Chris Ham on ‘bilingual’ clinical leaders

Geisinger is an impressive example of what integrated care can achieve. Like its close US cousins, Kaiser Permanente, Group Health and Intermountain Healthcare, it provides compelling evidence of the benefits that arise when budgets and services are joined up around defined populations.

‘They are just at home in the boardroom as in the clinic and are able to ensure the voice of clinicians is heard at the highest levels’

The experience of these organisations shows there is no single best way to provide integrated care but there are common ingredients. Three stand out. The first is financial incentives aligned around the purpose of integrated care. This means moving away from paying for activity to paying for outcomes.

It also means giving providers freedom to use capitated budgets to deliver care in the right place at the right time. Reducing avoidable hospital admissions enables resources to be released for investment in primary care and the community, for example, and to make a reality of care closer to home. This kind of financial flexibility will be a source of envy to many in the NHS.

The second ingredient is a culture that focuses on continuous improvements in care. This culture is driven by a commitment on the part of clinicians to provide care that is safe and of the highest possible quality. One of the ways in which improvements are achieved is by constant measurement of performance and feedback of the results to clinicians.

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The hallmark of integration

The third ingredient is leadership by clinicians and especially doctors. On my visits to integrated care organisations in the US I have been struck both by the high proportion of doctors in leadership roles and their evident skills in undertaking these roles.

Put simply, medical leaders in Geisinger and other systems are bilingual, being equally fluent in management speak and clinical language. This means they are just at home in the boardroom as in the clinic and are able to ensure that the voice of clinicians is heard at the highest levels. They are also able to work with clinical colleagues to ensure effective stewardship of resources.

A wise person once explained to me that delivering integrated care successfully was “more sociological than technological”. Geisinger is a living example of this truism. Beyond budgets, culture and leadership are the people who provide care and their commitment to perform to the best of their ability. This includes delivering the “whole person” care that is the hallmark of true integration by treating patients as people and not as diseases or conditions.

Professor Chris Ham is chief executive of the King’s Fund