This document discusses the challenges of transforming traditional healthcare systems to become more efficient, patient-centered, and results-oriented. It notes that aging populations and increasing chronic diseases are driving up healthcare costs. The major hindrances to achieving more preventative and predictive medicine are a lack of integration between departments, huge fragmentation among providers, and issues with sharing electronic health records. Future healthcare will see smaller hospitals focused on intensive care and day services, with more chronic disease management in the community by multidisciplinary teams. Performance challenges include developing a truly patient-centered approach, accountability, and using data and payments systems to incentivize better health outcomes.

1. Challenges to transform traditional healthcare services
in a more efficient, patient-centered, and results-oriented
healthcare delivery approach.

2. Cancer, Coronary Diseases, and AIDS as an example
of increasing life-expectancy and creating population
with chronic diseases living longer and consuming resources

3. Ageing Population
% of population over 65 years old
80%
70% 67% 65% 66%
60% 53%
51%
50% 46%
38%
40%
27% 29% 28% 28%
30% 26% 26%
22%
20%
10%
0%
U.S. France Germ Italy Japan U.K. Spain
2000 2050
Source: Standards & Poor

4. Ageing Population Costs in Healthcare
80%
Yearly cost per capita according to age (€)
% de població > 65 anys
30 70% 67% 65% 66%
28.479
60% 53%
51%
50% 46%
38%
40%
27% 29% 28%
14.996 28%
30% 26% 26%
15 22%
20%
10% 8.570
0%
2.192
U.S. France Germ Italy Japan U.K. Spain
60-65 65-79 2000 2050
80-94 ≥95 Years
Font: Standards & Poor

5. Health Expenditures as a Percentage of Gross Domestic Product (GDP) in
Increasing health expenditure in western countries
Selected OECD Countries, 1960–2009.
Fineberg HV. N Engl J Med 2012;366:1020-1027.

6. Expected growth of healthcare expenditure as
percentatge of GDP in OECD countries
The expenditure (8-17% of GDP) to restore health once
diseases have appeared, has a limited 15-20% impact on
life expectancy in western countries

7. Healthcare budget evolution in Public Sector (M €)
59.738
58.960 60.000
56.560 57.408
55.686
52.383 +14% -6,8% 55.000
50.000
SPAIN
10.000 9.888
9.426
9.200
9.159
9.000 +13,8%
8.684 -14%
8.500
8.000
2007 2008 2009 2010 2011 2012
CATALONIA (estimated)
Source: Secretaría General del MSPSI (Diciembre 2011)

8. Future drivers of health care delivery
From reactive medicine to preventive medicine
Predictive medicine
Patient itself as a driver force in decision
making and self care
Community patients as a decisive key player

9. At present, the three major hindrance
to achieve the mentioned goals are:
1. The lack of an integrative approach to diagnose, treat, and prevent the health
problems from different departments in the same healthcare level organization.
2. The huge fragmentation of organizations among primary care, social care,
and specialised care.
3. The lack of communication and standardization between different healthcare
electronic medical records.

10. Fragmented healthcare systems
(Barriers from professionals, citizens, and insurance companies)
Behaviour and attitudes of health professionals.
Lack of education for professionals promoting coordinated
efficient work.
Lack of citizen’s education on a rational use of healthcare
systems.
The payment systems that in many cases do not encourage
coordinated work.

11. What do we need to develop those new concepts…..
Open healthcare organizations, with innovation capacity both
in technology and organization, focused on patient’s need, and
with an advanced culture of cooperation among different areas
of knowledge and different providers of healthcare.

12. Scenarios on the horizon
Hospitals of the future will be mostly dedicated
to those procedures requiring high technology
skills and infrastructure. Therefore, they will
be smaller structures based on intensive and
intermediate care units, and day-care units.
Chronic disease management will be based on community territorial healthcare,
where familiy phisycians, specialists, nurses, and social caregivers will have to
work around the patient’s need and to prevent relapses. Home care organization
supported by new technologies will be a key player.
Both, hospital and community healthcare has to be provided by multidisciplinary
working teams organized not to pursue more activity but to achieve the best
outputs in health maintenance.

13. Adaptation of health services to chronic patients
(shared care arrangements across the system)
Hospital
Consultant
Emergency
Case
team
Manager
Primary Care
Mobile teams
Home
Primary
Patient Care
Team
Relatives & care givers

14. PERFORMANCE CHALLENGES
Patient-centered approach
Multidisciplinary working teams
Turning doctors into leaders in healthcare management
Accountability
Performance measurements
Data availability for all the actors
Validity and reliability of measurements
Risk adjustment
Time frame to be measured
Attribution responsabilities to diferent providers
Benchmarking
Revisiting payment systems as an incentive to deliver better healthcare

15. Scott A. Berkowitz, MD, MBA
Associate Professor of Medicine
Medical Director Accountable Care