Integrating healthcare for older populations.
The complex array of needs posed by older adults has frequently produced fragmentation of care in traditional fee-for-service systems. Integration of care components in newer health systems will maximize patient benefits and organizational efficiency. This article outlines the major issues involved in integration of care for older populations. A health system must integrate its care of older adults in many ways: among providers, both in primary care and specialty services; with community-based sources of care; and across sites of care (clinic, hospital, emergency department, and nursing home). Integrating reimbursement structures for various services will serve to create a client-oriented system, as opposed to a finance-centered system, thereby enhancing coordination of care. The extent to which two experimental comprehensive systems, PACE (Program of All-inclusive Care of the Elderly) and SHMO II (Social Health Maintenance Organization), have achieved clinical and financial integration are discussed in detail. Healthcare organizations are encouraged to create integrated models of care and to study the effects of integration on patient outcomes.
Boult
C
C
Department of Family Practice and Community Health, University of Minnesota, Minneapolis 55414, USA. boult001@tc.umn.ed
Pacala
J T
JT
D000368:Aged; D003191:Comprehensive Health Care / Q000191:economics / Q000458:organization & administration; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000458:organization & administration*; D004608:Eligibility Determination; D005381:Financing, Organized; D006279:Health Maintenance Organizations / Q000458:organization & administration; D006299:Health Services for the Aged / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D008134:Long-Term Care / Q000191:economics / Q000458:organization & administration; D008484:Medicaid; D006278:Medicare; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration; D014481:United States