Integrated health and social care in Catalonia

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Workshop timing:

Activity WelcomeLocal partnerships for integrated care. Lessons learnt from the implementation and assessment in CataloniaAssessment tools, information sharing, and evidence in health and social care. Marianne van den Berg. DG SANTE. European Commission. Group discussion:

• Which are the main causes of fragmentation?

• Which are the key elements to ensure that an integrated care model is ensured at the local but also at the regional level?

Conclusions: pooling ideas and getting shared position

Vicky Serra-Sutton1| Xavier Delgado2| Mireia Llorenç2|Ester Sarquella3| Cari Castillo4| Joan Carles Contel3,5| Marianne van den Berg 6|

(1) AQuAS Agència de Qualitat i Avaluació Sanitàries de Catalunya. Health Ministry.

(2) Social Welfare and Family Ministry(3) PIASS. Inter-ministerial Health and Social Care and Interaction

Plan. Presidency Ministry. Government of Catalonia (4) Gironès – Salt Social Welfare Consortium (local authority)(5) Chronic Care Programme. Health Ministry (6) Policy Analyst, DG SANTE. European Commission

Who we are?

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Catalonia at a glance

Introduction

32,108 km2

In the north-eastern corner of the

Iberian Peninsula

On the Mediterranean coast

7,504.008 people (2015)

947 municipalities

41 counties

70% population → 63 municipalities

with more than 20,000 inhabitants.Source: Idescat and Municat

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Current situation (I)Independent and unconnected social services and healthcare networks

Social services (exclusive powers for the regional

government)

▼

Run by local gov and regional gov

Healthcare services (plenty of powers for the regional gov.

accordig to Spanish law)

▼

Run by regional government

Different maps of service delivery areas

Universal coverage but not free access Universal coverage & free access

Funded by taxes but with significant co-payment for specialized services

Funded by taxes. Co-payment in pharmaceutical products

Multi-provision model

Budget: 1.500 million Euros + extra expenditure from Local authorities

Budget: 8.500 million Euros

Wide range of services covered partially publicly provided by local auth, private and third sector providers and regional government.

Wide range of publicly covered services provided mainly in public facilities

• 369 Primary Healthcare Centres (PHC) ranging from 20-45,000 inh.)• 69 “acute hospitals” (no far from 50 Km. from every home)• 96 “health long term & intermediate care” centres (long-stay,

convalescence, palliative care – 5,557 publicly funded users)• 41 Mental Health Centres

• 106 Basic social services Areas• 48,173 publicly funded users for residential care (including

residential homes, supervised housing and health long term care for

elderly, disability, mental health and children) & 19,287 publicly

funded users for daily care. (Ministry of Social Welfare and Family. 2014)

Catalan Healthcare System. Some features

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Catalan Social Service System. Some features

Current situation (II)

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From

Chronic condition care

to Integrated

Care

Source: Catalan Health Plan 2011-2015.

Health Programs: Better health and quality of life for everyone

Transformation of the care models: better quality, accessibility and safety in health procedures

Modernisation of the organisational models: a more solid and sustainable health system

I

II

III

For each line of action, a series of strategic projects will be developed, which make up the 31 strategic projects of the Health Plan.

9. Improvements to information, transparency and evaluation

1. Objectives and health programs

7. Incorporation of professional and clinical knowledge

6. New model for contracting health care

5. Greater focus on the patients and families

8. Improvement of the government and participation in the system

2. System more oriented towards chronic patients

3. A more responsive system from the first levels

4. System with better quality in high-level specialties

The Catalan Health Plan 2011 - 2015

2.1 Integrated clinical processes

2.2 Protection, promotion and prevention

2.3 Co-responsibility and self-care

2.4 Alternatives in an integrated system

2.5 Complex chronic patients

2.6 Rational prescription and use of drugs

Strategic lines Chronic Condition Care Programme

7 pilot projects on health and social integrated

care

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Pilot project stages

1. Selection of the areas and initial negotiations with local health and social services officials.

2. Drawing up the Local Functional Plan (healthcare and social services across the area).

3. Monitoring and support for the 7 pilot projects (Ministry of Health and Ministry of Social Welfare and Family).

4. External evaluation of the experiences of each project.

5. Selection of good practices and systematisation of protocols, documents and guidelines for action to facilitate transfer to new areas.

6. Presentation of conclusions and selection of new areas.

Model Tona

Model Lleida

Model Gironès

Model Mataró

Model Reus

Model Alt Penedès

Model Vilanova i la Geltrú

Model la Garrotxa

Model Sabadell

Assess collaborative organizational models of social and health care in Catalonia*

Aims of the AQuAs project

Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS)

Qualitative case study understand and describe the phenomenon under study (collaborative models and their benefits / results)

-describe organization and functioning of experiences-identify barriers and facilitators-identify benefits and perceived results-identify best practices -propose recommendations for decision makers-propose a conceptual framework for assessment and common indicators

*primary social services and health care

External assessment of social and health care models.

