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What To Know About Integrated Health Systems

What Is An Integrated Healthcare System? 

An integrated healthcare system coordinates efforts from a diverse team of medical professionals to survey a single patient’s mind, body, and spirit as one, maximizing the quality of care received.  This holistic approach to Western medicine has proven very effective in treating individuals with chronic and complex diseases and preventing similar conditions in others.

Today’s doctors have largely dropped the traditional concept of “mind-body dualism,” with many now asserting a correlation between mental and physical health.   By combining biological, cognitive, and behavioral disciplines through a patient-focused, team-based approach, integrated services play a unique role in paving future healthcare standards.  Integrated treatment strategies may include coordinated visits with primary care physicians, psychologists, care managers, social workers, and insurance navigators.

What Is The Goal of Integrated Healthcare? 

Integrated healthcare exists to provide for a patient’s unique needs through interdisciplinary medicine.  When successful, combining primary care with psychotherapy, social services, financial counseling, and insurance assistance through carefully coordinated measures helps ease patient stress and prevents chronic conditions like cancer, obesity, sleep issues, migraines, and much more.

Over the years, conventional healthcare has come under scrutiny for its impersonal, bureaucratic nature, high costs, over-reliance on pharmaceuticals, lack of transparency, and the deprioritization of patient education and chronic disease prevention.  With public access to information at its highest and constantly growing, many newly empowered consumers have become dissatisfied with traditionally paternalistic healthcare practices and begun advocating for more integrated systems.

How Does Integrated Healthcare Work? 

Your integrated healthcare experience will vary depending on your personal needs, insurance coverage, and existing health concerns.

Who Can Access Integrated Healthcare? 

Anybody can access integrated healthcare, given they find a primary care clinic that participates in a team-based approach to medicine.  This network of professionals sometimes share offices within the same building or lot.  Other times, they may coordinate services remotely by sharing encrypted electronic data online.  

Integrated care systems rarely impose more than baseline eligibility requirements, generally equal to that of most ACA marketplace plans.  Most networks prefer you have comprehensive, compliant health insurance coverage and live in the same region you plan to receive services.  Patients must also agree to standard cost-sharing procedures and coverage exemptions.  Essentially, anybody who wants their physical and mental needs treated holistically can join an integrated health system accepting new patients.

Where Do They Provide Integrated Healthcare? 

The Affordable Care Act of 2010 promoted the expansion of mental health services into primary care and addiction treatment to increase national access to quality health care.  In complying with these standards, many insurance carriers updated their policies to include services received within integrated healthcare systems.

Eligible Americans can compare and purchase insurance policies that cover integrated healthcare on the ACA Marketplace.  Because many employers have found that employees receiving mental health services work more productively and spend less on healthcare, a significant amount have begun to sell group insurance policies with integrated coverage.  Similarly, the CMS has many programs encouraging states to allow Medicaid and Medicare delivery through integrated systems. 

What Services Encompass Integrated Healthcare? 

In acknowledging that depression, stress, and financial concerns can compromise treatment effectiveness for chronic conditions, integrated healthcare professionals act as a team to work toward the best possible patient outcomes.  For example, your doctor might recommend a therapist to determine if physical symptoms have psychological roots.  This therapist might refer you to a social worker to help you through adversity in your personal life.  Meanwhile, insurance navigators can help explain coverage details, secure referrals, and manage costs.  

These professionals will continuously share notes and records through a secured digital database.  Though this eases the coordination process, doctors must remain wary of federal and local laws regarding patient confidentiality, self-referrals, exchanging favors, and other potential forms of malpractice. 

Types Of Integrated Healthcare 

Integrated healthcare is generally divided into two different categories: horizontal and vertical. The main differences lie in how they cooperate. Horizontal integration often refers to collaborating at the same level of care, like hospital to hospital. Vertical refers to different levels or stages of care.

  • Horizontal integration:  Coordinated care between health facilities, social services, and other providers centered around multi-disciplinary attention on a specific client group, such as senior citizens or underserved immigrant populations.
  • Vertical integration: Connects primary, hospital, community, and tertiary care services through protocol-driven approaches for people with particular conditions like cancer, COPD, and diabetes.  Vertically integrated systems also facilitate transitions between hospitals and community-based providers.

Though each method offers unique benefits, they are not mutually exclusive.  Coordinated networks can combine elements of horizontal and vertical integration as best suits their medical philosophy and even wholly integrate their systems to meet the diverse needs of entire populations.

Which Doctors Are Involved? 

System integration in healthcare involves a team of medical professionals, including:

  • Primary care physicians:  Utilize their deep knowledge of a patient’s needs to make educated referrals, recommend transfers, and annotate medical records for shared use.
  • Hospital doctors, surgeons, and specialists:  Perform complex procedures and implement specialized treatment strategies in standing with PCP guidance.
  • Psychologists:  Address behavioral and mental impacts of chronic conditions and prescribe relevant prescriptions in coordination with the overseeing doctors.
  • Family therapists:  Identify lifestyle and personal issues contributing to chronic conditions, offer advice, and coordinate with psychologists and doctors to eliminate unnecessary procedures and pharmaceuticals.

