiness assessment tool during a facilitated learning exchange planned for early March 2018. Small-scale vertical integration initiatives exist in most of the participating countries, but there is no information on features, lessons or impacts. 

The proposed tool will assess current local vertical integration initiatives while also appraising financial and institutional enablers and barriers to vertical integration. The tool will focus on integration strategies and operations along three major patient transition domains: between primary care and specialty care, between the hospital and primary care, and between the hospital to home or community-based care.

As part of the learning exchange, each country will share their experience and the areas it considers most critical to establish an enabling environment for integration across all levels of care. The tool will entail common components to measure initiatives and assess preparedness across all countries, as well as a country-specific component which will be adapted to each country’s context.

Forward Momentum for People-Centered Integrated Care
People-centered care continues to resonate as a key priority for joint learning across the JLN.  The People-Centered Integrated Care Service Delivery collaborative officially launched in October 2017 with facilitation from Ariadne Labs, providing a forum for countries to increase the knowledge and resources available to countries on people-centered integrated care models and the steps and requirements for achieving them. Learn more about their work here.

Photo credit: World Bank