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Chair - EUREGHA European Regional and Local Health Authrities Association

European Innovation Partnership on Active and Healthy Ageing EIP AHA Action Group B3 Integrated Care Dr. Toni Dedeu Senior International Officer Ministry of Health of Catalonia Istanbul, 10 th September 2013. Chair - EUREGHA European Regional and Local Health Authrities Association.

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Chair - EUREGHA European Regional and Local Health Authrities Association

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  1. European Innovation Partnership on Active and Healthy AgeingEIP AHA Action Group B3Integrated CareDr.Toni DedeuSenior International OfficerMinistry of Health of CataloniaIstanbul, 10th September 2013 Chair - EUREGHA European Regional and Local Health AuthritiesAssociation

  2. European Innovation Partnership on Active and Healthy AgeingB3 ACTION GROUP ON INTEGRATED CARE EFPC – ISTANBUL 10 SEPTEMBER 2013

  3. European Innovation Partnership on Active and Healthy AgeingHow many of you have ever heard about EIP AHA?Are your organisations involved in any EIP Action Group?

  4. European Innovation Partnership on Active and Healthy AgeingB3: INTEGRATED CARE COLLABORATIVEAN OVERVIEW

  5. Ageingsociety Lack of health professionals Chronic conditions Financial challenges HLY vs LE Health inequalities

  6. EUROPE 2020 FLAGSHIPS FOR SMART, SUSTAINABLE AND INCLUSIVE GROWTH Digital Agenda Youth on the Move Innovation Union New Industrial Policy New Skills and New Jobs Platform against Poverty Resource Efficiency HEALTH IN EUROPE 2020 EUROPEAN INNOVATION PARTNERSHIP ON ACTIVE ANDHEALTHY AGEING

  7. +2 Healthy Life Years by 2020 Triple win for Europe Action Groups Reference Sites

  8. ACTION GROUPSEIPAHA

  9. Political added value of the EIP Joint Action on Chronic Diseases and Healthy Ageing (28 countries + 5 networks) inspire for policy action support from the ground High level conferences (e-health, Gastein Forum, Conference of Partners, Frailty and Adherence Conferences) identify good practices working in real life EC: facilitator & supporter Alignment of priorities in Horizon 2020, CIP 2013, PHP 2013 etc. develop policy on active & healthy ageing align policy priorities with funding Reflection process of the MS: Towards modern, responsive and sustainable health systems mobilise efforts & resources

  10. POLITICAL ADDED VALUE OF THE EIP AT A REGIONAL LEVEL PERSONACTIVEAGEINGCITIZENHEALTHY

  11. OPPORTUNITY EUROPEAN COMMISSION CATALONIA

  12. STRATEGIC IMPLEMENTATION PLAN FORAHA EIP AHA A2 A3 B3 C2 A1 D4 2013 C RS OM Commitment/ ReferenceSite/ Market Place

  13. Building up EIP scale and critical mass 1,000 regions & municipalities > 500 commitments 1 billion euro mobilised 3,000 partners Marketplace >30,000 visits >650 registered users 30 mio citizens, >2 mio patients

  14. Invitation For Commitments 2013 Closed: 28 February 2013 • Stronger network of partners • 10 submissions expand existing commitments • 30 submissions involve existing AG member • Focus on Implementation • close to half of the committed organisations are care providers • over half of the commitments are directly contributing to the implementation of integrated health and care systems

  15. European Innovation Partnership on Active and Healthy AgeingB3 Action Group‘Replicating and tutoring integrated care forchronic diseases, including remotemonitoring at regional level’

  16. B3 Objective (Operational Plan 11/11) • Reducing avoidable / unnecessary hospitalisation of older people with chronic conditions, through the effective implementation of integrated care programmes and chronic disease management models that should ultimately contribute to the improved efficiency of health systems.

