Business and clinical integration is a watchword that will help define the future of health care, including for hospice providers, according to leaders in the space.

These kinds of integration span both the internal and external spaces. Providers can better ensure that the various pieces and departments within their organizations are working in a coordinated way, as well as fostering seamless interactions and transitions of care among their partners.

“Integration is our watchword. Now, without integration, you don’t have quality as defined by the payer, by the consumer or the provider. Integration is also key if you want to ultimately personalize care and service, and I think that’s critically important as we move forward …” Lynn Katzman, founder and CEO of the senior living operator Juniper Communities, told Hospice News in a recent webinar. “It means being able to integrate the services we provide, as well as curate, if you will, other services from other providers that come together to provide an integrated ecosystem of care and service around an individual for us being able to integrate from our set our own services.”

Juniper operates 28 senior living communities across five states.

Integration is also a priority for the hospice provider By the Bay Health, which also provides home health, palliative and pediatric care. The California-based nonprofit is an affiliate of University of California San Francisco (UCSF) Health and serves thousands of patients annually. 

By the Bay Health has completed a triple merger with two other hospices — Mission Hospice & Home Care and Hope Hospice. The combined organization has become the largest nonprofit hospice network in northern California, according to CEO Skelly Wingard.

The organization has developed a “shared services model” to foster greater integration, enabling it to streamline processes, best practices and ensure consistent, high-quality care, Wingard said during the webinar.

This model spans the hospice providers internal departments, including clinical operations, quality, finance, IT, human resources and compliance. It also includes electronic medical record system interoperability with its parent organization UCSF Health, as well as its hospital, health system and payer partners.

Another key component is cultural integration, particularly in light of its recent mergers, according to Wingard.

“The goal really is to reduce redundancy and allow our teams to focus more fully on patient care when possible …,” Wingard told Hospice News. “Integrated care is not just our model, it’s kind of the lens through which we approach every aspect of our work. We’re aligning clinical pathways, technology, operational workflows, so that the patient experience is seamless across hospice, home health, palliative care, pediatrics, and then, of course, all of our patients interact with so many other service lines and external payer systems.”

System integration is not only a priority for providers, but also regulators such as the U.S. Centers for Medicare & Medicaid Services (CMS), according to Dr. Taimur Mirza, chief medical officer for ArchCare.

The company is one of the 10 largest nonprofit providers of nursing home beds in the United States and also provides home-based care, palliative services, Programs for All-Inclusive Care of the Elderly (PACE), a specialty hospital and a home for children with special health needs.

“Integrated care is really accountability for outcomes. CMS is no longer encouraging integration, they’re requiring it. Hospitals, payers and post acute systems will be judged on how we manage patients jointly,” Mirza told Hospice News in the webinar. “Our programs can’t really work in isolation. Our PACE, nursing homes, home care need to have the same expectations for medication review, rapid response, fall prevention, for example, and blending teams and processes so residents do not experience sharp changes when they move between the different service lines and then just having stronger position infrastructure.”

ArchCare seeks to achieve this using a number of strategies. One crucial element is tying clinical predictions directly to action, Mirza said. This means building workflows in which patients’ risk scores lead to concrete steps, like same-day physician visits, nutritional and hydration assessments, laboratory tests and medication reviews, to name a few examples.

This also involves closer collaboration with ArchCare’s hospital partners, according to Mirza.

Integration going forward will shape the future of health care in significant ways, Wingard said, perhaps especially for community-based providers like hospices and home health organizations.

“We’re just really looking to be the future of what ‘seamless’ looks like, in delivering consistent, connected, high-quality care and positioning the organization for long-term sustainability and regional impact,” Wingard said. “Community based providers really must demonstrate clear value through consistent outcomes, strong operations and reliable patient experience.”