IFIC Nine Pillars of Integrated Care
The Nine Pillars work together as an integrated whole. Rather than representing a fixed sequence or a checklist, they describe the interconnected conditions that help integrated care take root, grow and improve across systems.
As a meta-framework, the Nine Pillars can be used at macro, meso and micro levels, providing a shared lens through which different approaches to design, implementation and evaluation can be compared and strengthened.
While each Pillar has a distinct role, none stands alone. Progress in one area strengthens the others, and lasting change depends on how they work together in practice.
Pillars
Shared purpose
Shared purpose for integrated care is collectively built and implemented by partners including community sector organisations, public health, primary care, social care, hospitals, long-term care providers, and local, regional and national decision-makers.
It aligns services and people to provide people- and community-centred, coordinated, continuous, fair and locally responsive care, leading to shared goals, stronger collaboration and improved health outcomes for the local population.
Health in context
Integrating care across prevention and early intervention, self-care, chronic care, social care, acute care, long-term care and end-of-life care requires a deep understanding of the wider factors that influence health, wellbeing and access to quality care.
These include access to good quality housing, food security, sense of belonging and secure employment. For integrated care to work, all actors in the care system are committed to addressing these determinants in order to reduce inequalities in health, wellbeing and care opportunities.
People as partners
People who need care, their family members and the communities they live in are recognised by care providers and system decision-makers as partners in integrated care.
As partners, they have an essential role in care integration, and their roles and responsibilities are explicit and valued in working towards a shared purpose. Their involvement in setting local priorities and shaping care helps enable place-based partnerships and better use of local resources and assets.
Teamwork
Integrated teamwork is the point at which most people experience integration, coordination and continuity, and is about how people and professionals collaborate, formally and informally, to plan and deliver care around what matters most to people.
A team may be a formal multi- or interdisciplinary team, an alliance across organisations and sectors, or a care partnership between providers and the person receiving care. What matters is that all those involved are connected, coordinated and working together.
Coordination
Coordination and continuity are central features of integrated care services, and service delivery is co-created with individuals, families, communities, public health, primary care, hospitals, social care, care homes, care at home and others including private providers.
It is focused on the health outcomes desired by the population, builds on the assets they already have, is informed by evidence, and covers the care journey from prevention through to end-of-life care. It also includes service design, testing, implementation, monitoring, evaluation and continuous improvement.
Governance
Governance is about how decisions are made, who is involved and how people work together to achieve shared goals. It refers to how decisions are structured, how priorities are set and how progress is tracked, while leadership creates a shared direction and motivates people across teams, organisations and communities to work together.
Together, these elements create accountability for delivering integrated care and help ensure that action happens with — or even by — people and communities, not just for them.
Information and Technology
Integrated care depends on the ability to access, share and act on the right information at the right time. Digital tools are one mechanism that supports this, but integrated care can also be strengthened through low-tech or no-tech approaches to effective information sharing.
Better access to health information improves communication, supports self-management and enables more coordinated and continuous care, while shared data at population level helps services understand health outcomes and respond more effectively to local needs.
Finance
Financial structures, payment and funding mechanisms are designed to incentivise integration, collaboration and delivery of shared health outcomes at scale, while ensuring fair and equitable resource allocation and value-based care.
Systems that encourage fragmentation are removed, phased out or mitigated. Aligned payment and funding mechanisms support collaboration between care providers, encourage teamwork across sectors, strengthen care coordination and improve the quality of care.
Learning
An integrated care system is a learning system, co-created with people and communities and grounded in people’s lived experience and what matters to them. It continuously adapts and improves based on evidence, including real-time data and feedback embedded into everyday practice.
Care is delivered, data is collected and analysed, and this is turned into actionable insight to support continuous improvement. It also uses qualitative and quantitative evidence from all relevant partners to ensure that measures of results and impact are comprehensive and understandable.
Why, what and how
The Nine Pillars can also be understood through three simple questions: why, what and how. This framing helps show how the Pillars work together as an integrated whole, moving from the purpose of integrated care, to what it looks like in practice, to the conditions that make it possible.
Why
The why of integrated care is expressed through Shared purpose, People as partners and Health in context. Integrated care needs a shared purpose that aligns partners around common goals, and it needs a clear understanding of the wider determinants that shape health, wellbeing and access to care. Together, these Pillars explain why integrated care matters and what it is ultimately trying to achieve.
What
The what is Teamwork and Coordination. These Pillars describe what integrated care looks like in practice: people and communities recognised as partners, professionals and carers working together in connected teams, and services designed to deliver coordinated, continuous and person-centred care.
How
The how is supported by Governance, Information and technology, Finance and Learning. These Pillars create the conditions that make integrated care possible, sustainable and scalable by shaping how decisions are made, how information is shared, how resources are aligned and how systems learn and improve over time.
Design
The revised Nine Pillars were developed through a structured process of review, refinement and validation. IFIC began by carrying out a rapid literature review of integrated care frameworks published between 2010 and 2024, covering both peer-reviewed and grey literature. From an initial set of 69 frameworks identified through screening, 26 were selected for full review. These were then analysed to assess how well the original 2020 Nine Pillars reflected the breadth of integrated care research and practice, where the Pillars were already strongly represented, and where the framework itself would benefit from greater specificity or refinement.
This review led IFIC’s research team to revise the labels and descriptions of the Pillars so they would be less tied to the pandemic context of the original 2020 publication and more generalisable across different systems and settings. The mapping exercise also identified an important gap around service design and delivery, which led to the introduction of a new Pillar on service delivery for coordinated and integrated care. Alongside this, the team refined the short titles and explanatory descriptions to better reflect the language, scope and practical application of integrated care internationally.
The revised Pillars were then validated through a modified Delphi process involving international experts in integrated care. Fifty experts from 20 countries were invited to take part, with 36 expressing interest and 29 participating in the first round. Across three rounds between September 2024 and February 2025, panellists reviewed, commented on and scored the proposed descriptions, allowing the research team to refine the wording and strengthen consensus. The process was later complemented by feedback from policymakers and care providers to help improve clarity and usability, resulting in the 2026 version of the Nine Pillars.
Click here to read the full paper on the Nine Pillars design, revision, and validation process.
Referencing
Suggested citation. IFIC’s Nine Pillars of Integrated Care: Revision and Validation 2024-2025: International Foundation for Integrated Care. 2026.
IFIC’s Nine Pillars of Integrated Care © 2026 by International Foundation for Integrated Care is licensed under CC BY-NC-SA 4.0. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-sa/4.0/