enabling integrated care · alfonso lara montero, policy director, esn. esn-eu.org / ....

Enabling IntegratedCarePlenary Session23 June 2016

esn-eu.org

Introduction

Alfonso Lara MonteroPolicy Director

European Social Network

esn-eu.org

Key enablers of integrated social services

Henk Nies, Executive Board, Vilans, Utrecht;Professor at Vrije Universiteit AmsterdamAlfonso Lara Montero, Policy Director, ESN

esn-eu.org / www.vilans.nl

Paternalistic system Welfare state

Ego-systemNew Public Management

Eco-systemValue creation

Central steering mechanismsTop-down & directive

Paternalising

Central frameworksEnforcement and Inspection

at a distance

Connecting governmentReciprocity

Flexibility of styles

Eco-network

CENTRAL REGULATION OF SUPPLY

Input financing:Budget & licenses

Focus: institution & professionalDisease oriented

CONTROLLED COMPETITION

Output financingPerformance financing

Focus: user as a care consumer

SUSTAINABLE VALUE SYSTEMS

Outcome financing:individual & community

Focus: Citizen and healthVitality, resilience and well-being

ProtocolsNormsDisease and care orientedInstitutionsPatients, residents

CertificationConsumers’ informationBehaviour and healthAccess to new providersClients, customers

Role of government

Caresystems

Careprovision

PersonalPreventionFormal and non-formalFunctioning and participation

Central government Funding agenciesProviders

Consumer organisations

Where are we coming from, and were are we heading to?

The state of play of integration in Europe

• Social services with education, employment and/or health

• Systematic literature review• English publications• Peer reviewed literature• Europe• 2010 - 2015• 60 analysed: 9 >3 sectors

• Practice review• Template• 44 practices• 17 European countries

How is practice organised, what works for whom, in what circumstances?

Guiding analysis questions

Reasons

Users’ involvementOrganisation, management & delivery

Transferability and sustainability

Outcomes and measuresFunding

What are we searching for?

• Is it just rhetoric or happening in practice?

• How and at what levels do we see real integration?

• Why and when does it work (and why and when not)?

Why integration across sectors?A mixture of reasons

Reasons/drivers Trends in public service provision

• Better outcomes for users • Better coordination• New policies• Trends in society• Trends in public sector• New, holistic models of (social)

care and support (focus on prevention & efficiency)

• Demography• Responds to multiple needs• Marketization• Decentralisation and outcome

based contracting• Users´ involvement• User centeredness and choice• Service co-production

personalisation• Crisis and financial constraints

Literature review findings

Organisation, management and delivery• Inter-professional teamwork• Trust and clarity about roles• Leaders who can cope with

complexity• Collaborative/shared• Neutral• Balance in power

• Delivery • ICT• Care plans, procedures• Information platforms

Funding• Often unclear (38/60)• Joint contracting• Pooled budgets

Monitoring and Evaluation• Weak (13/60)• Lack of tools and capacity• Mostly focus output, processes. • Little on outcomes/effects, some

tick box surveys, feedback• How to evaluate effectiveness?

Practice review findings

Reasons/drivers Users involvement• Increased no of service users• Improve coordination• Prevent from worse • New policy• Better use of resources

• Different forms of communication and information

• Co-produced services• Personalised plans with users

input• Design and implementation

Monitoring and Evaluation• Significant numbers, weaknesses in how and what (37/44)• Unclear if actual or perceived effects, what were the aims• Multi-method evaluation:

• Feedback, Interviews, External evaluation, Cost-benefit• Single-evaluation:

• Sometimes international scales (autonomy, social responsibility)

Practice review findings

Forms of deliveryFunding

• All those identified in the literature:• One stop shop• Case management• Exchange platforms

(information, consultation, protocols, guidelines)

• Multi-disciplinary teams involving users

• Single assessment

• Pooled budgets• Single agency funding (tasked with

implementing coordinated service/structure)

• Existing resources (no additional funding)

Organisation & management• Organisational management• Collaborative management• Professional management

• Limited examples of inter-sectoral integration• Person centeredness is hard to achieve!

• Key enablers• (Future) users needs, sense of urgency• System optimization: effective delivery system – ICT

enabled, joint case management, inter-organisational steering, efficiency, doing more with less

• The role of policies• Increasing focus on evaluation; hard job to do!

