Mark Hornbrook, PhD
In response to the billions of dollars wasted each year in the United States on fragmented, ineffective, and uncoordinated care, some healthcare reform efforts have focused on integrating the delivery of healthcare.1-3
Today, millions of Americans receive their healthcare from integrated delivery networks (IDNs).1,4
However, just what is an IDN? Today, there really is no single answer.4
“The phrase covers a spectrum of scenarios; it has not been defined and is actually used as a catchall phrase to cover a variety of types of healthcare arrangements,” explained health economist Mark Hornbrook, PhD, researcher with the Cancer Research Network and senior investigator and chief scientist at the Kaiser Permanente Center for Health Research in Portland, Oregon. Integration might take place vertically, across different levels of care, or horizontally, such as occurs with hospital mergers.1
In practice, an IDN might coordinate and standardize clinical care, disease management, financial management, and human resources across all of its providers and facilities. Some IDNs develop and employ patient care strategies with the end goals of cost-effective improvements in health outcomes, quality of care, and efficiency.1
Evidence demonstrates that patient care strategies are more likely to be used by IDNs than solo practitioners.1
According to the 2012-2013 National Committee for Quality Assurance (NCQA) private health insurance plan rankings, half of the nation’s top 10 ranked plans (N = 474) are IDNs that provide insurance and employ the doctors who serve their clients.5,6
The rankings were published in the November 2012 issue of Consumer Reports, which states,“Unlike traditional, independent fee-for-service doctors and hospitals that make money by doing as many treatments and procedures as possible, whether needed or not, integrated plans prosper by keeping their customers healthy and avoiding wasteful care.”6
Figure 1. Total Medical and Pharmacy Costs (per Patient per Month) for Patients With or Without Cancer
Source: Reprinted with permission from Kolodziej M, Hoverman R, Garey JS, et al. Benchmarks for value in cancer care: an analysis of a large commercial population. J Oncol Pract. 2011;7:301-306.
Why Integrate Cancer Care?
In the United States, substandard, heterogeneous, and excessive cancer care adversely affects a number of important short- and long-term outcomes including survival, quality of life, and cost.7,8
The complex and multidisciplinary nature of cancer care makes it prone to system failures, such as inadequate hand-offs, poor communication, and lack of accountability between providers. 9,10
Additionally, the cost of cancer treatments— especially medical oncology and specialty pharmacy drugs—is notoriously high. Hence, strategies to promote their cost-effective use have become key elements of cost-reduction efforts (Figure 1