  17. WHAT SOME ‘BRAINS’ SAY ABOUTINTEGRATED CARE PopulationBased PersonFocusedCare Normative Integration Personal Integration MicroLevel Meso Level Macro Level

  18. B3 Integrated Care Collaborative Regions, delivery organisations, patient / carers organisations, academia, industry collect experience, evidence to support policy-making provide input – expertise, best practice iterative, flexible process inspiration scale up innovative solutions synergies +2 HEALTHY LIFE YEARS by 2020 A triple win for Europe

  19. B3 ACTION GROUPMEMBERSHIP CAT 12 • 135EIP commitments received from: • Regions • Delivery organisations • Patient / carer representative organisations • Academia • Industry • 199 individual stakeholders from committed regions / organisations and growing…… 19

  20. EIP AHAINTEGRATED CARE FromChronicCare 2013 Integrated Care 2020

  21. CORE TOPICSINTEGRATED CARE YOUR IDEAS ? WAIT AND SEE EIP AHA ACTION AREAS

  22. challenges to the successful adoption of integrated care [1]. The focus of debate centred on four key systemic questions: what kinds of payment system best incentivise integrated care?; which organisational solutions are most effective?; how can care be better co-ordinated around people’s needs?; and what implementation strategies are likely to be most effective to stimulate change? CHALLENGES TO THE SUCCESSFUL ADOPTION OFINTEGRATED CARE Whatkinds of PAYMENT SYSTEMS best incentivise IC ¿ ? WhichORGANISATIONAL SOLUTIONS aremoreeffective

  23. CHALLENGES TO THE SUCCESSFUL ADOPTION OFINTEGRATED CARE How can care be BETTER CO-ORDINTED aroundpeople’sneeds ¿ ? WhatIMPLEMENTATION STRATEGIES arelikely to be most effective to STIMULATE CHANGE

  24. POLITICAL ADDED VALUE OF THE EIP AT A REGIONAL LEVEL Strategy Partnership Innovation PERSONACTIVEAGEINGCITIZENHEALTHY EUInitiave Opportunity Sustainability ICT Predictive models Collaborativeapproach

  25. European Innovation Partnership on Active and Healthy AgeingB3: INTEGRATED CARE COLLABORATIVEB3 DELTA QUESTIONNAIRE ANALYSIS

  26. THE DELTA QUESTIONNAIRE • Objective: Gain insights in the implementation of integrated care • Who: - Regions / delivery organisations with B3 commitments - Candidate EIP Reference Sites • What: • 27 European regions • Coverage of population of c. 54 million people • Spending of > €15 B per annum on care for people with chronic conditions.

  27. 27 REGIONSFROM EUROPE

  28. KEY FINDINGS OF THE DELTA QUESTIONNAIRE

  29. SHIFT TO PRIMARY/COMMUNITY BASED CARE

  30. USE OF THE DELTA QUESTIONNAIRE • Validating the Definition of Integrated Carefor the Action Plan • Validating and mapping of Action Areas • Mapping activities • Mapping gaps The work is on-going: • Further insights to be gained through B3 activities in different Action Areas • Lessons learnt

  31. PERSONACTIVEAGEINGCITIZENHEALTHYAGEINGEUEIPAHAINTEGRATE DEBATE FOOD FOR THE DEBATE

  32. B3 ACTION AREAS PERSONACTIVEAGEINGCITIZENHEALTHYAEIPAHAI organisational models change management workforcedevelopment riskstratifiction financing carepathways ICT patient/userempowerment dissemination

  33. B3 ACTION AREAS PERSONACTIVEAGEINGCITIZENHEALTHYAEIPAHAI AA1 Organisational Models AA2 Change Management AA3 WorkforceDevelopment AA4 CarePathways AA5 RiskStratifiction AA6 Patient/UserEmpowerment AA7 ICT AA8 Financing AA9 Dissemination

  34. EIP AHA B3 Action Plan • Increase the average number of healthy life yrs by 2 in the EU by 2020 • Health status and quality of life ।Supporting the long term sustainability and efficiency of health and social systems । Enhancing competitiveness of EU industry Chronic Conditions Integrated Care SIP TARGETS By 2015 Chronic Conditions’ Programmes available at least 10% of target population in at least 50 regions By 2015 - 2020 Integrated Care Programmes serving older people, supported by innovative tools and services, in at least20 regions Implementation and Scale Up of Chronic Care + Integrated Care Programmes Action Area  Organisational Models Action Area  Change Management Action Area  Workforce Development Action Area  Risk Stratification Action Area  Care Pathways Action Area  Patient / User Empowerment Action Area  ICT Tools Toolkit Map of partnership models for implementation of Chronic and Integrated Care Programmes Map of best practice methodologies to support the implementation of Chronic and Integrated Care Map of reusable learning resources Stratification of the population Mapping Best Practices in the EU regions Map of coaching, education and support patient/user empowerment and adherence Action Area  Finance/Funding Toolkit Action Area  Dissemination Toolkit Toolkit Toolkit Toolkit Toolkit Toolkit 2013 Monitoring impact and outcomes 2015

