Basque Country Re-HealthChronicity Strategy as a driver for quality and sustainability of                        Health Sy...
1.      Facing new Challenges: who and where are we?     Some figures...             Population (2011): 2.183.615 inhabit...
1.     Facing new Challenges: organization and funding of the         Basque Health System                    Basque Gove...
13.500 diagnosis        tests                4.000 Surgical procedures                     6.000 drugsomplexity        20....
1.        Facing new Challenges: It is time to do more with less     The total health expenditure has increased while chro...
Tripple agenda       Crisis management2009                                    2013                                        ...
Reforming delivery of care: why and how?         http://cronicidad.blog.euskadi.net/
The care of chronic conditions      nowadays accounts for• 80% of medical consultations• 75% of the Health BudgetFor a sys...
Disappearing from the radar screen has a price…  Condition          Insufficient attention                         Prevent...
Health Care Spending Increases With The Number Of                Chronic Conditions             Gerard Anderson, analysis ...
Poor Care Coordination LeadsTo Unnecessary Hospitalizations                         Source:Medicare Standard Analytic File...
Chronicity is an increasing epidemy
Or should we say a pandemy?
That grows as the population gets             older…And the population will gets older: we will  triplicate senior populat...
In short• Maintaining the current design of the Health  System, based on acute incidents:  – Consumes more resources than ...
The good new: It’s posible toimagine another Health System
The challenge is: HOW?Transform current systemMainteining responsiveness to an increasing  demandIn a moment of budgetary ...
2009-2010              2011           2012DEVELOMENT OF THE      TRACKING      FIRST RESULTS    STRATEGY        IMPLEMENTA...
Chronicity Strategy gives us apowerful and inspiring vision
A Global System response (Re-Health) to meet every Chronic          Condition
Using frameworks/models                   MEDICINE      POPULATIO                                  N HEALTH               ...
Launch interventions in a coherent package: alignment of manylevers = planning                                            ...
Reconfiguration of Health Care:         Management ProcessesTOP-                                               ELECTRONIC ...
Moving fast with         management processes….                                    Electronic                             ...
That create the right environement for                people  For example: Risk stratification.  Identification of 2.240.0...
Second good new: this effort can beshared with others. Industry and firms would appreciate the opportunity to       develo...
Tripple agenda       Crisis management2009                                    2013                                        ...
The need to meet the challenge of chronicity is increasingly a global                 one
Why the products and services      should be local?            Health System View               Provider’s View• At the st...
Opportunities from competing globally in a (current) multidomestic industry                                      Global In...
The biggest Chronicity Living LabTo develop the products and services that social and  health systems need to transform th...
Small… but big enough                                           BIZKAIA                                                   ...
A Health System that is also recognized   for its Chronicity Strategy and its     potential for transformation• Internatio...
… that creates strong internal                 alliances• With other ministries and constituencies in the Basque  Country:...
and that it’s developping a strong      international network• With other Health and Social systems that share our  vision...
The third good new: we are obteining          sustenaible results
1.   2010-2011 Preliminary results 11.000 acute hospital stays reduction (2011/2010); 52.000 from  2009. Which implies 8,...
Eficiencias generadas por la Estrategia          de Crónicos en 2011                                 2011  OSAREAN        ...
Eficiencias futuras por la implementación del              modelo de crónicos                           2012    2013     2...
Eficiencias futuras por la implementación del modelo de             crónicos                    2012   2013   2014EFICIENC...
The Big Picture of Basque Re-       Health System
Architectural Drivers
And Inside? The Integration Bus                          e-Health Integration Bus        Tele-Health                      ...