But… do not underestimate human side• Particularly relevant in social care• Key having stakeholders on board• Key facilitating time for joint relationship building & training

Integrated social servicesConclusions

Esittäjä

Esityksen muistiinpanot

Anita/Susan: Could you please add here the table from page 73 of integrated services report

Integrated social servicesKey elements –barriers & facilitators

OrganisationalManagement

• Continue traditional way of working in silos

• Case management• Multi-disciplinary

teams (with users involvement)

OrganisationalDelivery

• Ambiguity of roles • Joint assessment• Single/Joint care plan

ICT –enabled delivery system

• Systems incompatibility • Integrated & shared ICT platform

• Shared electronic records

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Integrated social servicesKey elements –barriers & facilitators

Elements Barriers FacilitatorsFunding • Lack of funding

information/fundingaltogether

• Pooled budgets

Monitoring & Evaluation

• Lack of capacity, tools• Different organisations

value evidence differently

• Journey: pre/post & during implementation

• Local adaptation

Commitment • Low priority• Lack of time &

resources

• Shared vision• Highly committed

individuals, clarity about goals

• Mandate

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Integrated social servicesKey elements, barriers & facilitators

Elements Barriers FacilitatorsInnovation • Underestimation of

complexity• Autonomy

Learning • Cultural differences • Joint-training

Sustainability • Political & financial considerations

• Sectoral-societal paradigm including

• policy • funding• structures

• Document the effects helps securing funding

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Integrated social servicesExamples Alborada: Early intervention information system, Andalucia (Spain)• Early childcare regional government

competence• Tool to facilitate coordination• For children under 6 with developmental

difficulties

• Used by healthcare professionals, social workers, social educators, psychologists & all professionals in early childcare centres

Main priorities: • Facilitate inter-institutional coordination • Standardise transfer of user records

between public health system and early childcare centres.

Kotitori, Tampere (FI)• Single access point for older people,

families and carers to ALL home care services (public & private) in Tampere

• Operated by private companies Maxwell Care Ltd & the Nordic Healthcare Group

• They manage the service providers, quality control & standards of private providers

• Tampere purchases services & defines quality criteria & coverage

• E-Kotitori online platform, call centre & walk-in office in same place

Thank you!esn-eu.org / www.vilans.nl

The views expressed are solely those of the author and do not necessarily represent those of the European Commission

Assessing the potential of ICT-enabled integrated social services across the EU

Gianluca MisuracaSenior Scientist, JRC-IPTSEuropean Commission

European Social services Conference'The Future is Local!'

The Hague, 20-22 June 2016

Joint Research Centre

Information Society UnitResearching the impact of ICT-enabled innovation on

the EU economy and society

Institute for Prospective Technological StudiesUnderstanding the links between technology,

economy and society

Serving society Stimulating InnovationSupporting legislation

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1

Addressing the social crisis of Europe…

Social Innovation promoting Social Investment through

exploiting the transformational nature of ICTs!

'Jobs, Growth, Fairness & Democratic Change'

Social Investment Package SIP - COM(2013)83 'Towards Social Investment for Growth and Cohesion’

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2014 2015 2016

Experts and Stakeholders' Consultation (i.e. peer-reviews, workshops, events, community-building)

i-FRAME (Methodological framework of analysis of social and economic impacts)

Year 1

1st Round Mapping & Analysis Year 2 Year 3

1st WS 2014

5th WS 2016

3rd WS 2015

2nd Round MappingCase StudyAnalysis

3rd Round MappingThematic Analyses

Conceptualisation Refinement & Consolidation

Validation & Recommendations

2nd WS 2015

4th WS 2016

In search of evidence…

https://ec.europa.eu/jrc/iesi

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WP1 Mapping and analysis of relevant ICT-enabled social innovation initiatives in the EU Review of literature, policies, theoretical approaches and level of deployment and integration of ICT-enabled service provision Collection and documentation of relevant examples of initiatives across the EU and in countries considered to be in the vanguard in the policy areas under investigation WP2 Development of a methodological framework to assess the impacts generated - from micro to macro level - by ICT-enabled social innovation initiatives promoting social investment (IESI-FRAME) to provide a framework of analysis of the initiatives collected through the Mapping activities (WP1) and as a guide to conduct the in-depth analysis of case studies (WP3) structured approach to analyse such initiatives and provide insights for their replicability and transferability; to serve as a framework for conducting analysis of social return on investment of initiatives, which have as key component ICT-enabled social innovation recommendations on how the European Commission and Member States could analyse (ex-ante, in-itinere and ex-post) the impact of ICT-enabled social innovations initiatives WP3 Thematic analysis / case studies Analysis of the initiatives and the services provided by various stakeholders and intermediaries, from the public, private and third sectors, with a specific focus on the role and relationships among them, and their ICT-enabled social innovation potential Gain insights from case studies in order to better understand the nature and impact of ICT-enabled social innovation in support of social investment, its drivers and barriers, determinants, and diffusion paths

