Integrated practice units: the first step toward 'fixing' healthcare
There are many moving pieces to health reform, and every organization has its goals and approaches that serve its particular purposes. But every once in a while, it helps to step back and compare the vision being pursued within your organization with one or another vision of what needs to take place across the entire healthcare system.
Last October, Michael E. Porter and Thomas H. Lee, a professor at the Harvard Business School and a chief medical officer for a healthcare consulting firm, respectively, took to the pages of the Harvard Business Review to present an analysis of what ails the U.S. healthcare system, and a six-step strategy that, in their view, will go a long way toward fixing it.
After articulating what might be called the "majority opinion" among healthcare stakeholders – that the system is plagued by, among other things, inefficiency due to misguided motivations (i.e., fee for service) and fragmented care – the writers begin their proposal at the top, so to speak, by recommending "a shift from today's siloed (healthcare) organization by specialty department and discrete service to organizing around the patient's medical condition. We call such a structure an integrated practice unit (IPU).
"In an IPU, a dedicated team made up of both clinical and nonclinical personnel provides the full care cycle for the patient's condition. IPUs treat not only a disease but also the related conditions, complications, and circumstances that commonly occur along with it—such as kidney and eye disorders for patients with diabetes, or palliative care for those with metastatic cancer. IPUs not only provide treatment but also assume responsibility for engaging patients and their families in care—for instance, by providing education and counseling, encouraging adherence to treatment and prevention protocols, and supporting needed behavioral changes such as smoking cessation or weight loss."
While noting that the Patient Centered Medical Home is a step in the right direction, they suggest that the place to begin is with primary care in general, because "primary care is holistic, concerned with all the health circumstances and needs of a patient."
That said, they observe that "today's primary care practice applies a common organizational structure to the management of a very wide range of patients, from healthy adults to the frail elderly. The complexity of meeting their heterogeneous needs has made value improvement very difficult in primary care—for example, heterogeneous needs make outcomes measurement next to impossible."
Changing primary care practices to IPUs would involve "multidisciplinary teams organized to serve groups of patients with similar primary and preventive care needs—for example, patients with complex chronic conditions such as diabetes, or disabled elderly patients. …Within each patient group, the appropriate clinical team, preventive services, and education can be put in place to improve value, and results become measureable."
And it's that "measureable" part that presents the next challenge, and step two in their strategy to fix healthcare.
Next time: How do you know if your organizational changes are working?