European Innovation Partnership on Active and Healthy Ageing

EIP AHA Action Group B3Integrated Care

Dr. Toni DedeuSenior International Officer

Ministry of Health of Catalonia

Istanbul, 10th September 2013

Chair - EUREGHA European Regional and Local Health Authrities Association

European Innovation Partnership on Active and Healthy Ageing

B3 ACTION GROUP ON INTEGRATED CARE

EFPC – ISTANBUL 10 SEPTEMBER 2013

European Innovation Partnership on Active and Healthy Ageing

How many of you have ever heard about EIP AHA?

Are your organisations involved in any EIP Action Group?

European Innovation Partnership on Active and Healthy Ageing

B3: INTEGRATED CARE COLLABORATIVE

AN OVERVIEW

Ageing society

Chronic conditions

Lack of health professionals

Financial challenges

Health inequalities

HLY vs LE

HEALTH IN EUROPE 2020 EUROPE 2020 FLAGSHIPS FOR SMART, SUSTAINABLE AND INCLUSIVE GROWTH

Innovation Union

New Skills and New Jobs

Digital Agenda

Youth on the Move

New Industrial Policy

Platform against Poverty

ResourceEfficiency

• innovation for tackling societal challenges, e.g. ageing and health• innovation for addressing the weaknesses & removing obstacles in the European

innovation system

Innovation Union

• ICTs for tackling societal issues - ageing, health care delivery• sustainable healthcare & ICT-based support for dignified & independent living

Digital Agenda for Europe

EUROPEAN INNOVATION PARTNERSHIP ON ACTIVE AND HEALTHY AGEING

health & quality of life of European

citizens

growth & expansion of EU industry

Sustainable & efficient care

systems

+2 Healthy Life Years by 2020Triple win for Europe

Improving prescriptions and adherence to treatment (A1)

Better management of health: preventing falls (A2)

Preventing functional decline and frailty (A3)

Integrated care for chronic conditions, inc. telecare (B3)

ICT solutions for independent living & active ageing (C2)

Age-friendly cities and environments (D4)

Action Groups

Reference Sites

A1 Improving prescriptions and adherence to treatment (A1)

A2 Better management of health: preventing falls (A2)

A3 Preventing functional decline and frailty (A3)

ACTION GROUPS

EIP AHA

B3 Integrated care for chronic conditions, inc. telecare (B3)

C2 ICT solutions for independent living & active ageing (C2)

D4 Age-friendly cities and environments (D4)

develop policy on active & healthy ageing

Political added value of the EIP

EC: facilitator & supporter

align policy priorities with funding

support from the ground

mobilise efforts & resources

inspire for policy action

identify good practices working in real lifeHigh level conferences (e-health, Gastein

Forum, Conference of Partners, Frailty and Adherence Conferences)

Alignment of priorities in Horizon 2020, CIP 2013, PHP 2013 etc.

Joint Action on Chronic Diseases and Healthy Ageing (28 countries + 5

networks)

Reflection process of the MS: Towards modern, responsive and sustainable

health systems

PERSONACTIVEAGEINGCITIZENHEALTHY

POLITICAL ADDED VALUE OF THE EIP AT A REGIONAL LEVEL

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OPPORTUNITYCATALONIA

EUROPEANCOMMISSION

2013

14

EIP AHA

A1 A2 A3 B3 C2 D4

C

RS

OM

STRATEGIC IMPLEMENTATION PLAN FOR

AHA

Commitment / Reference Site / Market Place

1,000 regions & municipalities

1 billion euro mobilised

30 mio citizens, >2 mio patients

> 500 commitments

3,000 partners

Marketplace>30,000 visits >650

registered users

Building up EIP scale and critical mass

Invitation For Commitments 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

Closed: 28 February

2013

A1 Prescription an

d Adherence

A2 Falls

prevention

A3 Prevention of F

unctional D

ecline an

d Frailt

y

B3 Integra

ted Care

C2 Interoperab

le Independent L

iving

D4 Age-Fr

iendly Envir

onments0

20406080

100120

36 39

10869

25 34

European Innovation Partnership on Active and Healthy Ageing

B3 Action Group

‘Replicating and tutoring integrated care forchronic diseases, including remote

monitoring at regional level’

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.

