Integrated care needs more than structural integration

care team
The structure of an organization has little bearing on a patient's perception of care coordination, according to a new study.

Medical groups may be integrating their structures to improve care coordination, but a new study suggests most patients don’t perceive the changes.

As important as integrated care is for patients, particularly those with chronic conditions, organizations attempting to improve care coordination through structural change may be barking up the wrong tree, according to the study, which was published in Health Affairs.

After looking at the structure of 144 medical groups and using a survey to gauge 3,067 Medicare beneficiaries’ perceptions of their care, the study found that patient perception of integration had little correspondence to the structure of the medical groups at which they received their care.

Patients at organizations focused on the provision of patient-centered care generally perceived their care to be less integrated than in other survey domains, according to the study. The fact that these results were consistent across organizations with both more and less structural integration suggests “dimensions of care that are important to patients are often neglected by providers in their efforts to integrate care,” per the study.

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Moreover, the authors suggest that attempts to align an organization’s structure may miss the boat entirely on the things that patients actually find important in terms of better coordinated care. Given the increasing importance of providing integrated care, the authors write, “providers and policy makers should focus on the conditions and strategies that enable structurally integrated organizations to capitalize on their ability to deliver care that is more integrated.”

The authors add that provision of such care may become more valuable as risk-based care models become more prevalent. In particular, accountable care organizations and patient-centered medical homes will need to go beyond mere structural change to deliver the integrated care expected of them by value-based payment models currently being encouraged in the industry. The study concludes that further investigation will be necessary to identify the underlying drivers of patients’ perceptions of integrated care.