Rivera,  Olga - Basque Country Re-Health: Chronicity Strategy as a driver for quality and sustainability of Health Systems
Rivera,  Olga - Basque Country Re-Health: Chronicity Strategy as a driver for quality and sustainability of Health Systems
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Rivera, Olga - Basque Country Re-Health: Chronicity Strategy as a driver for quality and sustainability of Health Systems

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Track 4: Sostenibilidad de los sistemas sanitarios
4.2. Gestión de la cronicidad

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Rivera, Olga - Basque Country Re-Health: Chronicity Strategy as a driver for quality and sustainability of Health Systems

  1. 1. Basque Country Re-HealthChronicity Strategy as a driver for quality and sustainability of Health Systems Prof. Olga Rivera Deputy Minister of Quality, Research and Innovation Department of Health- Basque Government
  2. 2. 1. Facing new Challenges: who and where are we? Some figures...  Population (2011): 2.183.615 inhabitants ≥65 years: 17.81%  Life expectancy at birth (2005/2006): 77,2 for men and 84,3 for women. The Basque Country’s position is the highest in the world, after Japan and Hong Kong.  Infant mortality Rate (2007): 2,9 ‰ Source: Eustat Basque Country BIZKAIA GIPUZKOA ARABA 2
  3. 3. 1. Facing new Challenges: organization and funding of the Basque Health System  Basque Government manages a strong Public healthcare system through a Public Entity, Osakidetza with:  320 Primary Health Centers  12 Acute Hospitals (4,278 beds) and 4 Chronic Care Hospitals (524 beds)  Mental Health: Three regional networks with 4 psychiatric hospitals, (777 beds) and 2 Contracted Long term Mental hospitals  Tax funded from revenues exacted from Basque Authorities Although healthcare activity Euskadi: Public health expenditure per capita vs healthcare activity has increased, Public health expenditure per capita in the Basque Country has been 254000 1660 decreasing over the last 252000 1640 years 250000 1620 The budget per capita 248000 1600destinated for healthcare 246000 1580in the Basque Country is 244000 1560 20% higher than the 242000 1540 Spanish average 240000 1520 238000 1500 2009 2010 2011 2012 3
  4. 4. 13.500 diagnosis tests 4.000 Surgical procedures 6.000 drugsomplexity 20.000.000 clinical events 22 profesionals to care a single patient
  5. 5. 1. Facing new Challenges: It is time to do more with less The total health expenditure has increased while chronic disease prevalence and complexity is growing as population ages. Public health expenditure(million euros) % of patients by age and number of chronic illnesses Current prices Constant pricesNew challenges undertake…  To contain the growth of public health expenditures under strict fiscal consolidation policies while servicing an ever increasing demand.  To address quality, safety and adequacy gaps in health services.  Basque Country is one of European regions with the highest proportion of elderly, it also addresses an increasing incidence of chronic pathologies:  80% of patient interactions with the public health system are related to chronic diseases  Chronic patients drive around 77% of the total Health expenditure  Health expenditure on current trends is expected to double by 2020. 5
  6. 6. Tripple agenda Crisis management2009 2013 Eficiency Reforming delivery of care2009 Conecting Health and Industry2009
  7. 7. Reforming delivery of care: why and how? http://cronicidad.blog.euskadi.net/
  8. 8. The care of chronic conditions nowadays accounts for• 80% of medical consultations• 75% of the Health BudgetFor a system designed:• to cure acute problems• Not to deal with chronic patients
  9. 9. Disappearing from the radar screen has a price… Condition Insufficient attention Preventable Blood glucose not measured in 24 % 2,600 blindness; Diabetes cases 29,000 renal failure Less than 65 % receives the suitable Hypertension treatment 68,000 deaths Between 39 % and 55 % do not Heart attack receive the preventive suitable 37,000 deaths medication 36 % + 65 years did not receive Pneumonia vaccine 10,000 deaths 62 % did not receiveColorectal cancer a screening when indicated 9,600 deaths Source: EBM Briefs. Laura Landro. The informed patient. http://www.thehealthgateway.com/
  10. 10. Health Care Spending Increases With The Number Of Chronic Conditions Gerard Anderson, analysis of the Medical Expenditure Panel Survey, 2004.
  11. 11. Poor Care Coordination LeadsTo Unnecessary Hospitalizations Source:Medicare Standard Analytic File,2004
  12. 12. Chronicity is an increasing epidemy
  13. 13. Or should we say a pandemy?
