Coordinated Care Lessons Learned from the OECD: A Review of the Literature

Paper summary: Overcoming fragmentation in the delivery network is a critical factor in achieving better health system performance. As health systems around the world expand to meet the population’s growing demand and rising expectations, the failure to address the fragmentation in care between primary care, specialists and hospital care will lead to increasing cost escalation and declining quality of care. The literature review of nearly ten years of coordinated care programs across the OECD shows that successful disease management or coordinated care efforts share a number of common design components. The paper highlights successful experiences and synthesizes the lessons learned for emerging market countries that aim to achieve greater integration. Introduction: Fragmentation is at the heart of the ineffectiveness of our increasingly chaotic efforts to achieve improvements in health systems. As health systems around the world expand to meet the population’s growing demand and rising expectations, the failure to address the fragmentation in care between primary care, specialists and hospital care will lead to increasing cost escalation and declining quality of care. Methods: The paper reviews the experience across the OECD with the introduction of integrated delivery systems, or coordinated care, to address the issue of system fragmentation. The paper follows the definition of integrated delivery systems established by Shortell (1984), that defines them as "a network of organizations that provides, or organizes in order to provide, a continuum of coordinated services for a defined population, and that is accountable for its clinical and financial results and for the health status of the population served. These systems, widely participated and vertically integrated, offer an extensive range of ambulatory services, hospital, of acute and chronic, and home care”. Discussion: The study shows that there are a number of common features that should be developed under any initiative for coordinated care. These range from the definition of the scope of the program to the content of the coordinated care efforts and the role of the providers in the system. The OECD experience points to a number of core components: Reference Population. Defined population and defined territory. Priority Health Needs. Based on the health needs of the population within a defined territory; Focused on the risks or pathologies of the population Scope of network of services. PHC based coordination strategy. Regulated access to specialists.