Beyond integrated care.

Integrated care tops the health care agenda. But more integration alone will not remedy the crisis in health care, and there is a danger in the increasingly prevalent conceptualization of care integration as a goal in itself rather than as an instrument for improving performance. Operating integrated care systems, staffed by an overly specialized medical workforce, is unsustainable in terms of human and financial resources and is likely to produce little benefit for patients with multi-morbidity. An alternative approach involves health care leaders going beyond integrated care and nurturing transformative change from within the medical workforce instead. To be fit for purpose, the doctors must be encouraged and facilitated to customize their expertise to current and expected future burdens of disease. This would lead to more adaptive doctors who could actively support people in healing and managing their own health. Integrated care should be conceptualized as one possible lever for transformative change rather than its endpoint.