Last week, Joanne Lynn addressed issues on population health for frail and disabled elders, and suggested the need for an integrator at this life stage. This week Debbie Chang Vice President of Policy and Prevention at Nemours, an integrated child health system, further discusses the integrator role, based on a paper she presented to the CMMI Population Health Models group earlier this month. Nemours has taken on the role of an integrator to improve child health and well-being in Delaware.
By Debbie I. Chang, MPH
Achieving the Three-Part Aim – better quality of care, better health for populations, and lower costs – has become a critical area of focus for health care reform. One approach to meeting the Three-Part Aim is to work to improve population health with a place-based focus by seeding and funding integrators. Integrators operate at a population level in a geographical region. Working in a sustainable fashion with health care, public health and other community partners, integrators:
- Promote prevention,
- Improve health and well-being
- Improve quality and reduce health care costs
An integrator is an entity that serves a convening role and works intentionally and systemically across various sectors to achieve improvements in health and well-being for an entire population in a specific geographic area. Examples of integrators range from integrated health systems and quasi-governmental agencies to community-based non-profits and coalitions. The integrator role is not one-size-fits-all, but rather must be flexible to adapt in response to the needs of the community or population it serves. Integrators, or a system of integrators, may take various forms, depending on available resources and on community strengths and needs. An integrator need not perform all of the functions listed below at once; external forces and contexts may require certain functions to take precedence at certain times.
Communities may have one or more integrators. In fact, large and/or complex communities may be most effective with multiple integrators. Integrators working within the same community may specialize. For example, one integrator may focus on children, to integrate key developmental aspects that address long-term needs and promote healthy development in the multiple sectors where children spend time such as schools, child care, primary care and neighborhoods. Another integrator in that same community may focus on another phase in the life course.
A wide array of organizations could assume an integrator role, depending on communities’ goals, contexts, leadership, and stakeholder capabilities and resources. Over time, there may be an evolution in the entity or entities serving in the integrator role. Ultimately, a successful integrator or system of integrators benefits the community and its population by transforming the system thereby making it transparent to those who pay for it and who use it and by catalyzing and facilitating the integrated systems-work necessary to address the upstream social determinants of health.
Population Health Integrator Functions
Leadership and Partner Engagement
- Engage partners from multiple sectors and/or connect with other integrators to achieve the Three-Part Aim, with an emphasis on integrating services and mobilizing interventions to address upstream determinants of health.
- Serve as a trusted leader in the community that accepts accountability for and strategically drives the integration functions.
- Facilitate agreement among multi-sector stakeholders on shared goals and metrics to improve the health outcomes of a population in a geographic area.
- Assess the community resources, including workforce capabilities, that are available to reach shared goal(s); determine what gaps need to be filled and what duplication needs to be reduced; and work with partners to make appropriate adjustments
Spread, Scale and Sustainability
- Work at the systems level to make policy and practice changes in both the public and private sectors that impact populations and/or support partners or connect with other integrators in making these changes to scale up what works so that the entire population can benefit.
- Serve as a source for spreading what works at both the policy/systems level and at the practice level to reach sufficient scale.
- Sustain change by impacting policies and practices in collaboration with institutions and community partners at the local, community and state levels.
- Pursue financial sustainability via various methods, including leveraging existing and new sources of funding, developing innovative uses of current sources, and testing payment reforms that promote value and incentivize disease prevention and healthy development.
Continuous Learning and Improvement to Promote Population-Level Solutions
- Gather, analyze, monitor, integrate and learn from data at the individual and population level. Apply this knowledge to improve care and the patient experience at the individual level, improve systems at the population level, evaluate progress, and ensure that resources are targeted most efficiently, based on actual needs of communities and groups of patients.
- Identify and connect with system navigators (those roles intended to help individuals coordinate, access and manage multiple services and supports) so the integrator can harvest and aggregate data from individual cases and use the data to promote population-level solutions.
- Develop a system of ongoing and intentional communication and feedback at multiple levels including with affected sectors, systems and communities.
For an expanded discussion on this topic, please read Integrator Role and Functions in Population Health Improvement Initiatives.