The Challenging Path Toward Integrated Healthcare

The industry is moving toward new health delivery models, which are oriented around the patient rather than the provider. The transition toward integral, integrated healthcare in Mexico will be filled with challenges, which are outweighed by the benefits to the economy and wellbeing.

The current state of health delivery focuses primarily on physical health, with models oriented around the provider offering fragmented and analog experiences that have negative consequences both for the patient’s health and for the country’s economy, said Alexandro Arias, Partner - Life Sciences and Heath Care Leader S-Latam, Deloitte. “There are cost overruns when information is lost between doctors, in time between appointments and non-attachment to treatments, causing patients to have a decline, which will translate to a greater cost for the health system and the economy in general.”

The future of health delivery models is patient-centric, taking into account the spiritual, emotional, financial, social, mental and physical conditions when discussing wellness or illness, said Arias. For this integral approach, “we must create a layer around” patients that includes education, counseling, monitoring, diagnostics, insights, behavioral nudges, intervention and treatment, he added. This layer can be built around workplaces, schools, hospitals, clinics, retail stores and community facilities, taking advantage of digital tools.

“Monitoring and diagnostics are crucial for silent diseases. An early diagnosed disease is better treated and reduces system costs. Being [Mexico's] a disintegrated system, there is not enough information to treat patients. This is one of the greatest opportunities in the sector. With enough data, patients will be treated more efficiently, both in-person or virtually,” said Arias.

Among the aspects taken into account for patients’ wellbeing, the pandemic did not only impact the physical side of the patients, it also affected their mental and financial health. Lockdowns and mourning impacted mental health, which has not been addressed with the importance it deserves, said Arias. The financial side was also affected during the pandemic.

In Mexico, over 50 percent of health expenditure comes from the public sector, 40.7 percent is paid out of pocket and 7.3 percent is paid by private insurers, reported MBN. Out-of-pocket expenditure increased during the pandemic due to people’s unwillingness to visit hospitals. “This situation impacts directly on the general economy. The money used for health expenses is replacing other expenses that people used to make,” said Arias.

Integrated care is whole-person, team-based care that provides access to affordable, evidence-based care at a population level and across the care continuum, said Arias. With the patient at the center, there are four key areas where actors across diverse sectors converge. One of these key areas is the primary care team, which includes health generalists, social workers, nursing staff, pharmacists, nutritionists and health coaches. Then, the specialist care team includes all non-primary care members involved in the patient’s healthcare, such as surgeons, endocrinologists or cardiologists. The other two key areas, said Arias, are social-community support and digital care tools such as telehealth, remote patient monitoring or digital therapeutics and self-management tools.

A patient-centric, integrated healthcare improves the patient’s experience, which translates to general benefits that include decreased hospitalization and readmission, lower rates of avoidable healthcare utilization, improved quality of work atmosphere, better communication and lower burnout rates among healthcare professionals, said Arias. “During the peaks of the pandemic, healthcare professionals’ burnout was impressive. They worked 24-hour, 36-hour shifts.” Integral, team-based healthcare for chronic patients reduces hospitalization by 18.6 percent, which translates into cost savings, according to a comparative study.

An integrated care model design must be grounded in all three foundational components to effectively operate, said Arias. These components are: data, which needs the core technology capabilities that enable cross-functional stakeholders to capture and access it; wellbeing and care delivery, which are the physical and virtual care facilities that provide the care services; and care enablement, which involves the clinical operational and financial factors and services that promote access to care.

“Today, there are unique opportunities to reform the underlying structures of public health. However, there are also extreme challenges, such as a decades-long backlog of funding needs, a global pandemic, ongoing preventable chronic disease epidemics and pervasive inequities that threaten our health, longevity and trust in government and its leadership,” said Arias.

The Mexican healthcare system, with lag, “is preparing to become more flexible, grow and reduce its size according to its needs,” said Arias. He added that the 15.2-percent increase in the public spending on health “is one of the most important in the last years.”

While the path toward integrated healthcare will be challenging, multiple players are already transforming their health delivery models, creating a positive ecosystem to boost patient-centric care. Overcoming the challenges will represent important benefits for Mexicans’ health and the country’s economy as a whole.