Integrated Care A European perspective Loukianos Gatzoulis, Economic Analysis, DG Health and Food Safety, European Commission Integrated Services Seminar, Manchester, 5 th November 2015
Integrated Services for Health and Ageing Well General Practitioners Health Authorities Hospitals Social Service Secure data networks and interoperable applications Nursing Homes Labs Care and Ageing Well @ Home 2
The European Innovation Partnership on Active and Healthy Ageing +2 Healthy Life Years by 2020 Triple win for Europe - A stakeholder-led, cross sectorial, collaboration initiative for research, innovation & intervention. health & quality of life of European citizens Sustainable & efficient care systems growth & expansion of EU ( industry - Launched 2012 as part of Europe 2020 Strategy. - Reach a critical mass for action by pooling EU resources/ expertise & recognising innovation/ excellence. SIX AREAS OF INTERVENTION A1. Adherence to treatment A2. Preventing falls A3. Frailty & cognitive decline B3. Integrated care C2. Independent Living D4. Age-friendly environments TWO STREAMS FOR ACTION Action Groups Reference Sites
Action Group B3 Integrated Care Objective: Reduce avoidable/unnecessary hospitalisation of older people with chronic conditions, through the effective implementation of integrated care programmes and CDM models, ultimately contributing to the improved efficiency of health systems Targets By 2015: Availability of programmes for chronic conditions/case management (inc. remote monitoring) serving older people in >50 regions, available to >10% of the target population By 2015-2020: Based on validated, evidence-based cases, scale-up and replication of integrated care programmes serving older people, supported by innovative tools and services, in >20 regions in 15 MSs
Action Group B3 Integrated Care 1. Organisational Models 2. Change Management 3. Workforce Development 4. Risk Stratification 5. Care Pathways 6. Patient Empowerment 7. Electronic Care Records / ICT/Teleservices 8. Finance, Funding provide input and expertise through an open collaboration Commitments of the partners Mapping of innovative practices Implementation on large scale Practical Toolkits for replication Scaling-up Strategy More integrated, more efficient services
Innovative practices from Action Group B3 Around 100 good practices Comprehensive regional programmes for chronic disease management Integration of health and social care Innovation in technologies, delivery of services and organisation Patient-centered Strong focus on implementation
Examples from Action Group B3 Scotland, UK Legislation on integrated care has been introduced recently. 32 integrated care bodies ( Community Health and Care Partnerships ) are being established. Joint budget and accountability, to overcome the lack of incentives for integration. South Denmark: SAM:BO & the Shared Care Portal A regional agreement for coherent care pathways & an integrated system backed by ICT. Involving primary care, regional hospital sector, municipal social care and patients. Electronic communication and shared care records for health-social care continuum. Chronically ill patients, rehabilitation, nursing, domestic help etc. Spain Basque Country: SAIATU care programme In-home intensive social support services to complement clinical palliative care. To improve care for people with advanced and terminal illness, spend last months of life at home. Valencia: Integrated care through case management Case management teams composed of physicians, nurses and social workers. Reduced the exclusive use of health care resources and promoted the use of social care at home in 55% of cases.
Action Group B3 Integrated Care Deployment & Achievements so far Innovative chronic disease management programmes in 45 regions 14 of them covering over 10% of the target population 22 aim to address vertical and/or horizontal care integration A Maturity model to assess the readiness of regions or care authorities for deploying integrated care An integrated care pathway for respiratory diseases (AIRWAYS-ICP) Tools for risk stratification of the population for optimised and targeted care An ICT Service Matrix : a reference document that characterises the different types of ICT services in an integrated health and care information infrastructure
Dimensions of Maturity Model
European Scaling-up Strategy in Active & Healthy Ageing A strategy and set of actions to engage actors - increase coverage in the same location/region - replicability in other locations http://ec.europa.eu/research/innovation-union/pdf/active-healthy-ageing/scaling_up_strategy.pdf
Evidence about integrated care More evidence on benefits? Analysis of 80 studies*: - 55% of studies improvements on patient outcomes - 45% of studies improved patient satisfaction - only 18% of studies positive economic outcomes Assessment is difficult Most integrated care programmes applied in parallel to traditional programmes decommission the old service to see net benefits Complexity of integrated care: it differs from traditional models of medical care & traditional health economic methods might result in invalid conclusions need new economic methodologies Fundamental question**: * Presented by Bert Vrijhoef, Tilburg University, at European Public Health Conference, 2014 Is integrated care to be considered as an intervention, ought to be costeffective, or is it to be interpreted and evaluated as a complex strategy to innovate and implement long-lasting change in the way services in health and social care are delivered? ** Report of the European Observatory on Health Systems and Policies: "What is the evidence on the economic impacts of integrated care?"
More information EIP on AHA Marketplace: https://webgate.ec.europa.eu/ eipaha Active and Healthy Ageing Partnership http://ec.europa.eu/activehealthy-ageing Disclaimer: The views expressed in this presentation are those of the author and do not represent the view of the European Commission on the subject matter