Is the focus on avoidable admission another re-invention of acute medical care in the guise of Integrated Care?
"The conceptual model at the foundation of America's health care system is the acute care model. As a result, the system is structured first and foremost to prevent, diagnose and treat acute medical conditions." - How the Current System Fails People with Chronic Illnesses
With the rising cost of health care, and the relatively poor cost effectiveness of care in this country, the health care service model changeover from an acute care model to a chronic disease management model has been well forecasted.
This includes the mounting pressures to:
- Address unabated high cost of acute care,
- Decrease use of acute care for non-acute services,
- Enhance the consumer’s health literacy knowledge base to yield increased patient involvement in his/her treatment,
- Increase emphasis on population health management and the impact of health disparities with advances in curative treatment lowering mortality risks, and
- Focus on early screening and preventive care of high cost sequela resulting in an acute care population living longer but with more chronic disease management needs.
Thus, the national push to address reduced cost with improved models for integrated care must take into account a paradigm shift from acute care to a true integrated chronic care model. This requires different measures other than preventable admissions of acute care. Otherwise the focus continues to be acute care, not integrated care. For example, pay-for-performance measurescontinue to focus on acute care need and primary health care intervention. Yet there are recognized behavioral health measures for initial screenings and assessments, medication adherence and support interventions, all of which can be facilitated without a designated behavioral health professional. Value based payment structures exist that recognize “cross stream” providers that collaborate and support preventive interventions and chronic disease management to achieve the Triple Aim of lower cost, quality treatment experience and improved population health outcomes.
In this new paradigm, behavioral health is not an intervention for just “wellness management” but of active treatment and engagement for continuous care to prevent disease escalation and bolstered by supports for emotional health. Integrated care without an emphasis on disease management, and patient involvement only equips those tasked for change with an inadequate toolset.
A system change for integrated care must be inclusive of true integrated care strategies and indicators, include providers across the disciplines, and bring intelligent data applications with robust data platforms that support preventive interventions, patient empowerment and effective chronic disease management strategies.
Be a champion of integrated care and push the discussion from avoidable admission of acute care to integrated care planning with emotional and social health interventions. It is critical for engagement and treatment success for population health -- one complex care patient at a time.