Value realization: an unattained challenge for integrated practice units

Overall, we recommend 6 means for IPUs to realize their value and meet the Quadruple Aim of health care: * leverage competitive market-based approaches to increase adoption; * incorporate preauthorized, dynamic care pathways for scheduling; * develop standardized outcome measurement processes; * administer training programs to improve provider collaboration competencies; * establish suitable technology and partners to continuously adjust care delivery; and * integrate risk-reward sharing between payers and IPU teams. _____ In his landmark framework on value-based health care (VBC), Michael Porter proposed the organization of condition-based care delivery through integrated practice units (IPUs).1 Conceptually, IPUs colocate clinicians, support specialists, and requisite care delivery services to effectively manage the end-to-end spectrum of medical conditions and garner large volumes by becoming a de facto center of excellence and multidisciplinary competency for chronic conditions, such as diabetes, hypertension, and breast cancer. Do these units achieve the Quadruple Aim of modern health care by improving the cost of care, health outcomes, patient experience, and provider experience? A patient with multiple conditions can benefit from properly structured IPUs instead of experiencing multiple referrals and hand-offs at single-specialty clinics. [...]the Diabeter, a Dutch practice, treats more than 2000 patients per year at 5 IPUs, achieving the lowest rate of hospital admissions and cost of care for type 1 diabetes nationally.2 Although a shift from single-specialty centers and large hospitals to IPUs is promising, a recent systematic review by Cattel and Eijkenaar indicates that the evidence regarding cost-effectiveness and improved outcomes remains inconclusive.4 Because IPUs are relatively unestablished entities in the health care ecosystem, they face the challenges of building credibility and avoiding perceptions of competition with mainstream hospitals. [...]increasing adoption and attracting break-even volumes at IPUs will continue to challenge proponents to explore novel partnership models such as clinically integrated networks (CINs) and market-based strategies from retail industries while frustrating those without an adequate understanding of critical success factors. [...]technology needs to support comprehensive patient management and strong electronic health record solutions.