INTEGRATING HEALTH AND SOCIALCARE : International Evidence andLessonsAge UKServices for Later Life 2012London, UK, 12 July...
“INTEGRATION” AND “INTEGRATED    CARE” DEFINED      “…a coherent set of methods and models on the funding,       administr...
MATCHING INTEGRATED MODELS WITH    CLIENT NEEDS (Leutz, 2002)    CLIENT NEEDS                     LINKAGE              CO-...
EVIDENCE: IS INTEGRATED CARE    WORTH IT?    Mixed evidence from programmes and projects in North America, UK,    Europe, ...
EVIDENCE: IS INTEGRATED CARE    WORTH IT? (cont’d)      Improved patient/client/user experience, quality of life (QoL),  ...
KEY LESSONS    Compelling vision, logic, theory, and evidence lay behind successful    integrated care models for the frai...
KEY LESSONS (cont’d)      4- GP involvement, preferably an active role      5- Direct control over broad package of servic...
FINAL THOUGHTS    While we are beginning to understand the parameters of successful    integrated care programmes, it is c...
FINAL THOUGHTS (cont’d)       Scale matters       Seriously weigh benefits of community- or neighbourhood-based        m...
INTEGRATING HEALTH AND SOCIALCARE : International Evidence andLessonsAgeUKThink Globally, Act Locally Seminar/Services for...
INTEGRATING HEALTH AND SOCIALCARE : International Evidence andLessonsAgeUKThink Globally, Act Locally Seminar/Services for...
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Services for Later Life: Are we any closer to integrating health and social care?

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Presentation from Dennis L Kodner, International Visiting Fellow, The Kings Fund, Co- Director of the Aetna Foundation Care Co-ordination Study

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Services for Later Life: Are we any closer to integrating health and social care?

  1. 1. INTEGRATING HEALTH AND SOCIALCARE : International Evidence andLessonsAge UKServices for Later Life 2012London, UK, 12 July 2012Dennis L. Kodner, PhD, FGSA, International Visiting Fellow & Co-Director, AetnaFoundation Care Co-ordination Study, The Kings Fund - Email: DLKodner@aol.com
  2. 2. “INTEGRATION” AND “INTEGRATED CARE” DEFINED “…a coherent set of methods and models on the funding, administrative, organizational, service delivery and clinical levels designed to create connectivity, alignment and collaboration within and between the cure and care sectors…[to]…enhance quality of care and quality of life, consumer satisfaction and system efficiency for patients with complex problems cutting across multiple services, providers and settings. The results of such multi- pronged efforts to promote integration…is called integrated care.” (Kodner & Spreeuwenberg, 2002)2
  3. 3. MATCHING INTEGRATED MODELS WITH CLIENT NEEDS (Leutz, 2002) CLIENT NEEDS LINKAGE CO-ORDINATION FULL INTEGRATION Mild to moderate Moderate to severe Moderate to severe SEVERITY STABILITY Stable Stable to unstable Unstable DURATION Short to long-term Short to long-term Long-term to terminal Mostly routine/ Routine/non-urgent sometimes urgent Frequently urgent URGENCY SCOPE OF NEED Narrow to moderate Moderate to broad Very broad SELF-DIRECTION Self-directed Moderately self-directed Weakly self-directed3
  4. 4. EVIDENCE: IS INTEGRATED CARE WORTH IT? Mixed evidence from programmes and projects in North America, UK, Europe, and Australia specifically targeted to the frail elderly and other populations with chronic, disabling and medically complex conditions suggests that integrated care is capable of achieving positive outcomes, although it is not always clear which combination of strategies—and under what circumstances—produce the best results:  Expanded service access, including primary care +++  Enhanced co-ordination and continuity +++  Improved health and functional status ++  Reduced hospitalisation/nursing home admission/LOS ++4
  5. 5. EVIDENCE: IS INTEGRATED CARE WORTH IT? (cont’d)  Improved patient/client/user experience, quality of life (QoL), and customer satisfaction +++  Reduced carer burden ++  Greater efficiency +  Controlled/reduced costs +  Perceived improvements in partnership working; also greater focus on governance and guidelines. +++5
  6. 6. KEY LESSONS Compelling vision, logic, theory, and evidence lay behind successful integrated care models for the frail elderly. Generally speaking, integrated care works. There are nine (9) main elements—probably acting synergistically—that account for overall impact: 1- Person-centred focus on frail elderly with relatively high care needs, including careful targeting 2- Responsibility for identified population and/or geographic area, including single entry point into system 3- Case managed, inter-professional, evidence-based team care6
  7. 7. KEY LESSONS (cont’d) 4- GP involvement, preferably an active role 5- Direct control over broad package of services 6- Heavy emphasis on service and clinical integration 7- Organised network of providers 8- Common organisational umbrella or “home,” including centralised or cross-agency governance/accountability arrangements and shared culture 9- Alignment of financial and other incentives, including funding flexibilities (e.g., funds pooling, single funding envelope or capitation).7
  8. 8. FINAL THOUGHTS While we are beginning to understand the parameters of successful integrated care programmes, it is clear that much more work needs to be done to unpack the transformative power of system-service-clinical integration. Here are some final thoughts:  Forget about one-size-fits-all approaches  Start from where you are and fine tune the model over time  Success demands social entrepreneurship, innovation, and risk- taking, as well as time and resources to achieve  Specialise; don’t generalise8
  9. 9. FINAL THOUGHTS (cont’d)  Scale matters  Seriously weigh benefits of community- or neighbourhood-based models vs. regionalised systems of care  Always keep the patient/client/user/customer—and their family carers—at the centre of the caring enterprise  Focus first on outcomes, not costs  Support development of integrated information systems  Step up education and training activities in integrated care at all levels.9
  10. 10. INTEGRATING HEALTH AND SOCIALCARE : International Evidence andLessonsAgeUKThink Globally, Act Locally Seminar/Services for Later Life 2012London, UK, 11-12 July 2012Dennis L. Kodner, PhD, FGSA, International Visiting Fellow & Co-Director, AetnaFoundation Care Co-ordination Study, The Kings Fund - Email: DLKodner@aol.com
  11. 11. INTEGRATING HEALTH AND SOCIALCARE : International Evidence andLessonsAgeUKThink Globally, Act Locally Seminar/Services for Later Life 2012London, UK, 11-12 July 2012Dennis L. Kodner, PhD, FGSA, International Visiting Fellow & Co-Director, AetnaFoundation Care Co-ordination Study, The Kings Fund - Email: DLKodner@aol.com

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