Better care for people: Integrated Care Strategy in Catalonia - - PowerPoint PPT Presentation

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

• r 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 services

Depending 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 NEEDS

61%

ADVANCED CONDITIONS

1,5%

TERMINAL CONDITIONS DEATH

BEREAVEMENT

Only 57% of complexity is explained by morbidity

155.000

persons with complex needs have been identified with a integrative care plan placed in shared information platforms

Carles Blay. PPAC

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Multimorbidity and 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?

10

14

• utcomes

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

PCC

Multimorbidity Severe unique disease Advanced frailty

MACA

Limited 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 Balancing c cur ure e and and car care Caring Caring as c as close lose as as po possible ssible Closi Closing ng the the ga gaps ps of

• f car

care

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Catalan Model of Health and Social Integrated Care. Core & Enabling elements Local Partnerships Community-based orientation Guarantee 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 Authority Social 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 Health Chronic 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?

1

Stakeholders 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/e vents/icic16-16th-international- conference-on-integrated-care

presidencia.gencat.cat/PIAISS

esarquella@gencat.cat @estersarquella