Driving More Value in MSK with Integrated Hybrid Care

As the tides of healthcare shift to value-based care, Integrated Practice Units, or IPUs, are being viewed with increasing interest and optimism. And for good reason. Studies show this model of healthcare delivery—which brings an interdisciplinary care team together under one roof to treat a specific medical condition—can drive value for clinical conditions ranging from low back pain to Parkinson’s disease. But what are IPUs, exactly, and is the value they generate tied to co-locating clinical teams within a physical location only?  An exploration of IPUs and their application to hybrid care shows their value goes well beyond four walls. Hybrid IPUs can cultivate even more merit by meeting patients where they are—either virtually or in person—with appropriate, cost-effective care.

What is an IPU exactly?

The IPU concept, itself, is not new. It has been around for almost twenty years, first appearing in 2006 in Michael Porter's and Elisabeth Teisberg's seminal publication on value-based care Redefining Health Care: Creating Value-Based Competition on Result.

At its core, an IPU is a health care delivery model centered around multidisciplinary care teams that focus on specific medical conditions (Porter 2013). IPUs run on a simple premise: When a multidisciplinary team focuses on all aspects of a patient’s journey, clinical outcomes improve and the value of care multiplies.

Hybrid IPUs can cultivate even more merit by meeting patients where they are—either virtually or in person.

What qualifies as an IPU?

All integrated care is not created equally. In order to qualify as an IPU, a healthcare delivery model must meet the following criteria (Porter 2021):

• The medical practice is organized around a defined condition or group of similar conditions.
• Care is delivered via a dedicated multidisciplinary team consisting of the clinical and non-clinical staff needed to support a patient throughout the entire care journey.  
• Clinicians identify themselves as part of this integrated practice unit.
• The IPU takes responsibility for the full cycle of care for a patient’s condition.
• Patient education, engagement, participation, and follow-up are integrated into the care plan.
• An IPU has a single management and scheduling structure.
• The clinicians are co-located in dedicated facilities tailored to specific care processes and technology needs.
• A physician team leader or clinical care manager oversees each patient’s care.
• Clinicians routinely measure outcomes and cost to improve quality of care, as well as the patient/staff experience.
• Care teams meet regularly in clinical huddles to continuously improve care plans.
• The IPU accepts overall accountability for outcomes and costs.

Following these criteria, IPUs have been implemented to improve outcomes and reduce costs for a variety of medical conditions including cancer, diabetes, and musculoskeletal diseases (Keswani, 2016).

The value of integrated care

Multiple studies show that integrated care, as a whole, drives value. A recent meta-analysis comparing integrated care to standard care revealed significant decreases in costs and improvements in outcomes (Rocks, 2020).

While there are fewer studies in the literature comparing IPUs to traditional care models, the themes are similarly positive across a spectrum of clinical conditions. One study focused on post-hospital discharge showed IPUs reduced 30-day readmissions by 33 percent and emergency department visits by 40 percent (Low, 2017).  In the treatment of hip osteoarthritis, Jayakumar and colleagues identified sustainable, clinically significant improvement in patient reported outcomes after developing a musculoskeletal IPU (Jayakumar, 2022).

One study focused on post-hospital discharge showed IPUs reduced 30-day readmissions by 33 percent and emergency department visits by 40 percent (Low, 2017).

How IPUs can intersect with virtual care

The original IPU idea was based on co-locating teams in a physical location. However, the acceleration of telehealth capabilities during the COVID-19 pandemic has uncovered opportunities to incorporate virtual care into the multi-disciplinary model.

Virtual care is a broad term that goes beyond just telehealth visits—it includes many ways in which a patient and clinician can remotely interact including audio, chat, or text messaging. At Vori Health, for example, we take virtual care even further by adding motion-guided physical therapy exercises to promote engagement and completion of home exercise programs.

While virtual care is not a replacement for in-person care, the data shows it is now a critical component of meeting patients where they are along the care continuum. From 2019 to 2020, medicare beneficiary telehealth visits increased 70-fold from 645,195 to more than 45 million. Although the number of visits decreased in 2021 to 25.2 million, a July 2022 survey revealed 46 percent of adults still use both virtual and in-person channels to seek care (BPC, 2022; PYMNTS, 2022).

This rise in virtual care has clear benefits for patients including comfort and convenience, as well as easier and broader access to medical specialists. Virtual care allows patients to be seen much sooner than traditional in-person visits. It can be done from a patient’s home and can also serve to bridge gaps between in-person visits. Some patients prefer virtual care as their primary modality, whereas others prefer in-person. Regardless, it is clear that the future of healthcare is a hybrid model that combines the two modalities.

While virtual care is not a replacement for in-person care, it is a critical component of meeting patients where they are along the care continuum.

Pioneering the Hybrid IPU Model

To meet patients where they are, hybrid care is required. If a patient needs an in-person visit but is also responding well to virtual care, how can we provide the same team-based integrated care throughout the patient journey? To optimize this support, Vori Health and its in-person partners have created the Hybrid IPU model.

The Hybrid IPU model combines both virtual and in-person care to meet patient needs. This model’s success relies heavily on communication between team members, partners, and patients. Improved HIPAA-compliant technologies allow for the secure transfer of data and records while also allowing for warm hand-offs between partners and clinicians. Virtual care technology also enables the co-location of multidisciplinary specialists who may live in different geographic locations. By increasing access, the virtual IPU can reach many more patients than an in-person IPU, making healthcare more equitable for all.

The virtual IPU can reach many more patients than an in-person IPU, making healthcare more equitable for all.

Together, the in-person and virtual IPU concepts are synergistic. With advanced technology comes better communication between partners, clinicians, and patients overall—culminating in a unified care plan with convenient virtual and in-person components. In the end, the patient sees only one care plan, eliminating confusion and increasing efficiency in care.

Driving more value for your members

The future of healthcare is hybrid. All care cannot be delivered virtually, and not all care needs to be delivered in-person. When we leverage the strength of both models, we can optimize the patient experience, clinical outcomes, and healthcare value. If you’re ready to drive more value for your members, talk to us to learn more about hybrid IPUs.

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REFERENCES

• Porter ME and Teisberg EO. Redefining Health Care. Boston, Harvard Business Review Press, 2006.
• Porter ME and Lee TH. The strategy that will fix health care. Harvard Business Review, October 2013;91(10):50-70.
• Porter ME and Lee TH. Integrated practice units: A Playbook for Health Care Leaders. NEJM Catal Innov Care Deliv 2021;2(1).
• Keswani A, Koenig KM, Bozic KJ. Value-based healthcare: Part 1—designing and implementing integrated practice units for the management of musculoskeletal disease. Clin Orthop Relat Res 2016;474:2100-3. 10.1007/s11999-016-4999-5
• Rocks S et al. Cost and effects of integrated care: a systematic literature review and meta-analysis. Eur J Health Econ 2020;21:1211-21. 10.1007/s10198-020-01217-5
• Low L et al. Applying the integrated practice unit concept to a modified virtual ward model of care for patients at highest risk of readmission: a randomized controlled trial. PLoS One 2017;12(1):e0168757.10.1371/journal.pone.018757
• Jayakumar P et al. Functional outcomes of a musculoskeletal integrated practice providing comprehensive whole person care for hip osteoarthritis. J Arthroplasty 2022;37(7S):S471-8. 10.1016/j.arth.2022.03.019
• Bipartisan Policy Center. Medicare Telehealth Utilization and Spending Impacts 2019-2021, October 2022. Accessed 11/01/2022
• PYMNTS. The Connected Economy^TM: Omnichannel Healthcare Takes Center Stage, September 2022. Accessed 10/28/2022: