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Better care for people: Integrated Care Strategy in Catalonia Friday, 15 April 2016
Better care for people:
Integrated Care Strategy in
Catalonia
Friday, 15 April 2016
Catalonia: a snapshot picture
Icons made by freepick available in flaticon http://www.freepik.com
7.4 Million People - Growth of 1M the last decade 16% of Spain
948 municipalities & 42 counties 63 municipalities over 20.000
83.2 Life expectancy at birth 80.3 for male 86 for female
1.5 Million people at risk of poverty - 20.9% of the population
26 % AROPE (risk of poverty or social exclusion rate)
18% population over 65 and 4.3% over 80
1.3 million over 65, 0.41 over 80 and 1.700 people over 100 (2013)
2.4 million over 65, 0.94 over 80 and 21.500 people over 100 (previsions for 2051)
20.3% Unemployment rate 47.1% youth unemployment
11.5 % long-term unemployment
Ester Sarquella. PIAISS
Source:
www.idescat.cat UE Indicators
Programa de prevenció i atenció a la cronicitat (PPAC)
Portal estadística dependència. IMSERSO
Departament de BSIF . Memòria 2014
Catalonia: our health and social service system
Social services Healthcare services • Exclusive powers to regional government • Run by local and regional governments
• Majority of powers for the regional governments according to Spanish law
• Run by regional government
Different maps of service delivery areas
Universal coverage and free access to some services
Universal coverage & free access
Funded by taxes but with co-payment for some services
Funded by taxes. Co-payment in pharmaceutical products
Multi-provision model
Wide range of services covered publicly by regional government and by local authorities,
provided directly publicly or by the Third Sector or private providers.
Wide range of publicly covered services provided mainly in public facilities
Budget: €2.279 million€1,878.33 million: regional government
€400,67 million: local authorities
Budget: €8.500 million
Ester Sarquella. PIAISS
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Catalonia: our health and social service system
2 Ministries Ministry of Health – Ministry of Work, Social Affairs and Family
7 Health regional services vs. 5 Social Welfare regional servicesDepending from the ministries
43 Clinical strategic areas commissioning health
103 Local Authorities commissioning social services
369 Primary Healthcare Centres
103 Basic Social Services Areas
69 acute hospitals
96 long term & intermediate care centres
41 Mental Health Centres
Ester Sarquella. PIAISS
1986 2006 2007 2010 2011 2013 2014 2015
Parliament
resolution for
health and social
care integration
(8/7/15)
Inter-ministerial Plan for public health
A history of trying to work together…
“Life to the years”
program
Directive Plan for
Health and social Care
Dependency Act (Spain)
Social service Act
12/2007
Chronic Care Program (5/7/11)
Inter-ministerial Plan for
Mental Health
Inter- ministerial Plan
for Integrated Care
(26/2/14)
Ester Sarquella. PIAISS
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Labeling two profiles of complexity: PCC & MACA
Guaranteeing a basic health assessment in Complex Chronic Patients
Ensuring a “key information summary” for all pcc
Defining a stratification model. Population based - GMA
Visualizing in Shared Clinical Record and different RISK scores
Defining shared indicators
Using quality measures. MSIQ
Implementing integrated care pathways (within the health system)
Changing the contract 2013 with common PHC-Hospital Targets
7 pilot projects on health and social integrated care
"Expert patient program Catalonia"
Chronic Condition Care Program (2011)
Ester Sarquella. PIAISS
Catalan Chronicity strategy 2011-2014 has worked successfully
Evolution of avoidable hospitalization rates in chronic patients 2011 - 2014
Effect of clinical pathways on main DM type 2 indicators 2008 - 2014
Carles Blay. PPAC
COMPLEX NEEDS61%
ADVANCED CONDITIONS1,5%
TERMINALCONDITIONS
DEATHBEREAVEMENT
Only 57% of
complexity is explained by
morbidity
155.000persons with complex needs have been identified with a integrative care plan placed in shared information platforms
Carles Blay. PPAC
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Multimorbidityand complexity are strongly related to social care needs
Carles Blay. PPAC
Better health and social welfare results
Better experience of care to the health and social needs
Better use of resources
Provide better care for people
Why integrated health and social care?
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14 outcomes
2014 the Catalan government takes a decision (PIAISS)
Ester Sarquella. PIAISS
Integrated Care, for whom?
Population based
but starting for high need & high risk & high use
PCCMultimorbidity
Severe unique diseaseAdvanced frailty
MACALimited live prognosis Palliative approach,
Advance care planning
Functional autonomy needs
Interpersonal and relational needs
Instrumental and material needs
Healthcare complex needs Social care complex needs
P
N
A
S
C
Ester Sarquella. PIAISS
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Font: morguefile.com
process of identification
shared assessment
join intervention plan
view for the use of resources
depending on the care needs
case manager
Balancing cure and care
Caring as close as possible
Closing the gaps of care
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Catalan Model of Health and Social Integrated Care. Core & Enabling elements
Local PartnershipsCommunity-based orientationGuarantee of continuity:• Integrated pathways |Transitional care | 7x24 care
Case Management and collaborative practice• Identification, shared assessment, and shared intervention plan •Defining new roles for professionals
Clinical & professional leadership
Health and social care boards
Integrated planning, commissioning and shared accountability
Shared vision for the use of resources
Digital health and care
New role of the people
ENABLING ELEMENTS
Multilevel strategy
Leadership and Change management
Font: Elaboració pròpia del PPAC i PIAISS. Contel, J. Sarquella, E.
Shared budgets
Local Partnerships
December 2015
LOCAL PARTNERSHIP BOARDS
• Social Welfare and Family Ministry• Health Ministry• 6 Local Authorities
SEM
CatSalut: Health AuthoritySocial Welfare Ministry. Regional
Gov
Basic Social Services. Local
Gov
PADES
Medical Director. Hospital
Children Mental Health
Home Care / Daily Care provider
Long term care service
Primary health care
Social Worker
Primary Healthcare Alt Pirineu
Adults Mental HealthChronic Care Program
Integrated Care Plan
3th Sector
LOCAL PARTNERSHIP OPERATIONAL COMMITTEES
Emergency admissions related to COPD exacerbation
More than a half
emergency
admissions
compared to
Catalan average
(x 100.000 inhab.)
More than a half
emergency
admissions compared
to Catalan average
(adjusted data)
Emergency admissions related to COPD exacerbation
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What have we learned?
1Stakeholders commitment:
Shared theory of change, policy support, professional leadership,
consensus strategies
2 Think globally, act locally:
Subsidiarity principle, local partnerships
3 Citizens power and public agenda: Redefining citizens’ role and work for increasing supports
4 Long term thinking, short term solving: The assembler role
5 Make things happen!:
Multilevel approach, disruptive strategy
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http://integratedcarefoundation.org/events/icic16-16th-international-conference-on-integrated-care
