Converging health and social care | KPMG | GLOBAL

Managing the convergence of health and social care

Converging health and social care

How commissioning can deliver a consumer-centric approach | 🕒 6-min read.

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Global Lead for Human Services

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Helping people cope with complex issues, which may include factors such as housing, mental health, employment and child care, requires a coordinated response from health and human services agencies. Contemporary responses are centered around the needs of the individual, not the convenience of the provider, and reflect a deep understanding of the continuum of services available in the community.

‘Converged care’ or ‘converged support’ aims to solve this issue by bringing the social and health needs of an individual together. Commissioning can provide a structure and approach for providing converged care. By looking at the existing structure of the market (including purchasing and service delivery models), considering outcomes, and taking a customer centric perspective, new purchasing models focused on client need can be developed, and/or service paths can be re-designed and re-presented to the market.

Many paths to integrated care

Governments around the world are redesigning service systems and/or commission integrated care initiatives to improve consumer outcomes and maximize resources1. The majority of these initiatives are taking place at a single level of government, and can take a range of forms:

  • Co-location
  • Frontline, e.g. online portals or one-stop shops
  • Back office, e.g. budgets, strategic planning, finance, payroll, IT systems
  • Case management.

There are also a growing number of examples of governments taking a system-wide approach, reflecting a greater focus on consumer needs, including for individuals to be able to access services delivered by agencies in different sectors and across different levels of government.

Models include:

  • Developing new funding and purchasing models focused on client need rather than programs.
  • Integrating operations across different levels of government (inter-government integration), including joint procurement, database integration and coordinated case management.
  • Collaborating with service delivery providers in the private or not-for-profit sectors (cross-sector collaboration)2.

Converged care is better for people

When done well, converged care should mean that individuals interact with fewer professionals and have a better, more seamless, experience.

  • Easier access: Creating one-stop-shops, integrated online portals and a ‘no wrong door’ policy, makes it easier for people to locate and access the support they need. The Swindon local authority in the UK, for example, calculated it had 73 different health and human services that people could access3.
  • Fewer hours, better outcomes: As duplicated processes are phased out, case managers can gain a more holistic understanding of clients’ needs, providing more targeted and personalized care. In the Netherlands, a not-for-profit homecare firm called Buurtzorg found that moving to a converged care model reduced the number of hours’ support needed by most people by 30to 40 percent compared to the average home-care organization4.
  • Faster response times: Streamlining back-office systems can improve processing times and enable case workers to make better decisions. New York City’s Worker Connect, for example, is a shared portal for case managers to quickly determine which other agencies and caseworkers are assisting a client to help coordinate care. There are considerable benefits given more than 30% of consumers access multiple services, for example, across income support, mental health services, and housing5.

It’s also better for agencies

For governments and providers, there are considerable operational benefits of converged care, including:

  • Less duplication: The individual’s care plan is all encompassing, which reduces the unintended consequences of separate treatment or support packages.
  • Reduced demand for crisis services: Faster and more coordinated assistance can help stabilize a person’s condition and facilitate earlier interventions, reducing the need for high-cost crisis interventions at a later date.
  • Increased capacity and value for money: Reducing administrative processes (e.g. identity verification and document authentication) means that organizations can focus resources on supporting outcomes.
  • Improved strategic planning and system integrity: Sharing quality information across agencies can support better delivery approaches through high quality analysis of usage patterns and needs.

Innovating on the Isle of Wight

On the Isle of Wight, off the south coast of England, the council, the health commissioning body and not-for-profit providers have established My Life A Full Life, a single point of access, integrated care and support program. The model includes:

  • an integrated care hub, where emergency call operators, paramedics, crisis response teams, mental health workers and social workers (amongst other clinicians and service providers) are physically co-located.
  • the concept of ‘one commissioning pound’, whereby the different agencies pool their resources to address the holistic needs of citizens. Services are coordinated around the individual, with people being empowered – and given a budget - to ‘self-serve’ the services that deliver the care outcomes they need6.

Managing convergence in seven key areas

Commissioning can play a crucial role in developing consumer-centric approaches to care by focusing on collaborative, intelligent service design, rather than traditional, siloed streams. But changing a system that has been in place for decades needs a rigorous approach to achieve long lasting results.

  1. Employment conditions - It can be difficult to empower people to work beyond their traditional boundaries. In theory, for example, community nurses could be trained to undertake basic social care assessments, or social workers could conduct basic nursing assessments, but in many countries, rigid employment law frameworks inhibit this.
  2. Training - Current training models tend to entrench professional separation, based in many cases on the needs and expectations of the mid-to-late 20th century, rather than the rapidly changing market of the 21st century. Updating training models to focus on broader, transferable skills is a key step, albeit a medium to longer term one. Leaders therefore need to be prepared for – and committed to – the long term.
  3. Culture – providing integrated responses requires a fundamental shift in professional practice and culture that goes beyond training. Industries need to understand the benefits of integrated approaches, and value each other’s complementary skill sets in supporting customers to achieve their care goals.
  4. Systems - commissioners and providers must find ways to overcome challenges posed by, for example, incompatible data or systems, or legislative obstacles for sharing data. The New York City HHS-Connect project, for example, included an inter-agency data sharing agreement that defined the legal framework for agencies to share data7.
  5. Funding - Service-specific funding streams sometimes prevent agencies from sharing resources and can incentivize siloed behavior. Systems need to be designed that enable the money to follow the individual, not the organization.
  6. Performance – Knowing how current systems are performing and how well practitioners are adapting to a new integrated model is vital. Robust evaluation methods enable new delivery models to be compared with existing service provision before they are implemented. This reduces risk and enables potential issues to be identified – and resolved - before launch.
  7. Monitoring – At the system level, governments need to monitor how the market responds to newly commissioned services and intervene where necessary to ensure sustainability and viability. At the program level, whether or not practitioners adhere to the way a specific integrated delivery model is intended to be delivered will significantly impact results. Monitoring if and how new systems and tools are being used will enable problems to be addressed, or additional training opportunities to be provided.

There are significant obstacles to overcome to achieve true convergence of support and care, not least cultural expectations, rigid professional frameworks, and the requirement for markets to adapt to new purchasing arrangements. The seven key areas we have identified should serve as a starting point. But continuing to invest in traditional, under-performing delivery models is not an option governments can afford to pursue. Gone are the days of one size fits all models; rather, providers must view the whole person and their unique stories and circumstances in order to provide the best care plan possible.

Footnotes

1The Integration Imperative: reshaping the delivery of human and social service, KPMG International, 2013.

2 See The Integration Imperative: reshaping the delivery of human and social service, KPMG International, 2013.

3NHS Swindon Clinical Commissioning Group

4Gray BH, Sarnak DO, Burgers JS. Home Care by Self-Governing Nursing Teams: The Netherlands' Buurtzorg Model, The Commonwealth Fund, May 2015.

5Government Business Council and KPMG, 2016. Life After the Big Bang (PDF 360 KB).

6A revolution on the Isle of Wight? How island became health hub pioneer

7KPMG 2016, Sharing government data for a better world

 

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