Many of the same principles that underlie the PCMH are also seen in a slightly different model known as integrated practice units (IPUs). PCMHs and IPUs grew from different gardens but ultimately seem to have converged on the same underlying principles. While PCMHs provide longitudinal care over a patient’s lifetime and generally regardless of his or her condition, IPUs tend to concentrate on conditions for which the care cycle is well-defined.
IPUs treat patients with specific circumstances or conditions, including specialty care. IPUs are generally co-located, multidisciplinary teams of clinical and nonclinical clinicians (e.g., case managers, social workers, activity coaches) who treat circumstances or conditions over a full care cycle. 1
Whereas PCMHs are for generalized care of all patients, IPUs develop solutions for patients who share a condition or set of circumstances (e.g. musculoskeletal pain, frailty, or breast cancer).
IPUs have health professionals work together as a team, focused on maximizing patient overall outcomes as efficiently as possible. “They are expert in the condition, know and trust one another, and coordinate easily to minimize wasted time and resources.”1
To focus on patient outcomes, these teams must frequently review data on their own performance and work together to improve care processes and interactions.
Consider a woman with breast cancer who may need to see a primary care physician, oncologist (cancer specialist), breast surgeon, radiation oncologist, and maybe even a palliative care specialist (a clinician focused on symptom-management and quality of life during serious illness). Rather than receiving each portion of this care from these different teams in various clinics, “who function more like a spontaneously assembled ‘pickup team’,”1 this patient could be seen at a Breast Cancer IPU, which includes all of these clinicians, in addition to case managers, social workers, financial counselors, and other staff. This way her care is organized and there is minimal duplication or failure to communicate and coordinate care.
The fundamental difference with IPUs when compared to the way most health care is delivered in the US is that care is organized around the needs of this patient, rather than by the expertise/specialty of a given health professional.
This model describes a framework for an IPU. Individual groups will have their own needs and adjust accordingly.
Source: “Effective Health Care policy: Improving Value for Patients”; Porter, ME. Used with permission.
STUDY
This article describes 6 key components of a strategy to rethink how we provide health care in the US.
Porter ME, Thomas HL.
Harvard Business Review. October, 2013.
STUDY
What do you need to think about when designing an IPU? This is one approach to tackling that question for a musculoskeletal IPU.
Keswani, Koenig, Bozic.
Clin Orthop Relat Research.
2016;474:2100-2103.
STUDY
This is a follow up to part 1 of this series and focuses on potential obstacles of implementing an IPU and how to tackle them.
Keswani, Koenig, Ward, Bozic.
Clin Orthop Relat Research.
2016;474:2344-2348.