Integrated healthcare and population health management are the new buzzwords. So two questions. Are they really happening? And what does this mean for for-profit health care?
A senior executive in a big international operator once told me he had been tasked with investing in integrated healthcare. He was pretty pissed off about this. In Europe and emerging markets there are very few for-profit operators who do this as their main business and even fewer who do it at scale. “What does it even mean?!” he asked me, pleadingly, over lunch.
You could also ask whether integrated healthcare isn’t just some soft and fluffy construct which makes politicians feel happy and achieves little else.
The correct answers are “yes, it is happening.” It is big, hard and achieves stuff when done properly. For-profit has, so far, had little or no involvement in its implementation. But you’d better take it seriously.
By integrated healthcare we mean aligning all the services which a citizen has access to in order to achieve greater health and happiness. This, for instance, is what has happened in Wigan over the last seven years. Care workers and doctors meet and talk weekly. Dustbin men look out for the elderly. People start doing stuff for themselves and others. Our casestudy shows that it has cut costs by over £130m, increased quality life expectancy by between a year and a half and nearly two years depending upon your sex and made Wiganers the happiest people in Greater Manchester. It is worth looking at this video and reading the report from health charity The Kings Fund, to get a better feel. (If you aren’t British – thee’ll need captions on to understand t’video).
Similar initiatives are happening elsewhere in Europe. But they only work if there is real, long-term culture change among health care workers. For many, decades of encrusted scepticism needs to be rubbed off first.
And these projects are unlikely to go on working unless governments start to dream up payment systems which reward quality outcomes rather than activity. Municipalities and healthcare systems also need access to robust data platforms and experts which enable them to properly segment their patients by condition. Someone needs to tell NHS England that adjuring primary care doctors to create a spreadsheet and start a conversation with the local pharmacist and care home isn’t going to cut much ice.
So what of the private sector?
The Alzira model which encouraged this sort of behaviour is being demolished in Spain by leftist politicians. The standout example in Europe is Gesundes Kinzigtal, where Optimedis, a small German company which has now gone international. Elsewhere, the big Finnish groups sell a vast range of services to municipalities and may (for all we know) be merging some of these together to create integrated healthcare at a local level. The big occupational healthcare networks Medicover, Mehilainen and Terveystalo are providing a degree of integration for the 4-5m people they collectively look after.
US insurers do a bit. But it is hard to separate their talk from their trousers. And they aren’t doing much outside of the USA.
Centene and Optum offer the data platform and management expertise in the UK. Generally, they are not winning much business.
Imaging services group Alliance Healthcare was kind of doing integrated healthcare when it cuddled up to lost of expert medics in the UK NHS and showed them how they could pool resources and what would happen. (What happened was that Alliance won a vast national contract).
So the private sector does have a wider role. We think integrated health care is going to become a reality in all well-functioning states. How else are we going to improve health outcomes and control costs as the old get older and we all live longer, sicker? The response from any for-profit operator should be to embrace the concept, find local partners and change your culture away from one where you just do what pays to one which does best for your patients. That, after all, is the only way you are going to retain and recruit staff. So start walking the walk and cuddle up to integrated healthcare. Get out of your silo.We would welcome your thoughts on this story. Email your views to Max Hotopf or call 0207 183 3779.