[EQ] ACROSS THE POND - LESSONS FROM THE US ON INTEGRATED HEALTHCARE

ACROSS THE POND – LESSONS FROM THE US ON INTEGRATED HEALTHCARE

Richard Gleave

The Nuffield Trust - London UK

 

http://www.nuffieldtrust.org.uk/members/download.aspx?f=%2fecomm%2ffiles%2fAcross_the_pond_210109.pdf&a=skip

 

 

“……….This report starts by exploring the differences between the conceptual models of integration between the UK and the US and then identifies potential lessons for the NHS from the US experience under three headings – integrated governance, risk management and the use of incentives, and the role of integrated information

technology.

 

The experience of larger integrated systems, especially the Veterans Health Administration and Kaiser Permanente California regions, has had a significant influence on the policy debate about integrated care in the UK. However, the potential lessons from the medium-sized and smaller integrated systems and other network models that are working to develop integrated delivery has not been extensively covered in the literature.

 

 This report draws on a detailed piece of qualitative research into performance improvement systems in four such systems (see Box 1) and on meetings with the leaders of a range of network organisations from around the US. The four case studies were selected using a purposive sampling frame informed by expert opinions. They were also chosen because they had core features that were common between the sites to enable meaningful comparison – thus all four case studies were not-for-profit integrated systems with a plan and physicians under single or quasi-single ownership.

 

However, the four locations had different business models and governance systems, which allowed for insightful contrasts to be identified. For example, the sites had different relationships between the health plan and the delivery system, including both ‘closed systems’, where only patients who were members of the health plan were entitled to access the delivery system, to ‘open systems’ where the doctors and hospitals would treat patients from with any insurance plan. The case studies also varied in the degree of direct management control over the hospitals, which ranged from a long-term close contractual relationship to direct line management….”

 

Content:

 

EXECUTIVE SUMMARY

INTRODUCTION

DIVIDED BY A COMMON LANGUAGE – INTEGRATION IN THE UK AND US

INTEGRATED GOVERNANCE

RISKS AND INCENTIVES

IT AND INTEGRATION

POLICY IMPLICATIONS FOR THE NHS

CONCLUSION

GLOSSARY

APPENDIX: ATTRIBUTES AND MODELS OF INTEGRATION FROM RECENT AMERICAN PUBLICATIONS

REFERENCES

 

 

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