Kelan Daly,  KPMG, Healthcare Consulting Director

We all know that health systems around the world face intense pressure from escalating demand. Hospital emergency departments can vouch for this. We also know that there is evidence to suggest that many of these patients could be treated and cared for in settings outside the hospital.

Many healthcare systems are still reactive, and the imbalance between specialty hospital-based care and community-based care still exists. Our systems are often configured to treat people at times of crisis in hospitals and are poorly designed to prevent hospitalisation or proactively treat people in the right care setting. Many politicians and system leaders believe out of hospital, community-based services are a vital component in shifting the provision of care and alleviating the financial and operational pressures in hospitals. However, the real driver for community services is to promote good population health and prevention at scale, increase easy access to services, and to reduce system-wide costs.

Well-functioning out of hospital, community-based services keep people well, help them to live independently, and ease pressure elsewhere in the health system. Despite the wide variation in systems, politics and funding, when we look across the globe, we see a series of common challenges and solutions. These out of hospital, community-based services can play a vital role in the move to broader integrated care networks that place the individual at the centre.

Designs for integrated care have been around for a long time. Some models are more effective than others. The case studies and lessons learned can be easily found. Getting there requires a change in thinking and attitude, with the focus on improving individual health outcomes by working in partnership across the system. Across KPMG, we’ve been looking at what we can learn from the different journeys health systems have been on, what has worked well, and what has worked not so well. Through sharing our collective experience, we’ve spotted five key traits to help bring about success in out of hospital care delivery:

  • If integrated care systems and networks are to flourish, it is vital that out of hospital, community-based services are at the centre of these plans. When considering healthcare system design and delivery models, the priority should be improving the quality of care and care coordination, rather than structural or organisational solutions. There are successful international examples such as the Clalit Health Maintenance Organisations (HMO) in Israel that people can learn from.
  • OOH interventions and solutions can improve patient experience, alleviate system pressures and reduce costs. Successful interventions typically target particular groups of patients (e.g. COPD), actively involve patients in their care, reduce service fragmentation, support and train staff, and address gaps in services.
  • Focus on collaboration and coordination. Patients and service users are often in contact with multiple health and care professionals during their treatment. To deliver high-quality OOH care, you need to draw on a broad array of partners and develop multidisciplinary teams of health and social care professionals, who work together and look holistically at the patient’s needs. Digital transformation and connecting care technologies are vital components in delivering seamless OOH care.
  • Primary care can play a lead role in coordinating care for patients with multiple needs, and evidence shows that health systems with a high-performing primary care sector achieve better health outcomes, better equity, lower mortality rates and lower overall costs of healthcare.
  • Digital disruption to traditional models of care creates excellent opportunities to deliver efficiencies, but health system leaders should carefully consider where to invest.

Designing the end state is just the beginning. It is the journey we all go on, together in a coordinated way that respects the contributions of all parties that puts the “Integrated” into Integrated Care.