What are the design fundamentals of an effective Integrated Care System?
The challenge facing the Australian healthcare system
Australia’s healthcare system is under increasing pressure, driven by rising demands and shifting patient expectations. In order to best meet the demand for healthcare services, it is of growing importance that the appropriate care is provided to the right patients, in the right place and at the right time.
To enable the effective and sustainable delivery of patient-centric, seamless care in an appropriate setting, new care models are required. One such internationally endorsed model is an Integrated Care System (ICS).
An introduction to Integrated Care Systems
The term integrated care is defined by the New South Wales Government as: “The provision of seamless, effective and efficient care that reflects the whole of a person’s health needs, from prevention through to end of life, across physical and mental health, in partnership with the individual, their carers and family and across public/private and Commonwealth/State boundaries.”
The primary function of an ICS is to overcome system siloes and misaligned incentives to facilitate collaborative, cross-system working. If well designed, an ICS can enhance value for care by utilising existing resources effectively to improve patient outcomes and care experiences.
However, designing and implementing an ICS is no simple feat. A key challenge faced by those looking to develop an ICS is that there is no ‘one size fits all’ model. To cater for local nuances in population demographics, provider services, funding models and legislation, all ICSs must, to some extent, be designed from the bottom up.
Fundamentals of success
To help health systems navigate the ambiguity regarding model design, we have provided guidance for those wishing to start or progress their journey toward the implementation of an effective and sustainable ICS model. By following this guidance, we hope that health systems will be better placed to unlock clinical and operational benefits at pace, and ultimately implement an ICS model that best meets the needs of their local population.
Our guidance focuses primarily on the following four fundamentals of a successful ICS model:
- A relentless focus on improving population health and wellbeing: Healthcare systems must consider the health and care needs of the entire local population by working collaboratively to provide the right care, in the right place, at the right time. To ensure that this remains front of mind, it is recommended that the design of an ICS model follows the ‘function before form’ mantra. This will result in an ICS model that is tailored to the needs of well-defined population segments, and subsequently supports the sustainable delivery of integrated, patient-centric pathways.
- Designing an ICS of an appropriate scale and scope: Examples of ICSs can differ significantly in both their size and scope. This is often due to the need to: achieve sufficient scale to coordinate change and realise efficiencies; cater for local variation in demand in order to best meet the needs of the population; and/ or align with the existing footprints of local healthcare bodies. By building an ICS from the bottom up – i.e. based on the desired patient pathways for each well-defined patient cohort – a series of effective ICS ‘levels’ can be created.
- Developing an effective governance structure and supporting processes: Establishing an appropriate ICS form (i.e. its governance and organisational structure) is often one of the more challenging aspects of system development. Typically, this is due to the need to find a balance between ICS forms that facilitate real change at pace and those that minimise the risk for all involved parties. For an ICS form to prove successful it must encourage the desired behaviours and facilitate an improvement in value for care. This can be achieved via a range of mechanisms including: alternative commissioning models; pooled provider risk; and collaborative agreements such as memoranda of understanding, joint ventures, or even the formation of new corporate vehicles.
- Effectively engaging stakeholders to build support and momentum: For an ICS to prove successful, its development and implementation must be supported by a comprehensive programme of stakeholder engagement focused on building trust among all key stakeholders and the momentum required to unlock benefits at pace. To help develop the stakeholder relationships that will form the foundation of the ICS, it may be beneficial to consider ‘softer’ contractual options (e.g. memoranda of understanding) as stepping stones on a journey to the desired ‘end-state’. Such options can provide excellent opportunities to bring together the providers and commissioners of healthcare services, build trust and understanding, and support the timely realisation of select system benefits.
There are several additional aspects beyond the four fundamentals of ICS design that require careful consideration. These include but are not limited to understanding the baseline from which one can build and driving continuous improvement. The effective management of such aspects of ICS design will support the delivery of a robust and effective care system that is able to unlock sustainable health and wellbeing benefits for local individuals, communities and populations.
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