Evolving Integrated Care: Moving Towards a Population Health Approach

Introduction: Current investments in integrated care have predominantly focused on downstream strategies designed to reduce the fragmentation of healthcare services. Yet, there is a growing recognition that integrated care strategies must also move upstream and focus on health and wellness at the population level. Progress in this area has been slow, but a number of early adopters of the population health approach in integrated care provide insights into key approaches. This research identifies early initiatives, identifies common design components, and analyzes the lessons-learned.Theory/Methods: We undertook a scoping review of the international literature to define and describe the broad range of initiatives underway using Arskey & O’Malley’s five stage scoping review methodology. Literature included academic and grey literature amongst developed OECD countries between the years 2000 and 2015. These papers were abstracted by two reviewers, thematic elements were identified by the team and the evidence synthesized.Results: Thirty-three papers were identified, describing 14 different initiatives taking place in eight different countries around the world. Most of the initiatives were initiated and lead by healthcare system providers (largely within primary care) who interfaced with local social services in order to meet the health needs of a target population. In some cases integrated care strategies were initiated and lead by public health or some other sector that then linked with healthcare. Target populations most often included seniors but also included other subpopulations including families living in high deprivation neighbourhoods, and mothers and children. Beyond healthcare, these initiatives often focused on such determinants of health as physical and social environments, personal health practices, education and literacy, and income.Discussion: There is a growing need to attend to population health within the context of healthcare delivery, rather than as a set of initiatives divorced from front-line practitioners. Several population health oriented integrated care strategies are underway around the world. These initiatives often face implementation challenges in creating robust partnerships across organizations and the alignment of vision, mandates, roles & responsibilities among partners. In addition, governance challenges and funding incentives must be addressed to support program success. Leadership, use of technology and community engagement are major enablers for success.Conclusions: Health systems in the industrialized world face increasing concerns about aging populations and the growing burden of chronic disease. Population health-oriented integrated care strategies have become an important part of sustainable health system reform. By studying early population health oriented integrated care initiatives, lessons learned from implementation can inform the broader thinking in reorienting models of care.Lessons learned: In the context of daily pressures to deliver care, it can be challenging to integrate population health based approaches, but these may be critical for managing chronic conditions.Limitations: This scoping review is limited to those initiatives reported in the literature. The literature is heterogeneous in terms of focus and methods so detailed comparisons between programs is limited.Suggestions for future research: Additional comparative case study research would help to elaborate on the strategies and mechanism for integrating population health approaches into integrated care.

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