AER BACKGROUND NOTE Integrated Care

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1 AER BACKGROUND NOTE Integrated Care An intrductin fr Reginal Plicy-makers Nte t the reader: this dcument is an evlving dcument. It aims at gathering backgrund infrmatin n integrated care as well as updates n Eurpean develpments in the field and recmmendatins t reginal plicy-makers. Last updated: June 2013 Integratin f care services is emerging as a central challenge f health care delivery, particularly fr patients with elderly and cmplex chrnic cnditins. In 2003, the Wrld Health Organisatin (WHO) already began t identify it as ne f the key pathways t imprve primary care (Wrld Health Reprt: 2003); in 2004, the Eurpean Cmmissin declared integrated care as vital fr the sustainability f scial prtectin systems in Eurpe. Nwadays, it is recgnised as a tpical issue and a cre cmpnent f health and scial care refrms acrss Eurpean regins. What is integrated care? Even thugh integrated care is a wrldwide trend in health care refrms, there is n unique definitin f it. Indeed, mdels that seek t apply the principles f integrated care are cntinually evlving and depend n the different initiatives taken at the reginal level. The WHO tries t define it as fllws: Integrated care is a cncept bringing tgether inputs, delivery, management and rganizatin f services related t diagnsis, treatment, care, rehabilitatin and health prmtin. Integratin is a means t imprve services in relatin t access, quality, user satisfactin and efficiency. At its mst basic, integrated care can be defined as a mre integrated and crdinated frm f care prvisin t be achieved thrugh the clsing f the traditinal divisin between health and scial care. It impses the patient s perspective as the rganising principle f service delivery and makes redundant ld supply-driven mdels f care prvisin. Integrated care aims t prvide health and scial care in a flexible, persnalised, and seamless way. Assembly f Eurpean Regins 6 Rue Oberlin - F Strasburg 210 Avenue Luise - B-1050 Bruxelles Tel.: Fax : Tel./Fax : secretariat@aer.eu aer.brussels@aer.eu

2 Structural Cmpnents f Integrated Care The crucial rle f ICT: successful integrated care implementatin requires that health and scial care prfessinals share infrmatin abut and with patients and users all alng the care prcess. Crdinatin within care team: Individual prviders deliver cnsistent care regardless f which care team member is prviding care. Timely, targeted, and frmal cmmunicatin systems acrss settings is built and maintained. acrss care teams: All care teams, frm specialists t pharmacists, deliver cnsistent care regardless f team. Prfessinals shuld cntinually ask themselves: what d I knw that thers need t knw? and share apprpriate infrmatin. between care team and ther cmmunity resurces: Care teams cnsider and crdinate supprt fr patients by ther teams in the cmmunity. Cmmunity resurces are any service r prgram utside the health care system that may supprt a patient s health and wellness. Cntinuity Familiarity with patient ver time: Care team members are cntinuusly familiar with the treatment, medical cnditins and payment needs. Practive and respnsive actin between visits: Care team members respnd t patients between visits. A friendly plitical and legal envirnment: the rle f plicymakers is crucial. They have t design integratin-friendly plicies, regulatins, and financing arrangement. Cre principles: Patient centred: Patient s perspective is cnsidered as the rganising principle f service delivery fr care team members. Patient s preferences, gals, and experiences are cmmunicated t prviders, and prviders cmmunicate t patients their assessment f the patient s health needs and care plans. Selfmanagement is als prmted. Shared respnsibility: Care team and patient are bth respnsible fr prmting health and managing financial resurces. What is the current situatin? A lng-standing divisin exists in the delivery f health and scial care acrss Eurpe: different infrmatin systems, different management structures, different funding surces and different rules characterize the tw systems, which ften tend t wrk in mutual islatin. In the EU, healthcare is widely seen as a universal right. Health care services are nrmally centralised and gverned by a cmmn set f standards and financial principles. On the ther 2

3 side, there is n universal right t scial care. Access t this kind f care is ften means-tested and individuals may be burdened with a significant share f the csts. Scial care services are typically prvided within highly decentralised systems, with multiple prviders and variatin in access and quality. What are the bjectives f integrated care? The success f integrated care slutins in respnding t the challenges health and scial care face tday still needs t be assessed. Hwever, we can already list the bjectives it intends t address. T tackle the changing demand fr care due t demgraphic and scial changes Integrated care aims at addressing the increase and grwing cmplexity f patients needs by respnding with a crdinated apprach. T take int accunt the existing interdependence f health and scial care, and t imprve the quality and cntinuity f care: - When talking abut individuals, the divisin between health and scial needs is nly artificial: individuals sci-demgraphic circumstances influence their health status and vice versa; - The success f health care interventins is ften dependent n scial care prvisin (e.g. scial wrkers shuld have knwledge abut patients hme cnditins, eating habits, etc.); - The patient and his carers are ften required t crdinate different treatments and prviders, which brings t difficulties. Withut crdinatin, the relatinship between patient and care prfessinals suffers frm disruptins. Integrated care aims at clsing the traditinal divisin between health and scial care and t prvide the user with a mre seamless care experience. T achieve scial integratin f sciety s mre vulnerable grups: Vulnerable segments f sciety (disabled, elderly peple, minrs at risks, drug-addicted, migrants and ethnic minrities, scially disadvantaged grups, persns with chrnic disabling cnditins and persns with mental health prblems) have mre difficulties in accessing care due t scial islatin and ther barriers. Integrated care mdels aims t develp a mre efficient apprach in dealing with the care f mre vulnerable grups as it can better tackle scial islatin. T make the system mre efficient and ecnmical: - Fragmented infrmatin systems result in duplicatin and extra administratin csts; - Lack f crdinatin can result in duplicatin f treatment r assessment by different prfessinals; 3

