Why Alignment Matters: The Role of Integrated Practice Units

Health care policy makers have tried many incremental fixes in the past, including reducing errors, attacking fraud, making patients better ‘‘consumers,’’ enforcing practice guidelines and implementing electronic medical records in a bid to improve the quality of health services delivered while reducing cost. All these efforts have, unfortunately, fallen far short of their intended goal. This calls for a fundamental change of strategy. There is an ongoing transformation that aims at maximizing value for patients while lowering costs. The new system is moving away from a supply-driven health care system that is organized around physicians to one that is focused on the needs of patients. Metrics such as physician visits, procedures, hospitalizations and tests are taking the back seat in favor of patient outcomes achieved. The current health care delivery structure has been sustained for many decades primarily because it has relied on a set of mutually reinforcing elements including: • Organization by specialty form independent private-practice physicians; • Cost accounting that is driven by charges and not by costs; • Measurement of quality defined by process compliance;

• Fee-for-services payments done according to specialty with numerous cross- subsidies; • Delivery systems that duplicate service lines with little integration; • Siloed IT system built around medical specialties; high fragmentation of patient populations that make it difficult for providers to achieve a critical mass of patients for specific conditions in a given region. The new system seeks to correct these anomalies by using the following measures: • Organizing into Integrated Practice Units (IPUs) • Measuring outcomes and costs for each individual patient • Moving to bundled payments for care cycles • Integrating care delivery across separate facilities • Expanding excellent services across geographies

Organizing into Integrated Practice Units At the core of this value transformation is changing the way physicians are organized to deliver health services. For a business to succeed, it needs to be organized around the needs of the customer. In health care, this requires a shift from the current siloed organization by specialties and discrete services to organizing around patients’ medical conditions. This is what is referred to as integrated practice units, or IPU.

IPUs are designed to treat not just one disease but other related conditions that commonly occur along with it--if a patient has diabetes, they also get treated for kidney or eye disorders that are common in diabetic patients or if a patient is suffering from metastatic cancer, they receive palliative care as well.

Take the case of patients with low back pain--one of the most common causes of disabilities. Under the conventional care systems, patients receive portions of their care needs from diverse types of clinicians who in effect function more like pickup teams than integrated units. A patient might begin with a primary care physician while another might make an initial visit to an orthopedist, neurologist or even a rheumatologist. The outcomes in these cases become unpredictable. These professionals might in turn refer the patient to yet other professionals with the result that the whole treatment process becomes highly uncoordinated. Such a system makes it very difficult to improve the value of care since no one accurately measures patient outcomes, how much the care costs or how long it takes.

In primary care, IPUs are made up of multidisciplinary teams that are organized to serve groups of patients with similar primary or preventive care needs. Different patient groups require different teams and different types of services. They also require the services to directly address the role of lifestyle change and preventive care so as to achieve desirable outcomes.

IPUs are commonly applied to high-risk and high-cost patients through patient-centered medical homes. For instance, care of patients with diabetes or heart diseases involves not only the physicians but also pharmacists and other clinicians. It has been found that the involvement of pharmacists in the treatment of complex conditions such as diabetes and heart disease results in fewer amputations, strokes, hospitalizations and emergency room visits.

McInnis & Associates is a healthcare management-consulting firm that specializes in delivering exceptional value by designing solutions that meet consumer needs and increase revenue and market share. Additionally, we are healthcare experts in serving the needs of underserved populations. If you would like to further discuss integrated practice units, Give us a call at 1-866-227-9457 and we will be glad to share our expertise with you. Also, follow Miguel McInnis on Linked-In and on Twitter @McInnis_assoc