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 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 Source: www.idescat.cat UE Indicators Programa de prevenció i atenció a la cronicitat (PPAC) Portal estadística dependència. IMSERSO Icons made by freepick available in flaticon http://www.freepik.com Ester Sarquella. PIAISS Departament de BSIF . Memòria 2014

Catalonia: our health and social service system Social services Healthcare services • • Exclusive powers to regional government Majority of powers for the regional • Run by local and regional governments governments according to Spanish law • Run by regional government Different maps of service delivery areas Universal coverage and free access to some Universal coverage & free access services Funded by taxes but with co-payment for some Funded by taxes. Co-payment in pharmaceutical services products Multi-provision model Wide range of services covered publicly by Wide range of publicly covered services provided regional government and by local authorities, mainly in public facilities provided directly publicly or by the Third Sector or private providers. Budget: € 2.279 million Budget: € 8.500 million € 1,878.33 million: regional government € 400,67 million: local authorities Ester Sarquella. PIAISS

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 4 Ester Sarquella. PIAISS

A history of trying to work together… “Life to the years” program Chronic Care Program (5/7/11) Inter- ministerial Plan for Integrated Care (26/2/14) Dependency Act (Spain) 1986 2006 2007 2010 2011 2013 2014 2015 Directive Plan for Health and social Care Parliament resolution for Inter-ministerial Plan for health and social Mental Health care integration Social service Act (8/7/15) 12/2007 Inter-ministerial Plan for public health Ester Sarquella. PIAISS

Chronic Condition Care Program (2011) 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 "Expert patient program Catalonia" Defining shared indicators Using quality measures. MSIQ Implementing integrated care pathways (within the health system) 7 pilot projects on health and social integrated care 6 Changing the contract 2013 with common PHC-Hospital Targets 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 ADVANCED TERMINAL DEATH NEEDS CONDITIONS CONDITIONS BEREAVEMENT 61% 1,5% 155.000 Only 57% of persons with complex needs have been identified with a complexity is integrative care plan placed in explained by shared information platforms morbidity Carles Blay. PPAC

Multimorbidity and complexity are strongly related to social care needs 9 Carles Blay. PPAC

2014 the Catalan government takes a decision (PIAISS) Why integrated health and social care?  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 14 outcomes 10 Ester Sarquella. PIAISS

Integrated Care, for whom? Population based but starting for high need & high risk & high use Healthcare complex needs Social care complex needs Functional autonomy P PCC MACA needs N Multimorbidity Limited live prognosis Interpersonal and Severe unique disease Palliative approach, A relational needs Advanced frailty Advance care planning S Instrumental and C material needs Ester Sarquella. PIAISS

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 as c Caring as close lose as as po possible ssible Closi Closing ng the the ga gaps ps of of car care 12 Font: morguefile.com

Catalan Model of Health and Social Integrated Care. Core & Enabling elements Health and social care Local Partnerships boards Community-based orientation Guarantee of continuity: • Integrated pathways |Transitional care | 7x24 care New role of the Case Management and collaborative people practice Clinical & professional • Identification, shared assessment, leadership and shared intervention plan • Defining new roles for professionals ENABLING ELEMENTS Integrated planning, Shared vision for the commissioning and use of resources shared accountability Digital health and care Leadership and Shared budgets Change management 13 Multilevel strategy Font: Elaboració pròpia del PPAC i PIAISS. Contel, J. Sarquella, E.

Local Partnerships December 2015

LOCAL PARTNERSHIP BOARDS • Social Welfare and Family Ministry • Health Ministry • 6 Local Authorities

Basic Social Services. Local Social Welfare Ministry. Regional CatSalut: Health Authority Gov Gov 3th Sector Primary Healthcare Alt Pirineu Primary health care Medical Director. Hospital Social Worker Home Care / Daily Care provider Chronic Care Program Adults Mental Health SEM PADES Integrated Care Plan Long term care service Children Mental Health LOCAL PARTNERSHIP OPERATIONAL COMMITTEES

Emergency admissions related to COPD exacerbation More than a half emergency admissions compared to Catalan average (x 100.000 inhab.)

Emergency admissions related to COPD exacerbation More than a half emergency admissions compared to Catalan average (adjusted data)

What have we learned? Stakeholders commitment: 1 Shared theory of change, policy support, professional leadership, consensus strategies Think globally, act locally: 2 Subsidiarity principle, local partnerships Citizens power and public agenda : 3 Redefining citizens ’ role and work for increasing supports Long term thinking, short term solving : 4 The assembler role Make things happen!: 5 Multilevel approach, disruptive strategy 20

http://integratedcarefoundation.org/e vents/icic16-16th-international- conference-on-integrated-care 21

presidencia.gencat.cat/PIAISS esarquella@gencat.cat @estersarquella