Posted by: ihfgeneva | September 9, 2014

Achievements and challenges in integrated care: different healthcare providers working together.

The Catalan Health System is a public healthcare system, funded by taxes, with universal coverage and a defined public health services portfolio. The range of health services guaranteed for our population covers health promotion, prevention, health care (primary health care, acute care, mental health care, long-term care health services) and palliative care till the end of life. The Health Authority is responsible for public health policy (funding, accreditation of health care facilities and healthcare services providers, quality evaluation, regulation). Through a Health Plan, that guides the public health policy, prioritizes health outcomes and establishes desired results. The Catalan Health Service is the public insurance, responsible for health services provision, according to health policies, and it works through a healthcare providers network that delivers different healthcare services on a territorial basis. All providers have a health care service contract with the Catalan Health Service that establishes the services portfolio that has to be provided as well as the activity, quality and expected results. They are evaluated on a yearly basis and get variable payment depending on the results achieved. Besides, there is a public agency, Quality in Health Care Agency that oversees public accountability and results evaluation of the Health System, through a system of benchmark.

What is characteristic and relevant in our health system (in relation to integration of health care and facing the challenge of a more patient-centred healthcare), is that the health provision system is a mixed one where public and private owned health organizations work together for the public health system. There is a wide rang of different kind of healthcare providers organizations, all working in a public healthcare providers network. One system, but many providers: different kind of healthcare organizations (primary care, hospitals, long term care, mental healthcare), different population characteristics and needs covered, different management models, labour conditions, juridical determinants, and so on.

That is our challenge:  we have to work together and achieve the desired results (promoting a patient needs’ centred healthcare system, guaranteeing continuity of health care services, providing healthcare in efficient conditions, improving primary care resolution, developing models of sharing healthcare information between healthcare providers) but with different conditions and management tools within the different health providers.

In a model like this, how do we assure integration and a patient-centred health care? Giving enough autonomy to health providers to adapt their activity and healthcare provision model to the needs of their population in each territory, allowing them to develop different solutions, singular responses depending on their conditions and capabilities). The health system must guarantee results by establishing a frame of risk and results shared, developing contract and purchasing systems that incentivize those results desired and developing models of accountability of the results achieved and, therefore, taking those decisions that help to improve.

European fIn the EFPC Conference in Barcelona we had the opportunity to share three different experiences that are an example of this complexity, with different solutions but the same results achieved -improving integration, guaranteeing efficacy, quality and efficiency in healthcare-. A technological tools-based model for integrated healthcare, were integration is achieved through the implementation of a patient-focused model, based on a comprehensive healthcare management strategy and a shared electronic medical record that allows integration of all levels of healthcare and allocating resources in to the more efficient place. The model ensures an overview of all the process and the continuum of care. Another experience shared was a model of functional integration, where primary care is the axis for patient’s needs-based healthcare organization. This experience shows functional integration of healthcare services based on patients needs through a healthcare facility managed by primary care doctors, called “light” Hospital. Ambulatory specialized healthcare services, continuous healthcare services, rehabilitation and physiotherapy services are provided in this facility where all healthcare services depend on primary care doctors, who organize healthcare attention, allocate resources and manage functional dependence. And, finally, we also had the opportunity to present a model of a self-management organization in Primary Healthcare centres managed by a group of health professionals organized themselves as a General Practitioners (GPs) association (so called Entitat de Base Associativa-EBA). They are responsible for the management of the Primary care centre and providing primary healthcare services, through a contract with the Health Authority. EBAs have fully autonomy and risk sharing in managing resources. The benchmarking efficiency parameters show remarkable results. EBAs have demonstrated to be a successful initiative as a model of organization.

The key message of our Health System is that managing and organization diversity is not a problem, is an opportunity that must help us to find innovative solutions for the main health care system challenges as integration, a patient needs’ centred healthcare system, always guaranteeing health results desired by a public accountability.

The IHF has formalized the issue of integration of health care in the context of growing challenge of Multi-chronic conditions  See document

View presentations at EFPC in barcelona 2014

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