NYAPRS Note: A timely piece by Open Minds' Monica Oss, who is a featured keynote and workshop presenter and Lunch 'n Learn facilitator at this week's NYAPRS Executive Seminar. Register today at https://registration.nyaprs.org/ and see final program at http://www.nyaprs.org/conferences/executive-seminars/documents/ESprogram.pdf What's In A Word? A Lot, If That Word Is "Integrated" By Monica E. Oss, Chief Executive Officer, OPEN MINDS April 23, 2013
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The word "integrated" has reached the point of no meaning (like "quality", "managed care", and "clinically appropriate" to name a few). We've reached the point that when someone uses "integrated" as an adjective, you need to ask for a definition.
It may not seem to be that important, but in my work with all types of organizations in health and human services, I'm seeing a misunderstanding of the words "integrated" and "coordinated" taking many organizational strategies far off course. The problem is that the two terms, while considered synonyms, have taken on specific constructs in the field. So, I want to discuss two concepts that are now critical to "Strategy 101" in health and human services.
First, "integrated" versus "coordinated" - Coordination is what payers and consumers want. It means getting appropriate services and minimizing duplicative services for individual consumers through enhanced communication around a consumer's care. A good description of "coordinated care" can be found in Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies<http://www.ncbi.nlm.nih.gov/books/NBK44012/> (Vol. 7: Care Coordination):
* [It] Involves numerous participants
* Participants are dependent upon each other to carry out disparate activities in a consumer's care
* Each participant needs adequate knowledge about their own and others' roles, and available resources
* Participants rely on exchange of information; and
* [It] Has the goal of facilitating appropriate delivery of services
Classically, "integrated care" is the fulfillment of system aims to facilitate cooperation and collaboration among and between the various parts of an organization or a system - essentially the "glue" that bonds the entity together to achieve common goals and optimal results (for more, see Integrated care: meaning, logic, applications, and implications - a discussion paper<http://r20.rs6.net/tn.jsp?e=001JnaKSaJxTRd-U74I_EogHyX7nde4t9chjRrgbQRHvMAVyHLCnxktca4Pw1bJWd5BnnExGUn2VLwgzOx4DPL3zFOm705pCGbMJYDtdG7KVWW3mwv7qA94NrHmXSuUysL_hM5b_NksQ7wfbYMAhG8ibs5V8oBBREe_>). Integration is more about the operation of an entity than communication between entities - with five key domains:
* Service delivery
* Clinical In my view of the field, integrated "systems" are a means (but not the only means) of achieving the highly-desired competency of coordinated care.
Second, integrated care management versus integrated service delivery - Assuming that your organization wants to "integrate", so as to deliver the coordinated care that both payers and consumers want, it is important to differentiate between integrated care management and integrated service delivery.
We have a whole new lexicon of integrated care management entities - ACOs, medical homes, health homes, disease statement management programs, wraparound services, coordinated care programs, and more. These "care management entities" do just that - they coordinate consumer care as a replacement of, or adjunct to, "managed care."
Integrated service delivery systems, on the other hand, are about the delivery of services - not the management of services. In the current market, this is most often the "one-stop shop" concept of all services in the same organization.
As every organization in the health and human service field (from large health insurers to hospital systems to private practices and specialty social service organizations) work on "repositioning" in a turbulent market, sorting out the local market factors and many models - to find a sustainable market position - is the challenge. This is strategy work at its most fundamental.