Health Challenges in the Basque Country:

Towards the next generation of

HealthCare Management

Simon Stone

1. Preliminary results

1. A comprehensive Strategy to tackle chronic

patients: innovative solutions and services

Towards the next generation of Healthcare in the Basque Country

1. Facing new Challenges

2

1. Facing new Challenges: who and where are we?

Population (2011): 2.183.615 inhabitants

≥65 years: 18%39% in 2050

Life expectancy at birth (2005/2006): 77,2 for men and 84,3 for women. Third highest

in the world.

Highest Public health expenditure in Spain (1.500 €) though below EU-15 average

3

Some figures...

Source: Eustat

Total health expenditure increases while chronic disease prevalence, co-

morbidity and complexity grow as population ages.

1. Facing new Challenges: It is time to do more with less

Tax revenue plunging impacts severely on health financing

4

13,72%

11,42%

-6,81%

-15,90%

8,40%

11,60%

13,00%

9,00%

-3,10%

-0,50%

7,50% 7,80% 7,60%

2,30%

-5,40%

1,90%

0,00% 0,00

-1,43%-1,88%

9,72%

9,30%

7,00%

2,40%

-20,00%

-15,00%

-10,00%

-5,00%

0,00%

5,00%

10,00%

15,00%

20,00%

2005 2006 2007 2008 2009 2010 2011 2012

5

RUB Nº people %

Population

Primary Care Prescriptions Hospital outpatient Emergency hospital Inpatient

5 23.883

4 80.168

3 720.644

2 527.441

1 311.862

0 628.303

Total 2.292.301 100%

77% 2,5% 6,7% 7,6% 6,3% =100% 1%

4% 60,3% 11,7% 11,4% 12,4% =100% 3,5%

20,6% 27% 17,7% 4% 30,7% =100% 31,4%

36% 19% 20,6% 7% 17,5% =100% 23%

35% 24% 27,5% 11% 2,6% =100% 13,6%

27,4%

NOTA: La extrapolación del coste a nivel de tipo de asistencia se ha realizado en base al estudio de estratificación (RUBs). Los datos de coste son del año 2007 y la población de referencia de septiembre 2009-septiembre 2010.

1. Facing new Challenges: Health care expenses from a population

perspective

5% of patients accounts for 35% of total costs

1. A comprehensive Strategy to tackle chronic

patients: innovative solutions and services

1. Facing new Challenges

6

Health Challenges in the Basque Country: Towards the next

generation of Healthcare Management

1. Preliminary results

Health Challenges in the Basque Country: Towards the next

generation of Healthcare Management

http://cronicidad.blog.euskadi.net

European Innovation

Partnership on Active and

Healthy Ageing

ec.europa.eu/active-healthy-ageing

5 Pillar Policies form the Basque Chronicity Strategy

8

1. A comprehensive Strategy: innovative solutions and services

TOP- DOWN

STANDARDIZABLE

INTERVENTIONS

BOTTOM UP

LOCAL INNOVATION

POPULATION

BASED

HEALTH

CLINICAL

EFFECTIVENESS

SYSTEM’S

EFFICIENCY

TRI

PLE

AIM

MULTI-

CHANNEL

SERVICES

ELECTRONIC MEDICAL

RECORD INTEGRATED

COMMISSIONING

E-PRESCRIPTION

PATIENT

STRATIFICATION

CARE

NURSES PATIENT

EMPOWERMENT

HEALTH AND

SOCIAL CARE

COORDINATION

SUBACUTE

HOSPITALS

INTEGRATED

CARE

PREVENTION

HEALTHY AGING

R&D

1. A comprehensive Strategy: innovative solutions and services

IT-enabled

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1. Strategic projects: Organizational and Care Integration

Two models of Formal and functional integration of health

providers (primary care centers, acute and chronic hospitals, mental

health services and public health districts) in 11 microsystems

Activity

Quality Bottom up

Innovation

Population

intervention Plan

97%

2%

0,5% 0,5%

Shared Plans,

shared funding

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MAD-245007111219

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Population-based Intervention Plans (PIPs) 2012:

Prevention

and

Promotion

Support for

self-

management

Disease

management

Case

management

Intervention strategies for each segment

or strata of the population

Diabetes CPOD CHD

Multi-pathologies

Tobacco withdrawal screening and advice

Anti-flu vaccination

Cancer screening programs

Physical Activity community programs

Child obesity early detection and prevention

Cardiovascular risk monitoring

Active patient

Physical activity and diet

Anti-flu vaccine

Tobacco withdrawal

Care Nurse

Telemonitoring

Actividad Actividad

Actividad

Plan de Intervención Poblacional

Calidad

Proyectos territoriales

Bottom.Up

Population

Selection

based on

complexity

of patients

within their

pathology

Associated

to risk

factors.

Healt

hy p

op

ula

tio

n

Ch

ron

ic p

op

ula

tio

n

5%

20%

75%

6.929

22.130 9.499 9.591

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1. Strategic projects: Single Electronic Clinical Record

to deploy Osabide Global, a sole solution for medical records which

enables professionals across levels of care to access patient data and

modify at any point of care.

The goal …

Its features …

Access to 360º clinical information from any Osakidetza workstation.

Personalized clinical desktop

Risk Stratification and Population Programs

Priority Pathways; Assisted tasks and alerts (pro-active medicine)

Integrated Electronic Clinical Ordering and Prescription.

Integrated access to Clinical evidence and Professional exchange messaging.

One single digital image repository and Life-long Rx dosimetric record.

Virtual consultations and Smart follow up of chronic patients.

Connected to Personal Health Record, Spanish EHR and in the future to European EHR.

Interoperable with social services information systems.

