Integrated Models of Care Working Group

What is integrated care? Why does it matter?

Integrated care organizes and manages health and social services across sectors and organizational boundaries. People receiving care experience coordinated and comprehensive services at the right time, by the right provider, in the right place. This includes all health and social services needed to meet the health and wellbeing needs of diverse people from birth to end of life, including those related to the social determinants of health such as housing. Integrated care is foundational because care fragmentation drives poorer health outcomes, poorer patient experiences, as well as increased costs.

Case Studies

Opportunities

In the news

Case studies

Resources to encourage the scaling of integrated care

Formed from the 2019 annual Patients Redefining the Future of Health Care in Canada Summit, the Integrated Models of Care (IMOC) Working Group is comprised of patient and citizen group representatives aiming to identify and examine promising, good, and best practices in integrated models of care; and to help spread these promising, good, and best practices to other jurisdictions of Canada, including rural and remote regions.

The members were particularly interested in integrated models of care that address physical and mental health; the determinants of health; equity; cultural safety; trauma-informed care; as well as models that specifically address Indigenous health and healing.

To date, they have created two case studies highlighting the benefits of integrated models of primary care in order to support patient/caregiver/citizen groups’ ability to advocate for access.

Case Study 2: Indigenous Primary Healthcare Organizations

Indigenous Primary Health Care Organizations (IPCHOs) refer to all Indigenous-governed and culture-based primary health care organizations that address the physical, spiritual, emotional, and mental wellbeing of First Nations, Inuit, and Métis (FNIM) peoples and communities.

The working group members also identified Canadian case studies on integrated models of cancer diagnosis prepared by All.Can Canada. This one is quite comprehensive with strong results.

Download Full Case Study

Case Study 3: Alberta Thoracic Oncology Program Case Study

Established in 2011, the Alberta Thoracic Oncology Program (ATOP) is committed to providing coordinated, efficient, and timely care for patients. ATOP’s expert teams include thoracic surgeons, interventional pulmonologists, and nurse practitioners specializing in thoracic oncology. The program's primary goal is to transform cancer care in Alberta by improving the patient experience, enhancing diagnosis and treatment outcomes, and ensuring a consistent standard of care across the province.

Read the Full Case Study

What are opportunities to use the case studies?

Congratulations after related government announcements (e.g. letters, social media)
Political cycle opportunities (e.g. budget submissions, election platforms)
Communications (e.g. website, blog, newsletter, podcast, social media, magazine)
Events (e.g. exhibit booths)
Meetings with policymakers, healthcare provider associations, and other key decision makers
- Prepare in advance by assessing your alignment with their strategies and priorities
- Offer case studies as evidence-informed tools to help with their policy decision-making on aligned priorities

1. Health Standards Organization. Integrated People-Centred Health Systems Standard (CAN/HSO 76000:2021). 2024.

2. Prior, A., Vestergaard, C.H., Vedsted, P. et al. Healthcare fragmentation, multimorbidity, potentially inappropriate medication, and mortality: a Danish nationwide cohort study. BMC Med 21, 305 (2023). https://doi.org/10.1186/s12916-023-03021-3 Mathematica. New Studies Reveal that Fragmented Care Persists Despite Efforts to Improve Primary Care and Care Delivery. February 27 2023. https://www.mathematica.org/news/new-studies-reveal-thatfragmented-care-persists-despite-efforts-to-improve-primary-care-and-care#:~:text=High%20levels%20of%20care%20fragmentation,testing%2C%20and%20increased%20medical%20costs. Agha et al. Causes and Consequences of Fragmented Care Delivery: Theory, Evidence, and Public Policy. National Bureau of Economic Research. April 2017. https://www.nber.org/system/files/working_papers/w23078/revisions/w23078.rev1.pdf

In the News: Examples of Canadian initiatives towards integrated care

Below are some examples of recent federal, provincial, or territorial announcements and initiatives that relate to these types of integrated models of primary care as well as integrated models of care more broadly.

It is worth noting that the recent Federal/Provincial/Territorial bilateral agreements prioritized family health services, so there will be ongoing investments, with associated targets, for family medicine/primary care/primary health care in Canada.

More broadly, the Canadian Medical Association (as well as some provincial counterparts like the Ontario Medical Association) are now advocating for team-based care, which supports the broader move towards models of integrated care across Canada’s healthcare systems, including during diagnostic investigations as well as for all types of specialties, mental health, addictions, and supportive care.