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Fragmented care: the causes and what we can do about it

Our healthcare is fragmented and is lacking an integrated value chain. The solution lies in cooperation and an integrated care approach.

Mrs. Jansen, 65 years old, has diabetes and osteoporosis. She is being treated by different providers. They are all competent, but nonetheless something is missing in her care. She doesn’t seem to be a participant of the healthcare process. There is no central coordination. Every healthcare provider asks the same questions over and over again. Once she was prescribed medicines that didn’t go well with other medication she received through a different specialist. The general practitioner wasn’t aware. We can describe Mrs. Jansen’s care as fragmented. Her situation is typical for many people that have multiple complex conditions.

What is fragmented care?

Fragmented care arises when different healthcare providers and/or organizations do not effectively work together. The lack of cooperation is caused by healthcare providers working from their own silo. These silos are preserved because financing, laws and regulations, data management and education are not aligned or integrated.

Sick care or healthcare?

Medical science has brought us many good things. Illnesses that were uncurable, can be treated. The average life expectancy has increased significantly over the last centuries, in part due to medical science.

There is a flipside, however. Medical science has also stimulated far-reaching specializations, which has led to a reductionist, disease-specific approach. Human beings are seen as a collection of cells, organs and/or diseases. A disease means a ‘misfunctioning of the body’. That means healthcare has become sick care: ‘fixing’ the body. The rise of specialization has led to professionals focusing entirely on their own specialism and losing sight of the bigger picture.

Disease specific specialization has led to us organizing the needs of the patients separately from each other. If someone has complex multiple issues, they have to walk multiple care pathways. Mrs. Jansen from our example is in a care process for both diabetes and osteoporosis. This means she has to go through two care pathways and those are not always aligned, as you can tell from the issues that arise. Mrs. Jansen’s doctors are focusing on their own tasks within their silo. Overarching questions such as ‘How does the patient experience their care?’ and ‘Do different practitioners who treat the same patient align the care they are providing?’ should be much more prominent in such a healthcare approach.

Causes of fragmented care

We distinguish five factors that can lead to fragmentation:

  1. 1. Specialization. The medical model divides the body up into parts in which different types of doctors have to specialize. That is not a problem if a patient only needs help from one specialist. It is different when people are dealing with multiple complex conditions. A patient then has to deal with multiple specialists. Each one focuses on their own task, so the patient is effectively walking multiple disconnected care pathways. We need a more generalist approach for the growing group of people that have one or more chronic conditions.
  2. 2. Lack of shared accountability. Who has the final responsibility over the patient’s overall care? Who plays what role in the healthcare process? In many cases this is unclear to a patient who has complex multiple issues and to their healthcare providers. As a result, healthcare providers stay in their niche and they all work in a silo without coordinating care with each other.
  3. 3. Healthcare providers don’t have a lot of personal contact with colleagues outside of the organization. Patients with complex healthcare needs have to deal with multiple care providers from different organizations. Professionals generally only coordinate care with colleagues from within their own organization. When they need to work with external colleagues all of a sudden, this generally does not have a positive impact on the coordination of care. That makes it more difficult to align the care of patients with complex multiple issues.
  4. 4. Effective referrals take time and effort. This time generally is not financially covered.
  5. 5. Most healthcare professionals do not have a shared electronic health record, or the information infrastructure needed to properly coordinate care. This makes the coordination between the different specialisms and/or organizations even more difficult.

The consequences of fragmented care

Fragmented care can be a health hazard. Prescribing different types of medicines without coordination causes serious health and economic risks. Research has shown that the number of unwanted hospitalizations in patients with inadequate care coordination is higher than for patients whose healthcare has been well coordinated.

Then there are the cost-related matters. Research has shown that fragmented care is twice as expensive as the integrated healthcare approach. This is largely due to duplicate tests, unnecessary services and medications, also known as polypharmacy.

The solution: cooperation

If parties fail to coordinate care, the simplest solution seems to be: better cooperation. Healthcare providers need to work towards a more integrated care approach. The patient needs to play a central role. All healthcare providers and other parties involved should know their medical history, preferences and needs.

What are the basic elements for an integrated care approach? We can distinguish between the following seven:

  1. 1. Integrated payment models. If we want to work together effectively, we need financial incentives that stimulate coordination of care across care providers involved. The lack of these models makes cooperation extremely difficult.
  2. 2. A renewed organizational structure, with more cooperation and multidisciplinary teams.
  3. 3. A shared electronic health records (EHR). That way, healthcare providers have access to the patient’s medical history and they can digitally coordinate the patient’s care journey.
  4. 4. Recognition and respect for those directly involved in the patient’s care: caregivers, family and friends.
  5. 5. A clear image of the patient journey. How does the patient experience their ‘journey’ through the healthcare system? We can find out based on surveys, so-called PREMs. They give us an idea of where the patient experiences fragmentation of care.
  6. 6. Minimal disruption of the patient’s life. People should be able to live their lives; taking care of things surrounding their care should not be the dominating factor.
  7. 7. Striving for health. First and foremost, caregivers should strive to give the patients a good life.

Masterclass Working Together on Value-based Healthcare

As indicated: healthcare is fragmented and there is a lot to be gained when it comes to cooperation. To achieve this, obstacles must be overcome. That is why Essenburgh Research & Consultancy is organizing a masterclass Collaborating on Value-based Care. Here you will learn to recognize and overcome obstacles within your organization and with other organizations. The masterclass is meant for managers, directors and other healthcare professionals. For more information, click here or click the banner for the brochure.

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Pim Valentijn

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