4 - Lack f crdinatin can bring t a situatin where care is nt undertaken by the right prfessinals (i.e. health care prviders used fr scial care needs); - Lack f crdinatin can bring t decisins that d nt target apprpriately health and scial care necessities and resurces. Integrated care mdels aim t avid wastes and inefficiencies in health and scial care. Implementing Integrated Care: What are the main challenges? Wh funds the cst f care? By remving the traditinal divisin between scial and health care, integrated care raises additinal questins n the way care is funded. Integrated care can bring t future ecnmic benefits, but with high shrt-term csts. Lack f resurces may limit the capacity f service prviders t engage in necessary rganisatinal changes. Hw t cnvince reginal and natinal plicymakers t cnsider the lng term benefits? Hw t vercme the current fragmentatin f scial and health care bureaucracies? Implementing integrated care will require crdinatin in scial and health care planning, financing and rganisatin. Integrated care requires that prfessinals frm different sectrs and backgrunds wrk and cperate tgether. Hw t vercme the differences between different cultures f care? Hw t avid the practice f cst-shifting amng different prviders and rganisatins participating in the integrated care system? Implementing Integrated Care: The fundamental rle f ICT The integratin f care calls fr investments in supprting infrastructures, and it is increasingly hard t imagine integrative initiatives withut a strng ICT cmpnent. Mdern infrmatin and cmmunicatin technlgies can facilitate access t care and break dwn barriers, enabling health and scial service prviders t cmmunicate and wrk mre clsely tgether. The health sectr is already investing in the use f ICT in health care services and ntably thrugh electrnic clinical recrds, telemedicine and remte patient mnitring. Hwever, little advance has been made in mdern means f scheduling care delivery. Scial care services have made even less use f client-facing electrnic systems, while in husing there have been advances in sme lcatins in remte activity mnitring and assisted living. The necessary infrastructural arrangements - such as shared patient recrds, reginal cllabratin - shuld therefre be realised t imprve a crdinated delivery f integrated health and scial care. 4

5 Implementing Integrated Care: Main initiatives in the EU Within the Innvatin Unin, ne f the flagship initiatives f the Eurpe 2020 strategy, the Eurpean Cmmissin has launched the Eurpean Innvatin Partnerships (EIP) with the bjective f accelerating innvatin t address a well defined target within an imprtant scietal challenge. Active and healthy ageing was chsen as the first Innvatin Partnership t tackle demgraphic change and its sci-ecnmic implicatins, but als because f the grwth ptential f innvatin in the field f health. The EIP Strategic Implementatin Plan, adpted in 2011, fcuses n actins develped arund 3 pillars: preventin, screening and early diagnsis; care and cure; and active ageing and independent living. Within the pillar care and cure, it identifies a pririty actin area that cncerns capacity building and replicability f successful integrated care systems based n innvative tls and services. The specific actin in this field cncerns the prmtin f integrated care mdels fr chrnic diseases, including the use f remte mnitring at reginal level. An actin grup (B3) has been created t reduce the unnecessary hspitalisatin f lder peple with chrnic cnditins, thrugh the effective implementatin f integrated care prgrammes and chrnic disease management mdels that shuld ultimately cntribute t the imprved efficiency f health systems. The Assembly f Eurpean Regins is part f the B3 Actin Grup. Smartcare Prject: demnstrating the added-value f integrated care in Eurpe Against the backgrund f the EIP n AHA, SmartCare, a prject c-funded by the Eurpean Cmmissin under the ICT Plicy Supprt Prgramme, will explre, demnstrate the added value and prmte the wider adptin f integrated care thrugh pilting the deplyment f ICT supprted care services in 10 pilt regins. The prject will therefre enable the delivery f integrated care t lder Eurpean citizens t supprt them t live independent lives by prviding the ICT tls necessary t integrate care pathways acrss scial and health service prviders. Are yu interested in Smartcare? Express yur interest in participating in the Cmmitted Regins Bard (CRB), a prject advisry bard that regrups regins interested in integrated care! Cntact: Bianca De Rsari (b.dersari@aer.eu). Bianca De Rsari, Camille Bullt 19/06/2013 REFERENCES Develping a New Understanding f Enabling Health and Wellbeing in Eurpe - Science Psitin Paper (Michael Rigby, Eurpean Science Fundatin) Integrated Care - A Guide fr Plicymakers (James Llyd and Suzanne Wait, Alliance fr Health and the Future, 2006) Integrating health and scial care frm an internatinal perspective (Jessica Watsn, ) What is integrated care? (Sara Shaw, Rebecca Rsen and Benedict Rumbld, Nuffield Trust, 2011) Patient perceptins f integrated care: cnfused by the term, clear n the cncept (Kara Odm Walker et al., ) Integrated health services what and why? (WHO technical brief n.1, 2008) Cnnecting practices: ICT infrastructures t supprt integrated care (Brit Rss Winthereik and Jørgen P. Bansler, Internatinal Jurnal f Integrated Care, 2007) 5