Top 3: UK Coordinated Care Findings

Care Coordination is a key concern in the UK healthcare landscape as it is globally. The need for systems to be integrated in order to reap business process benefits as well as capitalizing on the sheer mass of data that healthcare organizations produce on a daily basis is driving healthcare providers to seek out assistance from IT service providers to not only establish an integrated infrastructure but to also guide them through the possibilities of what value can be attained through this exercise. Today, I look at three characteristics of the UK healthcare ecosystem and its current status with coordinated care.

1. Healthcare providers struggle to coordinate care outside of the hospital: Between 2013 and 2014, the National Survey of Bereaved People (VOICES) was commissioned by the NHS to assess experiences of care in the last three months of patients' lives. The key point that stood out the most in my opinion was that healthcare providers struggle to coordinate care when the patient is outside of their usual care setting whether that be a hospital or at home. By no means is there a lack of technology in this area to enable coordination as there is a multitude of devices and means of communicating between care sites. The healthcare ecosystem however struggles with streamlining, integrating and standardizing workflow processes and in conjunction with telehealth technological developments, this is where IT service vendors need to be able to add value to their clients and ultimately their patients.
2. The introduction of the NHS vanguard sites demands care coordination: In January 2015, the NHS launched a program inviting individual organizations and partnerships to apply to become 'vanguard sites'. These are, in essence, test cases for new models of care going forward. Looking at the requirements set forth by the NHS, it is clear that success will not be possible without coordinated care. Throughout the ideologies of what the new models of care will look like, we see direct references to becoming an "integrated provider", having a "joined-up electronic health record" and using "patient population segmentation". In fact, the description of 'Enhanced health in care homes', even references how new telehealth technologies can be applied to provide better care. Together with MarketsandMarkets' forecast that the Population Health Management market will grow at a staggering 26% CAGR between 2013-2018, this further supports the need for IT vendors to sharpen up their integration capabilities and offer solutions that genuinely deliver coordination across the IT landscape.
3. The NHS is investing in support for harnessing technology such as interoperability: On the 31st July 2015, the NHS published a support pack for all vanguard sites. In section 5 of this document, it speaks to what will be made available for participating vanguard sites. Apart from a £200m transformation fund (of which around £140m remains unallocated as of this blog post), they plan to provide dedicated support for items such as interoperability, information governance and digital strategy. They are also looking to leverage best practice examples both from within and outside of the UK and so IT vendors will need to ensure they have solid case studies to back up their sales pitches.

Best Regards,

Jonathan Cordwell
Research Analyst, Healthcare Strategy
ResearchNetwork, CSC

1. Office for National Statistics, Statistical bulletin: National Survey of Bereaved People (VOICES), 2013, http://www.ons.gov.uk/ons/rel/subnational-health1/national-survey-of-bereaved-people--voices-/2013/stb---national-survey-of-bereaved-people--voices-.html?format=print
2. NHS England, New care models – vanguard sites, http://www.england.nhs.uk/ourwork/futurenhs/5yfv-ch3/new-care-models/
3. MarketsandMarkets, Population Health Management Market worth $40.6 Billion by 2018, http://www.marketsandmarkets.com/PressReleases/population-health-management.asp
4. NHS England, Vanguard support package launched, 31 July 2015, http://www.england.nhs.uk/2015/07/31/vanguard-support/

Coordination > Consolidation

As we have seen over previous years, there has been widespread consolidation in the healthcare market. Both providers and payers alike have been making acquisitions within their locales. Their goals include improving integration across their organization while reaping other benefits such as expanding revenue streams. Although this may seem a viable option right now, this will present challenges in the near future and so here are a few reasons why coordination might be a better bet than consolidation:

Consolidation

• Fewer options will result in higher cost for the patient: In some areas of the US, there are only one or two insurers. As competition decreases, the market drives towards a virtual monopoly and these payers are able to demand higher prices from consumers. This will drive consumers to seek out alternatives, and with this consumer demand will come new independent entrants into the market delivering a greater quality/value proposition, with whom the larger, consolidated health systems will struggle to compete.
• The rise of telehealth: As payers and providers consolidate, they solely focus on their immediate locale. With the gradual increase in adoption of telehealth, these regional borders will start to fade and patients will be exposed to more future-ready and cheaper alternatives leaving the larger, more expensive networks behind. Although consolidated health systems have the ability to drive scale and invest in telehealth, they are likely to be increasingly subjected to competitors further afield who can offer cheaper telehealth services from remote locations for non-critical care.
• Consolidation doesn't necessarily reap economies of scale: One reason why providers are looking to consolidate is to grow economies of scale. However, a 2012 study by the Robert Wood Johnson Foundation found that the main driver was to simply improve bargaining power with payers and so consolidation did not lead to true integration or enhanced performance.

Coordination

• Remain agile: Formal and informal care coordination enables both payers and providers to leverage their partner networks whilst also remaining agile enough to respond to market shifts, new competition and consumer demand. Larger, consolidated systems will find themselves unable to compete on price in a market where already around 20% of Americans cannot afford health insurance. This is supported by the RWJ Foundation study which found that price increases exceeded 20% when mergers occurred in concentrated markets. 
• Coordinated care encourages a value-based reimbursement model: As mentioned above, although consolidation seems to promote care coordination on the surface, it is usually due to financial reasons and so fails to achieve improved patient care. As the healthcare market progresses from a fee-for-service model to a value-based-care model, providers will be judged on the quality of care they are administering. A true effort to coordinate care will improve the quality of care whereas those purely looking for financial benefit may end up having to play catch-up.
• A multitude of both financial and operational benefits: The benefits of care coordination range from empowering patients, improving the delivery of care and increased efficiency to reduced costs, streamlined workflows, reduced waiting times and improved patient outcomes. Providers who have not consolidated have still been able to reap the benefits of coordinated care and so it makes sense to integrate, coordinate and remain agile.

Best Regards,

Jonathan Cordwell
Research Analyst, Healthcare Strategy
ResearchNetwork, CSC