Presentation from Dennis L Kodner, International Visiting Fellow, The Kings Fund, Co- Director of the Aetna Foundation Care Co-ordination Study

1. INTEGRATING HEALTH AND SOCIAL
CARE : International Evidence and
Lessons
Age UK
Services for Later Life 2012
London, UK, 12 July 2012
Dennis L. Kodner, PhD, FGSA, International Visiting Fellow & Co-Director, Aetna
Foundation Care Co-ordination Study, The Kings Fund - Email: DLKodner@aol.com

2. “INTEGRATION” AND “INTEGRATED
CARE” DEFINED
“…a coherent set of methods and models on the funding,
administrative, organizational, service delivery and
clinical levels designed to create connectivity, alignment
and collaboration within and between the cure and care
sectors…[to]…enhance quality of care and quality of
life, consumer satisfaction and system efficiency for
patients with complex problems cutting across multiple
services, providers and settings. The results of such multi-
pronged efforts to promote integration…is called integrated
care.”
(Kodner & Spreeuwenberg, 2002)
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3. MATCHING INTEGRATED MODELS WITH
CLIENT NEEDS (Leutz, 2002)
CLIENT NEEDS
LINKAGE CO-ORDINATION FULL INTEGRATION
Mild to moderate Moderate to severe Moderate to severe
SEVERITY
STABILITY Stable Stable to unstable Unstable
DURATION Short to long-term Short to long-term Long-term to terminal
Mostly routine/
Routine/non-urgent sometimes urgent Frequently urgent
URGENCY
SCOPE OF NEED Narrow to moderate Moderate to broad Very broad
SELF-DIRECTION Self-directed Moderately self-directed Weakly self-directed
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4. EVIDENCE: IS INTEGRATED CARE
WORTH IT?
Mixed evidence from programmes and projects in North America, UK,
Europe, and Australia specifically targeted to the frail elderly and other
populations with chronic, disabling and medically complex conditions
suggests that integrated care is capable of achieving positive outcomes,
although it is not always clear which combination of strategies—and under
what circumstances—produce the best results:
 Expanded service access, including primary care +++
 Enhanced co-ordination and continuity +++
 Improved health and functional status ++
 Reduced hospitalisation/nursing home admission/LOS ++
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5. EVIDENCE: IS INTEGRATED CARE
WORTH IT? (cont’d)
 Improved patient/client/user experience, quality of life (QoL),
and customer satisfaction +++
 Reduced carer burden ++
 Greater efficiency +
 Controlled/reduced costs +
 Perceived improvements in partnership working; also greater
focus on governance and guidelines. +++
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6. KEY LESSONS
Compelling vision, logic, theory, and evidence lay behind successful
integrated care models for the frail elderly. Generally speaking, integrated
care works. There are nine (9) main elements—probably acting
synergistically—that account for overall impact:
1- Person-centred focus on frail elderly with relatively high care
needs, including careful targeting
2- Responsibility for identified population and/or geographic area,
including single entry point into system
3- Case managed, inter-professional, evidence-based team care
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7. KEY LESSONS (cont’d)
4- GP involvement, preferably an active role
5- Direct control over broad package of services
6- Heavy emphasis on service and clinical integration
7- Organised network of providers
8- Common organisational umbrella or “home,” including centralised
or cross-agency governance/accountability arrangements and
shared culture
9- Alignment of financial and other incentives, including funding
flexibilities (e.g., funds pooling, single funding envelope or
capitation).
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8. FINAL THOUGHTS
While we are beginning to understand the parameters of successful
integrated care programmes, it is clear that much more work needs to be
done to unpack the transformative power of system-service-clinical
integration. Here are some final thoughts:
 Forget about one-size-fits-all approaches
 Start from where you are and fine tune the model over time
 Success demands social entrepreneurship, innovation, and risk-
taking, as well as time and resources to achieve
 Specialise; don’t generalise
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9. FINAL THOUGHTS (cont’d)
 Scale matters
 Seriously weigh benefits of community- or neighbourhood-based
models vs. regionalised systems of care
 Always keep the patient/client/user/customer—and their family
carers—at the centre of the caring enterprise
 Focus first on outcomes, not costs
 Support development of integrated information systems
 Step up education and training activities in integrated care at
all levels.
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10. INTEGRATING HEALTH AND SOCIAL
CARE : International Evidence and
Lessons
AgeUK
Think Globally, Act Locally Seminar/
Services for Later Life 2012
London, UK, 11-12 July 2012
Dennis L. Kodner, PhD, FGSA, International Visiting Fellow & Co-Director, Aetna
Foundation Care Co-ordination Study, The Kings Fund - Email: DLKodner@aol.com

11. INTEGRATING HEALTH AND SOCIAL
CARE : International Evidence and
Lessons
AgeUK
Think Globally, Act Locally Seminar/
Services for Later Life 2012
London, UK, 11-12 July 2012
Dennis L. Kodner, PhD, FGSA, International Visiting Fellow & Co-Director, Aetna
Foundation Care Co-ordination Study, The Kings Fund - Email: DLKodner@aol.com