The idea of a continuum of care—an approach to patient care which prioritizes integrated services and the long-term tracking of patient health—is not new in the health care world. The first published piece on the concept appeared as far back as 1989. However, in today’s complex care system, in which patients are attempting to deal with complex and chronic needs, providers are seeking to optimize resource use, and payors are aiming to contain escalating costs, the continuum of care framework is enjoying a new wave of popularity. Read on to learn more about the approach that many believe is the future of effective health care delivery.
What is the continuum of care?
The key to understanding the continuum of care framework is “integration.” Broadly defined, the continuum of care is a client-oriented approach to health care delivery in which integrated services and mechanisms ensure that patients are able to benefit from coordinated, holistic care at whatever level of intensity they might need over a long period of time. This represents a major shift from the acute, episodic model, which dominates much of today’s health care system, in which services are delivered in isolation and often without regard to previous treatments and with little in the way of follow-up care. It’s also important to note that one of the central operating principles of the continuum of care is that it is centered around the client. Thus, the focus is on integrating the services that the client receives rather than necessarily integrating the service organizations themselves.
Why is integration important?
Integration has been widely identified as the best way to provide care that is both high quality and cost-effective, particularly for patients and clients with complex, chronic conditions. When services are appropriately integrated, the implication is that multiple services can be delivered, whether at the same time or in sequence in an appropriate, coordinated fashion, with no services missed or unnecessarily duplicated. This approach ensures that patients obtain the quality and level of care that they need and that providers are able to make the most of limited resources.
Integration will be especially important to the future of health care in the coming years, as the number of Americans living with chronic or disabling conditions is expected to increase significantly. In 2005, roughly 133 million Americans were living with at least one such condition. By 2030, that number is expected to rise to an estimated 171 million people. The development of a framework of care, which is well suited to caring for these types of conditions in a cost-effective way, is therefore an important priority for today’s providers.
What are the main services of the continuum of care?
Given the extent of care which the continuum of care aims to provide, it naturally encompasses a very wide range of services. For convenience, these services tend to be distilled into seven major categories: extended care, which supports patients who require medical or other care over a prolonged period; acute care, which refers to emergency treatment and other critical care; ambulatory care, which encompasses services provided on an outpatient basis; home care, which provides services at a patient’s place of residence; outreach, which deals with public information and education on health; wellness, which is concerned with all levels of physical and mental well-being; and housing, which addresses the question of one’s place of residence as related to health care delivery.
Given the range of these services, it’s easy to see that there is little that is inherently integrated, or even coordinated, about them. In fact, many of today’s public policies, regulations, and financing streams have a decided bent against integration. However, this is something that must change if the continuum of care framework is to be deployed more widely. Four types of mechanisms have been identified as useful tools in helping to promote and facilitate such integration. They are:
Inter-entity management and structure—Care coordination across services is more easily handled when management structures, processes, and relationships are in place to support it. Developments in the 1980s provide a helpful example of what this scenario could look like. During that time, many hospitals expanded their offerings, adding medical centers, urgent care centers, nursing facilities, home care agencies, and physician practices to their core offerings in order to create an expanded and better coordinated vision of care.
Case management—While true integration is yet to be achieved in any broad or meaningful sense, the practice of case management that first emerged during the 1970s has proven to be a popular way of coordinating clinical care. Using this mechanism, a designated professional oversees the care of a clinical case with an emphasis on direct patient assessment and a level of monitoring and decision-making that can range from intense to minimal.
Integrated financing—Financing has long been viewed as one of the main drivers behind health care delivery. Consequently, if a financing model is fragmented, so too will the delivery system. Today, many people in the health care industry believe that if financing and payment mechanisms can be integrated—for example, as in the managed care model offered by organizations such as Kaiser Permanente—service integration will soon follow suit.
Integrated information systems—From the clinical perspective, a seamless continuum of care will be impossible to achieve without an integrated information system. This mechanism is best represented by the increased focus on creating interoperable electronic health records with the idea that when information sharing can be coordinated and integrated, so can the actual delivery of services.