Some preliminary results …

650.000 patients already included, 12.000 professionals use it

67 % reduction of pharmaceutical registered incidents; 3,4 million Euros / year savings with digital radiology

repository.

12

13

1. Strategic projects: e-prescription

a single electronic pharmacotherapeutic record, encompassing all care levels,

available to any professional involved in patient care and reaching integration of the

prescription-dispensation.

The goal is…

Its features…

End-to-end prescription solution (prescription – authorization – delivery – reimbursement –

analysis).

Assisted prescription

Single electronic pharmacotherapeutic record (not single prescriptions) visible to all actors with

security levels.

Dynamic “Treatment plan” (“drugs credits”).

Electronic authorizations of treatments (not single prescriptions).

Enables collaboration between all care levels (GPs, specialists, pharmacists, nurses) and

improves communication between health agents and patients.

Manages changing co-payment schemes

Interoperable within Spanish National Health System

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14

Patient-

professional

collaboration

New

Appointment

Model

Health

Counseling

Patients remote

monitoring

Prevention

campaigns

Customer

services

administrative

procedures

Active

Patient

Personal

information

access

•Web 2.0

•CRM

•IVR

•BI

1. Strategic projects: Multi-channel Health Service Center.

The service portfolio consists of 8 service sets:

Health advice over the

phone, internet and smart

phones by

Osakidetza nurses.

Personal Health Record

Professional and technical

Support for non face

to face consultations and

tele- assistance. Administrative

procedures online

Tele-medicine

solution for chronic patients

through

mobile platforms

Public Health Campaigns.

Citizens and Users surveys

Patient empowerment:

Customized health advice.

Patient Forums,

Assisted health promotion

Appointments to GP,

Pediatricians, nurses and

midwives, through the telephone

channel (IVR and call center),

internet and smart phones.

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Service portfolio

Service portfolio

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1. Strategic projects: Multi-channel Health Service Center

Beti-ON, A Unified social and health telealert service: disability,

chronicity and dependency attended together

Beti ON operator Primary Healthcare

Practitioner

ALERTS

Family carer

Nurse advice center

Healthcare

Emergency

Social

worker

REINFORCING

CARE PLANS

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1. Strategic projects: innovative solutions and services

1. Facing new Challenges

16

Health Challenges in the Basque Country: Innovation in Healthcare

1. Preliminary results

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Virtual Consultation

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19% of total interactions between primary care

professionals and patients are now made by phone

or internet.

Health Advice services (web/phone)

Health advice: 85% Resolution

Consultation Causes: 13% Fever, 10%

Medicines, 8% Diarrhea, 4% Dermatology…)

1. Preliminary results of Virtual Consultations

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CONSULTAS NO PRESENCIALES

60000

70000

80000

90000

100000

110000

120000

130000

140000

150000

ene-11feb-11m

ar-11abr-11m

ay-11jun-11jul-11ago-11sep-11oct-11nov-11dic-11ene-12feb-12m

ar-12abr-12m

ay-12jun-12

MAS DE DOS MILLONES DE CONSULTAS NO PRESENCIALES EN OSAKIDETZA EN DOS AÑOS MÁS COMODIDAD Y ACCESIBILIDAD PARA EL CIUDADANO, MENOS

SOBRECARGA EN EL CENTRO DE SALUD

Primaria2011 Total

llamadas

1.809.131

Total

llamadas

191.311

Especializada

2.000.442

CONSULTAS TELEFÓNICAS

Enero 2011-junio 2012

LA ACTIVIDAD NO PRESENCIAL SUPONE EL 19% DE TODA LA

ACTIVIDAD EN ATENCIÓN PRIMARIA

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CONSEJO SANITARIO

0

2000

4000

6000

8000

10000

12000

14000

abr-11m

ay-11jun-11jul-11

ago-11sep-11oct-11nov-11dic-11ene-12feb-12m

ar-12abr-12m

ay-12jun-12

Nurses

Doctors

85.5 %

14.5 %

NUEVO SERVICIO DE CONSEJO TELEFÓNICO Y APOYO A DISTANCIA A ENFERMOS CRÓNICOS

APRIL

2011

24 hours * 7 daysHEALTH ADVICE

SERVICES

117.177 Calls

Non-presential services: more timely, more accesible, more

convenient, more efficient care

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1. Preliminary results of Telemedicine: TELBIL

Telemonitoring patients at-home with Heart Failure or lung disease

(≥ 2 hospital admissions (≥ 1 due to one of the diseases considered) in the previous year

14,32

11,56

3,073,8

12,07

8,88

15,14

12,68

3,75

13,84

0

2

4

6

8

10

12

14

16

appointments al HC GP home visits nurse home visits total home visits telephone contacts

GC GI

Results (6 months) Use of healthcare resources

MORTALITY HOSP

ADMISSIONS

(any cause)

HOSP

ADMISSIONS

(considered

diseases)

NO HOSP

ADMISSIONS

DURATION OF

HOSPITAL

STAY

RESULTS Patients (Nª) Patients (Nª) Patients (Nª) Patients (Nª) Days(Nª)

IG 1 29 22 13 7,58

CG 2 28 25 12 11,83

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1. Preliminary results: System’s Performance Indicators

2.009 2.010 2.011 % 2011-2009

Acute Hospital Discharges233.410 235.005 238.945 2,4%

Acute Hospital Discharges (DRG MED)131.918 129.662 130.537 -1,0%

Surgical discharges (Prog)100.870 104.306 108.833 7,9%

Sub acute hospital stays 144.102 151.529 153.770 6,7%

Hospital at home discharges8.981 12.249 12.442 38,5%

Datos Osakidetza

Historical reduction of ambulatory prescriptions number (-1%)

and Hospital pharmacy cost (-2.5%)

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http://cronicidad.blog.euskadi.net