Designing Healthcare Systems That Work for People With Chronic Illnesses & Disabilities

Consumer-Centered Integrated Care Systems

"Consumer-centered care" refers to care that has joint participation from both the provider(s) and consumer(s). It requires consumer participation at many levels, professional collaboration, a supportive organizational structure, clear understanding of the needs of the population being served, and integration.

Integrated care—provided across settings and caregivers—requires that all caregivers/providers agree on goals, information/communication systems, incentives, and coordinated policy.

Coordinated care seeks these same objectives but falls short of full integration. Coordinated systems often require a larger governmental role than integrated systems.

Dr. Bowers and Mr. Saucier stressed that integration is not achieved by simply pooling funds; planning must occur on many issues to keep services from "re-fragmenting" and to develop a consumer-centered system. The critical questions are:

• Who is ultimately responsible?
• How does that person/entity relate to all the other players?

The New England States Consortium's Service Delivery Work Group is developing guidelines to help policymakers think through the issues related to integrating health and long-term care for Medicaid and Medicare beneficiaries. The guidelines are intended to be flexible enough to encompass a range of approaches across States, from fully integrated systems to more loosely coordinated networks and can be used at various stages of planning. Each issue is examined from three vantage points: the point of care, the plan or provider organization, and the government.

Categories are:

• Consumer and family involvement in both program and care decisions.
• Enrollment and screening.
• Assessment and coordination of complex needs.
• Communication and collaboration among care providers.
• Consistency of providers.
• Enhancing system accountability for outcomes (and reducing "buck-passing").
• Financing and payment integration issues.

Reference

New England States Consortium. Guidelines for consumer centered integrated care systems serving dually eligible beneficiaries and other adults with special healthcare needs, [working draft]. The Consortium, Portland, ME; 1999 Nov.

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