7. Aligning governance and funding

Ways to work together on integrated care:

  1. Create shared purpose – aligned mission and goals. An example of this working well is Peninsula Health, Victoria where primary and secondary care join forces to agree a charter of collaboration; all projects relate back to this mission statement and involve joint working committees with all organisations represented.
  2. Create shared responsibility – joint accountability in patient care. Examples include shared obstetrics care between GPs and antenatal wards in Australia, and discharge units with GPs and specialists co-writing discharge letters in UK NHS hospitals.
  3. Create shared funding – pooled budget to cater for holistic needs. Examples include patient vouchers in Singapore, where families draw down on different services as needed, and combined health and social care budgets in Scotland, that tackle common challenges across both agendas.
  4. Create shared metrics – common KPIs for different providers. Examples include Tower Hamlets, UK that shared diabetes management metrics between primary care and hospital providers (linked to bundled payments) and Discovery in South Africa, where costs are shared between providers within a care package (or on per capita basis), and a true-up of surpluses or deficits occurs annually.
  5. Create shared and transparent progress – track progress to maintain joint accountability. Examples include the UK’s Prime Minister Delivery Unit under the Blair Government, where Tony Blair chaired meetings with heads of Departments to monitor priority deliverables, and in Arkansas, where regularly published reports track delivery of coordinated care packages between GPs and hospitals.