  35. 4

  36. STRATEGY

  37. STRATEGY

  38. European Innovation Partnership on Active and Healthy AgeingB3: INTEGRATED CARE COLLABORATIVEB3 GOOD PRACTICES

  39. B3 GOOD PRACTICES • Objective: to gather an initial map of current integrated care activities relating to the B3 Action Areas • Who: All B3 members were invited to complete the B3 Good Practice template • What: 37 regions / organisations completed the template by the end of April 2013

  40. COLLECTION OF GOOD PRACTICESMARCH-APRIL 2013 • 37 good practices • 29 organisations • 16 regions • 8 action areas … and the collection is still on-going SEPTEMBER 2013 > 50

  41. THEMATIC COVERAGE OF THE GOOD PRACTICES B3 ACTION AREAS

  42. COVERAGE OF THE GOOD PRACTICES - Size of the target population varies from 50 patients to 7.5 million citizens - Total: over 13 million people

  43. SEMEHT THEMES 50% of the good practices target one or more chronic disease (cardiovascular diseases, COPD, diabetes, etc) Numerous examples of comprehensive regional programmes for chronicity Wide range of issues, incl. insurance, social security, housing, independent living, volunteering, impact on competitiveness Innovation in technologies, delivery of services and organisation Patient-centered Strong focus on implementation

  44. AND …..A FEW EXAMPLES ParkinsonNet, RadboudUniversityNijmegenMedicalCentre Successfully improved Parkinson care in the Netherlands by: • Developing regional networks of primary and secondary Parkinson care around general hospitals • Selecting and training physiotherapists to work according to evidence-based guidelines • Boostingpatient volumes per therapist by stimulating selective referral to ParkinsonNet therapists • Supporting these networks with online tools to enhance information exchange and communication and therefore collaboration between allied health professionals, neurologists, and empowered patients. The model demonstrates: • An improvement in the quality of care for those patients • Prevention of disease complications (including a 50% reduction in hip fractures) • A reduction in hospitalization • A substantial cost reduction (€20 million annually in the Netherlands alone) SUSTAINABILITY

  45. GOOD PRACTICE IN AA7 ICT AND TELESERVICES NHS24, Scotland: ICT for prediction of risk improves planning healthcare and better address of resources . Puglia, Italy: Telecardiology - Over 550.000 ECG performed, significant reduction of avoidable death, 60% underwent appropriate treatment and no hospitalization unless urgent (only 11%) Lombardia, Italy: Homebasetelesurveillance programme COPD patients. 60% of patients didn’t occur hospitalization. FondazioneB.KesslerTrentino, Italy: Access to personal HER a key element for empowerment. Best practice in the field of Public-Private partnership for e-health procurement

  46. GOOD PRACTICE IN AA7 ICT AND TELESERVICES NHS24 Scotland: ICT to support learning network – to share knowledge and foster peer to peer review. Catalonia NEXES Project: ICT Platform for health information sharing, Patient self-management, Electronic Health Record. Basque Country TelBil: ICT telemonitoring resulted in significant reduction in hospital admissions for patients with Heart Failure and COPD Saxony, Germany: ICT for Diabetic patients, management of patients data, networking among stakeholders, real time monitoring of related costs Lombardia FondazioneMaugeri, Italy: Telesurveillance programme for Heart Failure patients demonstrated reduction of hospitalisation and improved access to appropriate care SIPE, Emilia Romagna, Italy: R.A. financed Industrial District, creating partnership between enterprises and Universities to foster R&D processes followed by technology transfer

  47. NEXT STEPS... • An analysis of good practices will be undertaken to determine: • Success factors – why initiative worked well • Lessons learned – what didn’t work / what could be done better / differently • Transferability to other regions / organisations – to promote scale up of integrated care • Will inform the development of the B3 toolkits

  48. European Innovation Partnership on Active and Healthy AgeingB3: Integrated Care CollaborativeAction Area 7: ICT and Teleservices

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