Additionally, many non-medical professionals like social workers, care coordinators, and insurance assistants cooperate with these doctors to achieve the best possible patient outcomes.

How Much Does Integrated Healthcare Cost? 

Studies have shown that patients in integrated medical systems spend significantly less overall on healthcare and experience more positive outcomes.  However, this discrepancy primarily comes from improved mental health decreasing the need for repeat medical attention, meaning that costs from service to service remain relatively similar to traditional healthcare.

Remember that healthcare expenses vary widely depending on your insurance, medical condition, location, doctors, etc.  The chart below broadly estimates what integrated care patients may spend out-of-pocket in a given year.

Cost
Integrated Care
Traditional Healthcare
Premiums
$3,402/yr
$3,402/yr
Copays
$130/yr
$180/yr
Coinsurance
19% for eligible services.
19% for eligible service.
Prescriptions
$980/yr
$1,250/yr

Who Should Consider It? 

Integrated healthcare best suits individuals with complex needs and chronic diseases like obesity, diabetes, recurring pain, addiction, and cancer.  These patients often require interdisciplinary attention, leading them in and out of hospitals, therapy centers, and specialists’ offices.  When utilized effectively, integrated services prevent fragmentation between these facilities, allowing for continuous, informed care that often results in more positive outcomes.

While chronic patients have the most to gain, anybody with mental, physical, or behavioral concerns could benefit from joining an integrated healthcare system.  Research conducted through the years has repeatedly affirmed that our bodies and minds are connected and that managing stress, anxiety, depression, and emotional trauma can directly correlate to reduced disease and chronic pain.

Pros
  • Reduces medical costs
  • Facilitates quick decision making
  • Reduces policy management time
Cons
  • Can confuse healthcare providers
  • Risks data breaches
  • Can cause disagreements between providers

Advantages 

Integrated health care offers many benefits, including:

  • Reduces medical costs over time.
  • Immediate access to medical records prevents fragmentation and allows integrated providers to make quick decisions and identify health needs early on.
  • Saves patient’s time on policy management.
  • Employees with easier access to mental health benefits tend to work more efficiently and take fewer sick days, improving workplace morale.
  • Reduces the likelihood of homelessness, psychiatric hospitalization, drug rehabilitation, and emergency room visits.
  • Gives providers and patients the information needed to prevent chronic conditions from developing.
  • Social workers and care managers can help patients navigate unique financial and personal hurdles.
  • Insurance assisters can guide patients through complex coverage details, network restrictions, referrals, and medical expense planning.

Disadvantages 

However, healthcare integration does present a few key downsides:

  • A lack of standardization in data management, storage, and sharing can confuse participating healthcare providers.
  • Sharing information between multiple facilities increases the risk of data breaches and malfunctions.
  • Medical providers of varying disciplines may disagree on the best approach to treatment, delaying or complicating required services.
  • Achieving and sustaining integration can prove difficult, considering the complexity of these systems and the many parties involved.
  • Integrated care requires a larger workforce, most requiring specialized IT training.
  • State and federal policies can hinder reimbursement.
  • Reduces competitive business and can lead to unethical practices like self-referrals and exchanging favors in bad faith. 

Putting It All Together 

As increased access to online information has empowered consumers nationwide, many have become dissatisfied with traditional healthcare’s impersonal and one-dimensional nature.  To combat this, some individuals learned about and opted into integrated systems combining services from a diverse team of medical professionals.  This coordinated approach to healthcare has shown comparable efficiency when improving a patient’s physical and mental well-being together as one.

Though integrated healthcare is still developing and not perfect, it offers patients and doctors many advantages.  Furthermore, it helps prevent and manage chronic conditions by factoring in lurking emotional and behavioral issues, potentially playing a significant role.  If you believe you could benefit from coordinated, holistic medicine, talk to your doctor or insurance agent about enrolling in an integrated healthcare system.

Chronic diseases usually affect multiple bodily systems.  Whereas conventional doctors may isolate symptoms and prescribe parallel treatments, such as independent prescriptions for migraines and depression, integrated doctors will view your body and mind as one to determine the root cause and potential relation of these problems.  For example, patients experiencing multiple physical health issues may find they all link back to their dietary choices, lifestyle, or lingering stress and anxiety.

Healthcare providers within the same system will freely share your personal and medical information to streamline cooperative diagnosis and treatment strategies.  Patients should remember this to avoid surprise at their medical group’s knowledge of any confidentially shared details.  Because this frequent channeling of data makes records more vulnerable to infiltration, medical providers must practice standard encryption methods, work cautiously, and keep your information private outside of medically necessary purposes.

The team-based approach and free-sharing of data between affiliated doctors in an integrated healthcare system make it easier for these professionals to conduct and compare research and modernize treatment strategies.  By studying the connectivity of all biological activities and cross-referencing discoveries with other specialists and psychologists, doctors can craft alternative remedies that occasionally prove effective enough to become standardized medicine.

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