Major Topic #3: Integration into Existing Regional Health Care Systems

For the purposes of this document, two types of integration were defined:

• horizontal – integration within existing health care system, and
  
  
• vertical – integration with other/neighboring health care systems.

Both are desirable in achieving seamless patient flow during IFT.

Highly specialized health care services (e.g., stroke centers, cardiac centers, trauma centers, high-risk obstetrics) may be more expensive than those services providing a general level of care. Integration may also avoid redundancy and promote the most efficient use of resources. IFT can be an important means to support integration and regionalization of health care services.

Considerations for a regional IFT plan include:

• delineation of legal authority and responsibilities;
  
  
• a definition of integration and a description of a region the stakeholders agree to (see Definitions, Major Topic #1);
  
  
• what is meant by an integrated regional health care system – components involved and how they interoperate;
  
  
• education of personnel in all system components;
  
  
• identifying synergies that can result from, and the overall value of a regional approach to
  integration of services;
  
  
• the need for and problems caused by integration of services across State lines (as it applies to IFT);
  
  
• benefits of open communication among stakeholders, particularly with third-party payers;
  
  
• the potential impact of regional integration on competition and service duplication; and
  
  
• transfer agreements and reciprocity of services and personnel.

To determine the current level of regionalized care and how IFT can be integrated, several questions may be helpful:

• What defines current practice related to regionalized health care? Factors may include:
  • referral patterns and
  • legal requirements such as contracts, agreements, memoranda of understanding.
    
    
• What currently triggers IFT? What services currently exist to fill this need? What needs continue to exist?
  
  
• What are current practices/processes regarding decisions related to mode of patient transfer and patient’s destination facility?

Potential or perceived challenges in developing a regional plan for IFT:

• designated IFT providers may be perceived as curtailing competition;
• complications caused by interstate IFT system;
• quantity and quality of personnel needed to provide service;
• in a free market system, providers may choose not to participate, creating gaps in coverage; and
• unique challenges of providing IFT in urban areas and rural areas.

Potential or perceived benefits of developing a regional plan for IFT:

• avoiding duplication of services;
• leveraging limited resources;
• maintaining optimal skills, knowledge and abilities by assuring adequate patient volume;
• synergy of well-coordinated process may be applied to other EMS needs, e.g., disaster
  management;
• providing optimal care in a timely fashion, and
• self-determined cooperation and collaboration.

Strategies for overcoming challenges:

• open and constructive communication among stakeholders;
• education and active participation of all stakeholders including service providers, payers, administrators and regulators;
• transfer agreements/partnerships, and
• reciprocity among states for services and individual licensing