34
Impact: This would:
• Improve the poor care faced by older people in the health and social care
system.
• Promote much needed integration between health and social care providers.
• Ensure that incentives are aligned within single commissioning budgets to
focus on patients, thus reversing the perverse incentives that currently exist.
4.4 Flexible primary care provision
In this new landscape, stronger primary care provision is both a positive outcome
but also a necessary underpinning service. Several interviewees argued for a far
more flexible approach, drawing on often citied international examples of best
practice (see box below).
International Examples of Best Practice
Kaiser Permanente: The largest non-profit health maintenance
organisation in the United States which serves nearly 9 million people in eight
regions. It is a virtually integrated system in which the health plans, hospitals
and medical groups in each region remain distinct organisations and work
together using exclusive interdependent contracts. The key feature of the model
is an emphasis on the integration of care- combining the roles of insurer and
provider, and providing care both inside and outside hospitals. This enables
patients to move easily between hospitals and the community and allows for
the active management of patients in primary care through care pathways.110
A report found that by providing a multi-disciplinary and integrated approach
to cardiac care for 12,000 patients Kaiser Permanente has seen a 76 per cent
reduction in all-cause mortality, a 73 per cent reduction in cardiac mortality and
$30 million in annualised cost savings.111
ChenMed: ChenMed is an innovative primary care-led group practice
serving those who are older and which has optimised its delivery system for
risk- and value- based payments, as opposed to fee-for-service.112 Operating in
the United States it differentiates itself through providing specialists at every
clinic, door-to-door transportation and limited ratios of patients to doctors
(375:1 compared to the typical 2000:1113)A report found that through this model
the practice when compared to its peers had increased patient satisfaction,
boosted the amount of time doctors and patients spent together, improved
patients' medical adherence and achieved lower rates of hospital use with 40
per cent fewer days in hospital than the national average.114
Gesundes Kinzigtal: Whilst a key feature of the German health service
system is its institutional fragmentation, Gesundes Kinzigtal is a populationbased
integrated care approach. It organises care across all health service
sectors and is run by a regional health management company in cooperation
with the regional physicians' network and two statutory health insurers. The
population-based integrated care approach is designed to lead to a substantial
population health gain realised by patients' enhanced self-management
capabilities combined with intensified health promotion and prevention within
an integrated care framework.115 A recent medical report found that this was a
"promising approach" which would lead to substantive comparative savings in
relation to normal healthcare.116
110 King's Fund, Clinical and service
integration (2010)
111 McKinsey, What health
systems can learn from Kaiser
Permanente: An interview with
Hal Wolf (July 2009)
112 The Economist, "The problemsolvers" (20 September 2014)
113 Moukheiber, Z, "Concierge
medicine for the poorest", Forbes
(23 February 2012)
114 Health Affairs, The care span:
Innovations at Miami practice
show promise for treating highrisk Medicare patients (June
2013)
115 International Journal of
Integrated Care, Gesundes
Kinzigtal Integrated Care:
Improving population health by
a shared health gain approach
and a shared savings contract
(23 June 2010)
116 International Journal of
Integrated Care, Gesundes
Kinzigtal Integrated Care:
Improving population health by
a shared health gain approach
and a shared savings contract
(23 June 2010)