  14. 14. That grows as the population gets older…And the population will gets older: we will triplicate senior population for 2050
  15. 15. In short• Maintaining the current design of the Health System, based on acute incidents: – Consumes more resources than needed – Leads to poor quality of care and health results for the population
  16. 16. The good new: It’s posible toimagine another Health System
  17. 17. The challenge is: HOW?Transform current systemMainteining responsiveness to an increasing demandIn a moment of budgetary shortages?
  18. 18. 2009-2010 2011 2012DEVELOMENT OF THE TRACKING FIRST RESULTS STRATEGY IMPLEMENTATION
  19. 19. Chronicity Strategy gives us apowerful and inspiring vision
  20. 20. A Global System response (Re-Health) to meet every Chronic Condition
  21. 21. Using frameworks/models MEDICINE POPULATIO N HEALTH EFFICIENC Y
  22. 22. Launch interventions in a coherent package: alignment of manylevers = planning 3 2 4 1 Prevention and Self care and Electronic 5 promotion patient education Stratification clinical record Integrated medical care 14 6 Advanced nursing Bottom-up responsabilities 13 7 Kronikgune: Chronic illness Socio-health research centre collaboration 12 Sub-acute hospitals 8 Financing and Commissioning 9 11 10 OSAREAN: Virtual Telemonitoring Care, TeleMedicine E-prescription
  23. 23. Reconfiguration of Health Care: Management ProcessesTOP- ELECTRONIC FINANCING AND ELECTRONICDOWN VIRTUAL AND MEDICAL JOINT PRESCRIPTION STRATIFICATIÓN TELE- RECORD COMMISSIONINGSTANDARIZABLE MEDICINEINTERVENTIONS OSAREAN POPULATIO MEDICINE N TRIPLE HEALTH AIM CASE EFFICIENC Y INTEGRATED NURSING PATIENT SUBACUTE CARE EMPOWERMENT HEALTH AND CENTRES SOCIAL CAREBOTTOM COORDINATIONUP R. BENGOA / J. MoraLOCAL INNOVATION
  24. 24. Moving fast with management processes…. Electronic Medical 100% of record is being the implemented population in the whole stratified health care organizations Electronic Medical recordRisk stratification… More than 30 Telehealth coordination and projects to telemedicin improve e with continoum of good health of ous chronic results patients Call center Integration 3 New More than cases 500 active nursing is patients on being diabetes implement and 1500 ed (71 in 2012 ECGA) Case nursing Patient empowerment
  25. 25. That create the right environement for people For example: Risk stratification. Identification of 2.240.000 people in relation to their risk• Case 43.000 management 863.888 patients• Disease 100% HEALTH with chronic 173.000 PROFESIONALS CAN management NOW KNOW IN WHICH disease RISK STRATA A SPECIFIC PATIENT IS• Self- 636.000 managem ent• Preventio Population without chronic disease 1.394.539 n and promotion
  26. 26. Second good new: this effort can beshared with others. Industry and firms would appreciate the opportunity to develop a global market• The Basque response: a strategy of organizational innovation based on new products and services• Are these products and services local or global? Which is better?• Towards a global market for Health: the Basque Living Lab
  27. 27. Tripple agenda Crisis management2009 2013 Eficiency Reforming delivery of care2009 Conecting Health and Industry2009
  28. 28. The need to meet the challenge of chronicity is increasingly a global one
  29. 29. Why the products and services should be local? Health System View Provider’s View• At the start: • At the start: – it promises a short – Each Health system has development process and different priorities, – a better adaptation to our strategies and needs or current situation administrative processes (interesting to minimize initial – Historic Business Models costs) based on individual• In the long term… projects and not on scale – it requires lone financing of – Fidelization links gives them upgrading and updating a market advantage – Switching costs also increase, • In the long term: making it difficult to adopt – Economies of Scale are better standards never achieved – Budget shortages will reduce potencial margins We have strong incentives to develop globalproducts and services for global market needs