1) Tona 2 discussion groups (n=3 /n=7) presentation/functional strategic internal plan

2) Lleida ciutat 2 discussion groups (n=4 /n=9) presentation/ protocols/ other documentation 2 questionnaires

3) Gironès 2 discussion groups (n=5 /n=9) 1 interview with co- leader presentation/ protocols/ other documentation 2 questionnaires

4) Mataró 2 discussion groups (n=4 /n=7) poster health plan 1 questionnaire

5) Reus-CAPI District V 2 discussion groups (n=4 /n=10) presentation

6) Alt Penedès 2 discussion groups (n=4 /n=11) presentation 2 questionnaires

7) Vilanova i la Geltrú 2 discussion groups (n=8 /n=16) presentation/ results of needs survey of professionals 3 questionnaires

8) La Garrotxa 2 discussion groups (n=3 /n=10) presentation/ circuits Several subprojects

9) Sabadell (3 ABS) 2 discussion groups (n=6 /n=11) presentation/ circuits/ other docs 2 questionnaires

Most frequent professional profiles: social work, social pedagogy, nursing, family and community medicine, psyquiatry; management / professionals involved in social and health care

Information collected: organization, operation leadership & management barriers & limitations conceptualization & definitions perceived benefits areas for improvement

External assessment of social and health care models

Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS)

Interpretation of reality ...Strategies to ensure rigor and validity of qualitative results

Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS)

Profiles of collaborative models in Catalonia

Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS)

Aims/ target population (main)Models focused on users with an explicit preventive point of view (more social)

Chronic case management model (more health)

Primary care based model (integrated health and social services)

La Garrotxa (1996, IV)

Mancomunitat Plana-Tona(2013, II)

Mataró (2013, I)

Gironès (2013, III)

Alt Penedès (2013, II)

Sabadell (1986/ 2012)

Reus (2002, IV)

Vilanova CAPI (ABS3; 2011, III)

Lleida (2013, II)

Vilanova (ABS1 & ABS2; 2013, I)

Model focused on improving regional/ local efficiency and balanced scope of social & health care

Phase IDefinition and conceptualization + professionals getting to know each other

Phase IIDesign and writing of functional plans, protocols, circuits

Phase IIIDesigned model.Implementation and experience as a team

Phase IVAdvanced phases.Formal model with longer trajectory +assessment and continuous improvement

Collaborative model Coordination

Shared work/ team

Integrated care

closer and more agile relationship

take into account all points of view

the person (user) is at the centre of attention

share views, decide together, work as a teamholistic view of the person, integrated work

the two sides in equal conditions

implies agreement, consensus & common objectives

differentiated circuits are needed

involves coordination but in a more formal manner, more systematic, a better way of organization

a unique window or multiple windows for a single response

shared individual intervention plans, shared professional decision making in periodical comissions

Key perceptions of professionals regarding the conceptual meaning of a “collaborative model of social and health care”

How this process was perceived from the Local Authorities

involved?

Perceived benefits of collaborative models mentioned by professionals

Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS)

For who? Benefits and expected outcomes/ outputs

For professionals

More preventive care strategies and identification of needs (social and health)

Greater professional security and facilitates work

More knowledge and understanding of others and resources available

Enhancement of social work (from the health perspective)

For managers

Optimization of resources and avoids duplications

Improves the quality of care

More agile processes (efficiency)

More professional and users satisfaction

For users & caregivers

More security and tranquillity

More individualized answers and more based on users needs

Decreased stigma of being user of social services

Facilitates accessibility

For the system

Allows preventive actions and anticipate situations

Improves confidence and appreciation of health and social services

Resources are better recouped and more precise needs assessment

Reduce of stigma from receiving social benefits

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2014. A step forward to a model of integrated health and social care. Some starting points:

The Plan develops a regional agenda.

Promoted by the Presidential Ministry (Government of Catalonia) with the participation of the Ministry of Social Welfare and Family and the Ministry of Health.

The aim is to catalyze necessary actions to accomplish an integrated system that guarantees social and health care to people who have care needs of both services.

This is not a point 0 but an evolution of many experiences and programs run before and specifically an evolution from the chronic condition care programme.

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 with complex health and social care

needs

Integrated care, why?

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Integrated Care, for who?

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

PNASC

Catalan Model of Health and Social Integrated Care. Core & enabling elements

“Microsystems”•Community-based and primary care leadership

• Integrated care pathways•Multiprofessional work•Transitional care •Out of hours care•Home care strategies

Joint case / care load. Shared needs assessment + action plan

Stratification models: assessing population needs

Clinical and professional leadership

Health and social care local Partnerships

Shared outcome framework : shared responsibility & joined accountability Shared vision about

the use of resources: Aligned Incentives

Shared Electronic Health and Social record

Person Empowerment and Self-care

ENABLING ELEMENTS

Multi-lever approach: ALL things at the same time

Culture and change

management

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Stakeholders commitment

Developing a strong theory of change shared and supported for the policy level

Subsidiarity principle. Local partnerships

Challenge 1

Challenge 2 Long term thinking for short term problems

Ensuring an assembler role

Challenge 3 Make something happen

Multilevel approach - Disruptive strategy & Start up methods

Challenge 4 Workforce role transformation

Professional leadership and consensus strategies

Challenge 5 Citizenship involvement

Redefining the citizens role

Lessons learnt:

presidencia.gencat.cat/PIAISS

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Assessment tools, information sharing, and evidence in health and social care.

Marianne van den Berg. DG SANTE. European Commission.

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Group discussion

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Which are the main causes of fragmentation?

POLICY STRATEGY ORGANIZATION & OPERATIONS

PROFESSIONALSCITIZENSHIP OTHER STAKEHOLDERS

FR A

GMEN

T A T I O

N

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Which are the key elements to ensure that an integrated care model is guarantied at the local but also at the regional level?

INTEGRATED CARE

PERSON CENTRED

CARE

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Pooling ideas and getting shared position.

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Main causes of fragmentation

At the policy level

At the strategic levelAt the organizational and operational level

From the stakeholders: citizenship

From the stakeholders: professionalsFrom the stakeholders: providers, 3th sector...

Key elements

INTEGRATED CARE

PERSON CENTRED

CARE

Presidencia.gencat.cat/PIAISS