In 1775, the patriot Paul Revere warned colonists, "The British are coming."
Now, more than 200 years later, if Revere delivered a warning to healthcare systems it might go something like this: "The baby boomers are coming."
The baby boomers are heading into their golden years, and they're bringing with them an increasing demand for healthcare services, particularly for chronic medical conditions.
With that as their backdrop, the healthcare consulting practice at Arthur Andersen and the National Chronic Care Consortium teamed up to study "progressive practices" in system integration and the care of patients with chronic diseases and disabilities.
The Bloomington, Minn.-based consortium is a group of 36 health systems. Consortium President and Chief Executive Officer Richard Bringewatt says the group is trying to show which system models provide the best care and services for people with chronic conditions.
Seven not-for-profit healthcare systems from around the country participated in the study. System facilities are in urban, rural and suburban areas.
The report doesn't identify the systems. Research for the study was conducted through both on-site visits and telephone interviews.
"I think the main finding is that people still believe it's valuable to integrate systems," says Jerry Reardon, the Baltimore-based director of Andersen's healthcare consulting practice. "That's going to be the most effective way to ultimately provide care-seamless care-across place and across time to people with chronic illnesses."
The study says the '90s was the decade to assemble the parts of an integrated delivery system, and the early years of the new millennium "will be focused on making those components truly work together."
What that may mean, the survey suggests, is that systems will have to shift focus from owning all their parts to partnering with others to better care for people with chronic conditions.
By partnering with others to handle duties such as claims payments or to provide access to sophisticated information systems, the study says, systems can stick to what they know best: patient care.
"Perhaps the strategic focus needs to change from amassing and owning more bricks and mortar to finding innovative ways to implement the patient-focused principles of integrated and coordinated care," according to the study.
"Do you actually need to own the nursing home or home care, or can you just have a contract?" Reardon says.
The seven systems studied had varying levels of integration, but each made the most progress in "functional integration," or their core business functions, including human resources, finance, patient registration and billing.
The systems made some progress in clinical integration, although "comprehensive, systemwide clinical integration seems to be a challenge for all health systems."
The reasons cited include:
* Different cultures in various system components.
* Lack of integration leaders.
* Lack of physician support.
* System size and geographic disparity.
One thing the study makes clear is that physicians must be involved if integration is going to work.
However, the level of physician integration was only "low to moderate" in six of the seven systems studied.
Another vital piece of the integration puzzle is information systems.
"Information technology is the least-advanced area of functional integration, yet it is acknowledged as one of the key factors in achieving systemness," according to the study.
Some healthcare organizations are using information technology in innovative ways.
One system created a patient registry, which provides information to primary-care doctors across the system. For example, through the registry doctors can compile the names of all their patients with cardiac diseases and highlight those who are overdue for tests or checkups.
Another healthcare organization uses its information systems to track patient-satisfaction scores.
When a physician's scores fall below par for three consecutive quarters, the health system sends the doctor to a training course.
Additionally, the system's information technology tracks physician compensation, which is tied to patient-satisfaction scores.
Regarding disease-management programs, the study found that the systems out in front dedicate the most money and personnel to the effort.
For example, one system assigns a team of administrators and caregivers to each clinical area developing a disease-management program.