WHAT SOME ‘BRAINS’ SAY ABOUTINTEGRATED CARE

System Integration

Organisation Integration

Financial Integration

Professional Integration

Service Integration

Personal

Integration

Population Based

Person Focused

Care

Micro Level Meso Level Macro Level

NormativeIntegration

Personal Integration

+2 HEALTHY LIFE YEARS by 2020A triple win for Europe

provide input – expertise, best practice

inspiration

B3 Integrated Care Collaborative

iterative, flexible process

collect experience, evidence to support policy-making

scale up innovative solutionssynergies

Regions, delivery organisations, patient / carers organisations, academia, industry

B3 ACTION GROUPMEMBERSHIP

135 EIP commitments received from:

• Regions• Delivery organisations • Patient / carer representative organisations • Academia• Industry

199 individual stakeholders from committed regions / organisations and growing……

12

19

CAT

EIP AHAINTEGRATED CARE

2013From Chronic Care

2020 IntegratedCare

CORE TOPICSINTEGRATED CARE

?YOUR IDEASWAIT

AND SEEEIP AHAACTION AREAS

CHALLENGES TO THE SUCCESSFUL ADOPTION OF

INTEGRATED CARE

?What kinds of PAYMENT SYSTEMSbest incentivise IC

¿ Which ORGANISATIONAL

SOLUTIONS are more effective

CHALLENGES TO THE SUCCESSFUL ADOPTION OF

INTEGRATED CARE

?How can care beBETTER CO-ORDINTEDaround people’s needs

¿ What IMPLEMENTATION STRATEGIES are likely

to be most effective to STIMULATE CHANGE

PERSONACTIVEAGEINGCITIZENHEALTHY

POLITICAL ADDED VALUE OF THE EIP AT A REGIONAL LEVEL

StrategyEU Initiave

Opportunity

Collaborative approach Sust

aina

bilit

y

PartnershipInnovation

Predictive models

ICT

European Innovation Partnership on Active and Healthy Ageing

B3: INTEGRATED CARE COLLABORATIVE

B3 DELTA QUESTIONNAIRE ANALYSIS

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 REGIONSFROM EUROPE

KEY FINDINGS OF THE DELTA QUESTIONNAIRE

SHIFT TO PRIMARY/COMMUNITY BASED CARE

USE OF THE DELTA QUESTIONNAIRE

• Validating the Definition of Integrated Care for 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

PERSONACTIVEAGEINGCITIZENHEALTHYAGEINGEUEIPAHAINTEGRATE

DEBATE

FOOD FOR THE DEBATE

PERSONACTIVEAGEINGCITIZENHEALTHYAEIPAHAI

organisational modelsrisk stratifiction

care pathways

dissemination

finan

cing

change management

workforce development

patient/user empowerment

ICTB3 ACTION AREAS

PERSONACTIVEAGEINGCITIZENHEALTHYAEIPAHAI

AA1 Organisational Models

AA5 Risk StratifictionAA4 Care Pathways

AA9 DisseminationAA8 Financing

AA2 Change ManagementAA3 Workforce Development

AA6 Patient/User EmpowermentAA7 ICT

B3 ACTION AREAS

Action Area

Change

Management

Action Area

Workforce

Development

Action Area

Risk Stratification

Action Area

Care Pathways

Action Area

Patient / User Empowerment

Action Area

Organisational

Models

Act

ion

Are

a

Fi

nanc

e/Fu

ndin

g

Actio

n Ar

ea

Di

ssem

inati

on

Act

ion

Are

a

IC

T To

ols

EIP AHA B3 Action Plan

By 2015Chronic Conditions’ Programmes available at least 10% of target population in at least 50

regions

By 2015 - 2020Integrated Care Programmes serving older people,

supported by innovative tools and services, in at least 20 regions

SIP TARGETS

2013 Monitoring impact and outcomes 2015

Toolkit Toolkit Toolkit

Tool

kit

Tool

kit

Toolkit Toolkit Toolkit

Increase the average number of healthy life yrs by 2 in the EU by 2020Health 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

Implementation and Scale Up of Chronic Care + Integrated Care Programmes

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

4

STRATEGYMapping

• How?

Desktop search • Method?

Good Pratices

• Analysis From Commtments

EU projects • Analysis

Other sources • Analysis

STRATEGYMapping

• Collecting info

Analysis

• How?

Toolkit

• SCALE UP

European Innovation Partnership on Active and Healthy Ageing

B3: INTEGRATED CARE COLLABORATIVE

B3 GOOD PRACTICES

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

COLLECTION OF GOOD PRACTICESMARCH-APRIL 2013

• 37 good practices

• 29 organisations• 16 regions• 8 action areas

… and the collectionis still on-going

SEPTEMBER 2013 > 50

THEMATIC COVERAGE OF THE GOOD PRACTICES B3 ACTION AREAS

AA1 AA2 AA3 AA4 AA5 AA6 AA7 AA80

2

4

6

8

10

12

14

11

87

3

13

11

14

3Rele

vant

goo

d pr

actic

es

AA1 Organisational ModelsAA2 Change ManagementAA3 Workforce DevelopmentAA4 Risk Stratification

