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Integrated Health Care: Crucial for Quality, Efficiency and Population Health?

Integrated care is a major priority for America’s Essential Hospitals and its members. Essential hospitals and health systems provide a range of inpatient and outpatient services for millions of patients across the country. Many of these patients are economically disadvantaged, non-English speaking, or suffer from chronic disease.

Providing safe, efficient, and effective care in these complex settings is a challenge, which is accelerated by the requirements of the Affordable Care Act (ACA) of 2010. Integrated care delivery is a critical tool for addressing these challenges and helping safety net hospitals and health systems achieve the Triple Aim: cost-efficiency, better quality care, and a focus on population health.

America’s Essential Hospitals’ research affiliate, the Essential Hospitals Institute, conducted a study on integrated care in safety net hospitals with support from the Aetna Foundation.

Survey of Information Gaps

This project investigated these particular information gaps by developing a literature review and surveying all association members. We then visited four member hospitals to determine the barriers to achieving system integration, strategies implemented by the most highly integrated safety net hospitals to overcome common barriers, and understand the outcomes of integrated systems.

We have outlined:

  • Characteristics of an integrated delivery system
  • Related policies
  • Why integrated care is valuable
  • The barriers

The literature review featured here, initially completed in February 2012 and updated July 2013, provides a map of integrated care, especially as it relates to safety net hospitals and health systems.

Given the span of the project and the rapidly changing landscape of health care policy, researchers updated this analysis to capture and reflect the most recent literature and current events impacting integrated delivery systems.


  • Overview of Integration: Learn about the history and evolution of integrated delivery systems in the United States.
  • Integrated Delivery System Definitions: There are more than 70 terms or phrases related to health care integration and 175 concepts or definitions. This section outlines several varied definitions of integrated delivery systems.
  • Types of Integration: Integration can occur at the system level or across a patient population. The degree of integration depends on local market realities and multiple other factors.
  • Integrated Delivery System Models: This section outlines organizational and payment models for integrated delivery systems.
  • Characteristics of a Fully Integrated Delivery System: After consolidating the literature on integrated care, America’s Essential Hospitals found seven characteristic domains that encompass a fully integrated health care delivery system.
  • Policies for Accountable Care Organizations: The ACO has emerged as a delivery model that promotes integration and addresses some of the issues organizations have encountered when attempting to integrate.
  • Policies for Electronic Health Records: One of the major components of an integrated delivery system is a health information system that can collect patient-level data through an electronic health record.
  • Integrated Care for Dual-Eligible Populations: There are currently nearly 9 million people in the U.S. who qualify for both Medicare and Medicaid. These dual-eligibles are more likely to be a poor, sick and challenging population to manage.
  • Population Health: A well-integrated hospital system must work with community organizations, particularly local public health systems that have traditionally focused on population health and integration, to address health determinants.
  • Value of Integration: America’s Essential Hospitals, along with many other organizations, is promoting integrated care as a means to address the current fragmented health care delivery system.
  • Barriers to Integration: There are several challenges to forming integrated health care systems, including regulatory, operational and cultural barriers.


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