  30. 30. Opportunities from competing globally in a (current) multidomestic industry Global Industry Multidomestic Industry Multidomestic Strategy Best choice? • Economies of Scale reduces cost •Standardized solutions attains more Global Strategy easily the required cost-effectiveness • Big Market Share increases the Global solutions for global potential to maintain a quality and innovation differential needs • The reduction of costs can be partially invested in local adaptation •Transform the dominant logic in the industry: good deal for innovators
  31. 31. The biggest Chronicity Living LabTo develop the products and services that social and health systems need to transform their model of delivery
  32. 32. Small… but big enough BIZKAIA GIPUZKOA ARABASocio-demographic data Euskadi–Basque EU -27 CountrPopulation (no, inhabitants) 2,172,175 499,753,500Population density (inhab/km2) 300.2 117.8Life expectancy (years) - Men 77.2 76.1Life expectancy (years) - Women 84.3 82.2Hospital beds (per 100,000 375 590 inhabitants)Internet access (% homes) 60 65Per capita GDP (EU 27= 100) 136 100
  33. 33. A Health System that is also recognized for its Chronicity Strategy and its potential for transformation• Internationally: – The Basque Country is one of the 5 regions in the world that is creating the Health provision model of the future » Alex Jadad• In Spain: – Headquarters of the CNIE (Centro Nacional de Investigación en Envejecimiento) – Hube of Knowledge Innovation Community- KIC on Ageing – Reference of effective and quality health system for its Health and Social Care System
  34. 34. … that creates strong internal alliances• With other ministries and constituencies in the Basque Country: – KRONIKBASQUE as PCTI 2015 Strategy – Ministry of Industry is supporting our Chronicity Strategy : • Special programme on Innovative Public Procurement already launched • Lidera Initiative, with prioritized access to the R&D&i programmes – Ministry of Social Affaires is working with our Osarean capacity to supply virtual care and defining with us new ways of providing Social care• With main technological corporations and CIC’s: – Chair on the Board – Committees on Health• With other regions in Spain: – Galicia, Catalonia, etc
  35. 35. and that it’s developping a strong international network• With other Health and Social systems that share our vision and means: – Remember: our vision gains adepts• With the corporate and technological world: – The potential gains of a Global Health Market for products and services are enormous – It’s posible to maintain business models based on local adaptation, with business models based on standards and a global approach to set needs It’s a WIN-WIN deal!
  36. 36. The third good new: we are obteining sustenaible results
  37. 37. 1. 2010-2011 Preliminary results 11.000 acute hospital stays reduction (2011/2010); 52.000 from 2009. Which implies 8,9 M € savings (2011/2010) or 42,5 M € savings (2011/2009) Surgical discharges increasing (+6,7%) and medical discharges decreasing (-1,5%) Higher average complexity (Surgical: +6,1%; Medical: +1,2%; Psyquiatric: +5,1%) Sub acute hospital stays increasing (+6,7%), acute hospital stays decreasing (-4,3%) Hospital at home stays increasing (+48,9%) Historical reduction of the number of prescriptions (march 2011-march 2010=-1%) and a hospital pharmacy cost reduction (-2.54%)
  38. 38. Eficiencias generadas por la Estrategia de Crónicos en 2011 2011 OSAREAN 14 OSABIDE GLOBAL 4 NUEVAS FORMAS DE HOSPITALIZACIÓN ADAPTADAS A CRÓNICOS 10 TOTAL EFICIENCIAS 2011 28
  39. 39. Eficiencias futuras por la implementación del modelo de crónicos 2012 2013 2014 ABORDAJE DE PACIENTES CRÓNICOS 30 69 130 HERRAMIENTAS QUE FACILITAN LA COORDINACIÓN 16 17 18OSAKIDETZA NO PRESENCIAL 14 16 21EFICIENCIAS POR NUEVO MODELO DE CRÓNICOS 60 102 169
  40. 40. Eficiencias futuras por la implementación del modelo de crónicos 2012 2013 2014EFICIENCIAS POR NUEVO MODELO DE CRÓNICOS 60 102 169
  41. 41. The Big Picture of Basque Re- Health System
  42. 42. Architectural Drivers
  43. 43. And Inside? The Integration Bus e-Health Integration Bus Tele-Health Monitoring Brokers Pharmaceutical e- Wireless Monitoring Care Mobile Health e-Health Identifierrs Mobile Dispatch Health 3.0 Health Domotics Re-Health!

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