AA5 Care PathwayAA6 Patient / user empowermentAA7 Electronic Care Records / ICT / TeleservicesAA8 Finance, Funding

COVERAGE OF THE GOOD PRACTICES

under 10,000 10,000-50,000 50,000-1000000 over 1,000,000 N/A0

2

4

6

8

10

12

14

- Size of the target population varies from 50 patients to 7.5 million citizens

- Total: over 13 million people

THEMES50% 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 implementationSEMEHT

AND …..A FEW EXAMPLES

ParkinsonNet, Radboud University Nijmegen Medical Centre

Successfully improved Parkinson care in the Netherlands by: 1. Developing regional networks of primary and secondary Parkinson care around general hospitals 2. Selecting and training physiotherapists to work according to evidence-based guidelines 3. Boosting patient volumes per therapist by stimulating selective referral to ParkinsonNet

therapists4. 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:5. An improvement in the quality of care for those patients6. Prevention of disease complications (including a 50% reduction in hip fractures) 7. A reduction in hospitalization8. A substantial cost reduction (€20 million annually in the Netherlands alone)

SUSTAINABILITY

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: Homebase telesurveillance programme COPD patients. 60% of patients didn’t occur hospitalization.Fondazione B.Kessler Trentino, Italy: Access to personal HER a key element for empowerment. Best practice in the field of Public-Private partnership for e-health procurement

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 costsLombardia Fondazione Maugeri, Italy: Telesurveillance programme for Heart Failure patients demonstrated reduction of hospitalisation and improved access to appropriate careSIPE, Emilia Romagna, Italy: R.A. financed Industrial District, creating partnership between enterprises and Universities to foster R&D processes followed by technology transfer

GOOD PRACTICE IN AA7 ICT AND TELESERVICES

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

European Innovation Partnership on Active and Healthy Ageing

B3: Integrated Care Collaborative

Action Area 7: ICT and Teleservices

B3 ACTION AREA 7 ICT AND TELESERVICES Objectives/activities

Highlight the potential of ICT/teleservices to underpin the delivery of integrated care and to realise service efficiencies/cost-effectiveness (Action Plan, 2012)

Improve the effectiveness of health and social care ICT systems and data sharing by identifying solutions which improve interoperability between record systems and data sharing (Action Plan, 2012)

B3 ACTION AREA 7 DELIVERABLES

Mapping of ICT solutions

Electronic care records Personal health records

Aligning existing projects (epSOS, Calliope)Common security processes (identification, authentification, authorization and patient consent)

Teleservices

Increased levels of integration of clinical and social data Increased implementation of electronic consent and share record capabilities

Availability of functionality in Electronic Health/Care Record

Toolkit for Electronic Care Records/ICT/Teleservices:

Approaches to managing regulatory issues, security, privacy, liability, confidentiality and interoperability

Reductions of risk and time to market costs for industryModel business cases to support implementation and scale up

European Initiative Service Specification for the development of personal digital health records

Increased implementation of teleservices as part of Integrated Care Programmes

B3 ACTION AREA 7 WORK PLAN FOR 2013 Work package description WP7-1 Map of ICT solutions focusing on how services for chronic disease

management or integrated care are being supported by common eHealth infrastructure

Task Description T7-1 T7-1-1 Definition of services for integrated care and chronic disease

management T7-1-2 Analyse the compatibility of services with the outcomes of other

existing European projects (e.g. epSOS, Calliope) T7-1-3 Validate the outcomes of T7-1-2 through the practical workshop T7-1-4 Develop indicators for ICT solutions T7-1-5 Evaluate models of ICT solutions supported by common eHealth

infrastructure

TIME TO GETINVOLVED! How can we better utilise ICT /

Teleservices to support and promote the scale up of integrated care in Europe?

How could EIP and the B3 Action Group help?

TIME TO GETINVOLVED! Are you currently working on the

projects where the outcomes of which can help to achieve the objectives of AA7, or AA1, AA2, AA3, AA4, AA5, AA6, AA8

?

TIME TO GETINVOLVED! In your opinion, what are the services

necessary to support and stimulate the delivery of integrated care

?

PERSONACTIVEAGEINGCITIZENHEALTHY

Thanks from

JeanMagda

Donna

Orsi

Bria

n

EstebanCristina

GeorgeAnd

reaLoukianos

BartJoana

Toni

Francesca

European Innovation Partnership on Active and Healthy Ageing

thank youB3 Action Group on

Integrated Care Dr. Toni Dedeu

tdedeu@gencat.cat

https://webgate.ec.europa.eu/eipaha/actiongroup/index/b3