Integrated Care around the World Moving towards population health management K. Viktoria Stein, PhD International Foundation for Integrated Care National Health Fund Poland, Integrated Care Conference Warsaw, 18 March 2016

The reality of care settings Adapted from Goodwin 2008 and 2014 Hours with professional / NHS = 3 in a year Hours of self care = 8757 in a year  Need for people engagement  Need for patient empowerment  Need for people engagement  Need for patient empowerment

Approx inhabitants

Key lessons: change cultures and strengthen competencies Common goals Consistent leadership Engagement – of professionals and communities Quality improvement, not cost containment Developing skills and capacity Robust primary care – Pegasus Health Focus on care transitions Focus on care at home Information systems to support communication and used to drive quality improvement Effective learning strategies Long-term view Professional cultures that support team work – “One System, One Budget” Timmins & Ham,

Gesundes Kinzigtal, Germany Mio € surplus improvement for the two sickness funds in the Kinzigtal region in 2013 against 75 Mio € norm costs Participants die 1.4 years later (78.9 vs 77.5 control) 98.9 % of enrollees who set an objective agreement with their physician would recommend becoming a member to their friends or relatives Community building and securing health care for the region Satisfied and healthier professionals Hildebrandt H. Fully Integrated Person- Centered Health Care: „Gesundes Kinzigtal“ – An Accountable Care Organization in Germany, developing a new Business Model in Health Care. Presentation during the WCIC3, Mexico City 2015 Approx people enrolled

Key Lessons: create shared accountabilities, processes and incentives Shared health savings account and accountable care organisation Financial incentives to integrate Continuous improvement cycle Integration of – health care & social care – clinical wisdom & scientific competence (health sciences) – targeted prevention & mobile innovation – electronic data exchange & analysis of Big Data for improvement – community organizing & health promotion – health care & public health Organization / Management Physicians/ Medical Professions Psychosocial Interventions / Public Health Research & Development / Innovations Citizens & Patients Based on Hildebrandt H. Fully Integrated Person-Centered Health Care: „Gesundes Kinzigtal“ – An Accountable Care Organization in Germany, developing a new Business Model in Health Care. Presentation during the WCIC3, Mexico City 2015

Adjusted clinical groups©, Veneto Region, Italy Pilot project started in 2012 with 2 local health units, roll-out continued until 2015 Construction of database, retrospective analysis of population, identification of risk groups and gaps analysis lead to: Based on Corti MC. USING A POPULATION RISK-ADJUSTEMENT TOOL TO INTEGRATE HEALTH SERVICE DELIVERY IN REGIONE VENETO. Presentation during Second CIHSD Technical Meeting of the WHO Regional Office for Europe. Istanbul 2015 Almost 5 mio inhabitants

Key Lessons: population health management does not work without data analysis Align all available data sets Invest in data quality Use predictive modelling Concentrate on quality improvement of service delivery NOT cost reduction Based on Corti MC. USING A POPULATION RISK-ADJUSTEMENT TOOL TO INTEGRATE HEALTH SERVICE DELIVERY IN REGIONE VENETO. Presentation during Second CIHSD Technical Meeting of the WHO Regional Office for Europe. Istanbul 2015

3 key principles: – People will be empowered to direct their care and support and receive the care they need in their homes or local community. – GPs will be at the centre of organising and coordinating people's care. – Our systems will enable and not hinder the provision of integrated care. Started as an Integrated Care Pilot in 2011 Has now been transformed into a Pioneer and established a network of over 30 organisations from the health and social services, as well as community and lay partners Taking care of over 2 mio people North West London Whole Systems Integrated Care

Key lessons: active involvement of community through co-design approach Involvement of over 150 representatives from across the health and social care system including service users and carers, to work together and define the framework for North West London Service users and carers work in equal partnership with professionals at every stage of the journey in the Lay Partners Advisory Board, which oversees and challenges the programmes WSIC Toolkit Toolkit is a living document and repository to support local communities and partners on how to implement whole systems integrated care

A Strategy to Tackle the Challenge of Chronicity in the Basque Country Approx 2 mio inhabitants

Key Lessons: it needs senior leadership and a top-down/bottom-up approach TOP- DOWN STANDARIZABLE INTERVENTIONS CALL CENTER ELECTRONIC MEDICAL RECORD FINANCING AND JOINT COMMISSIONING ELECTRONIC PRESCRIPTION STRATIFICATION CASE NURSING PACIENT EMPOWERMENT HEALTH AND SOCIAL CARE COORDINATION SUBACUTE CENTRES INTEGRATED CARE BOTTOM UP LOCAL INNOVATION Bengoa, Mota 2013

So how did they do it? Change Management StepsRelationship Building Activities Time Developing Collaborative capacity Establishing a guiding coalition Building support for change Needs Assessment Establishing mutual gain Strategic plan Situational Analysis Value Case Development Vison and mission statement Communication Implementation and institutionalisation Monitoring and evaluation Source: Goodwin N (2015) Managing Change Towards Co-ordinated/Integrated Health Services Delivery WHO Regional Office for Europe, November 2015 Feedback Loop Cycle of Learning

Summary 1 Whole-of systems and health in all policies approach for integrated care Source: Adapted from WHO-HQ Global Strategy on people-centred and integrated health services 2015 HEALTH SYSTEM Governance, financing and workforce OTHER SECTORS Education, sanitation, social assistance, labor, housing, environment, others PERSON SERVICES DELIVERY CONTEXT Epidemiology, cultural, socio-demographic and economic

Source: Valentijn et al (2013) Understanding integrated care: a comprehensive conceptual framework based on the Integrative functions of primary care, IJIC, vol13. Jan-Mar Summary 2 The ‚Rainbow Model‘: Interventions on all levels

WHO Regional Office for Europe. Lessons from transforming health services delivery: Compendium of initaitves in the WHO European Region. WHO, Copenhagen 2016, forthcoming The WHO European Region: 53 Member States – 900 Mio inhabitants 10 Lessons learned from 85 cases across the Region 1.Put people and their needs first 2.Reorient the model of care 3.Reorganize the delivery of services 4.Engage patients, their families and carers 5.Rearrange accountability mechanisms 6.Align incentives 7.Develop human resources for health 8.Uptake innovations 9.Partner with other sectors and civil society 10.Manage change strategically

A patients‘ definition: “I can plan my care with people who work together to understand me and my carer(s), allow me control, and bring together services to achieve the outcomes important to me.” K. Viktoria Stein, PhD Head of the Integrated Care Academy© International Foundation for Integrated Care National Voices 2013