Third Sector

Private Sector

Multi-sector

Public Sector

ICT-ENABLED INNOVATION POTENTIAL

Incremental Sustained Disruptive Radical

LEVEL OF GOVERNANCE OF SERVICE INTEGRATION

Intra-governmental

Inter-governmental

Inter-sectoral

Isolated

Pervasive

Trasformative Social Innovation

Mapping initiatives against their ICT-enabled social innovationpotential and governance level/type of service integration

AnalyticalFramework

Type of Integration: Funding; Administrative; Organisational; Delivery

system

Stakeholders Role

Functionalist Social Innovation

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Levels of governance of services integration: Isolated: There is no integration of services at administrative or strategic level with government operations. Intra-governmental: Single level of government. E.g integrated case management; frontline integration to offer clients a 'single window'; back-office integration to provide the necessary support structures; and co-location of services and back-office functions. Inter-governmental: across multiple levels of government. E.g. database integration, coordinated case management/joint procurement Inter-sectoral: Collaboration between government and service delivery providers in private or non-for-profit sectors. E.g. joint investment strategies, co-location of staff and formal networks of service delivery organisations. Pervasive: Service integration goes beyond the traditional boundaries of administrative/operational integration, it is embedded in a new modus-operandi where service providers and beneficiaries co-produce services innovating delivery mechanisms and reallocating resources and roles in order to maximise public value creation (Functional) Type of services integration: Funding: e.g. pooling of funds at various levels; and pre-paid capitation at various levels. Administrative: e.g. consolidation/decentralisation of responsibilities/functions; inter-sectoral planning; needs assessment/allocation chain; joint purchasing or commissioning Organisational: e.g. co-location of services; discharge and transfer agreements; inter-agency planning and/or budgeting; service affiliation or contracting; jointly managed programmes or services; strategic alliances or care networks; common ownership or mergers. Delivery system: centralised information, referral and intake; case/care management; multidisciplinary/interdisciplinary teamwork; joint training; around-the-clock coverage

IESI Knowledge Map 2015

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IESI Knowledge Map 2015210 initiatives across EU28+

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a powerful means to achieve integration of services facilitating partnerships with private/third sector providers it is at the inter-sectoral level of governance of service integration that 'things happen' and the potential impact of ICTs can be transformative

0,0%

10,0%

20,0%

30,0%

40,0%

50,0%

60,0%

70,0%

80,0%

90,0%

100,0%

Isolated Intra-governmental Inter-governmental Inter-sectoral Pervasive

Funding

Administrative

Organisational

Delivery system

Focus on Integrated services

Governance levels vs Functional types

Type

s of

inte

grat

ion

(Mis

urac

a et

. al,

2015

, Kod

ner,

2009

)

Governance Levels of integration(Misuraca, et al. 2015, KPMG, 2013)

0,0%

10,0%

20,0%

30,0%

40,0%

50,0%

60,0%

70,0%

80,0%

90,0%

100,0%

Need-driven/outcome-oriented production

Open process of co-creation/collaborativeinnovation networks

Fundamental change in the relationshipsbetween stakeholders

Public value allocation and/or re-allocation

Integrated services and social innovation

Elem

ents

of S

ocia

l Inn

ovat

ion

(Mis

urac

a et

. al,

2015

, Bek

kers

etal

., 20

13)

Governance Levels of integration(Misuraca, et al. 2015, KPMG, 2013)

Evidence shows that ICTs highly support integrating health- and social careservices and contribute to better quality, cost-efficient, seamless case transfer andmore accessible long-term care of older people living with chronic conditions

at the micro level initiatives address long-term conditions, aiming to help olderpeople to live independently and support formal and informal carer

at the meso-level, the most frequent benefit is productivity gain, followed bysimplified administration and improved care delivery and cost-effectiveness.

Better targeted caring services and improved access and service take up arealso important outcomes

Integration efforts are all facilitated by ICT-enabled case management services,electronic health- and social care records applying a service user approach

Many initiatives use information-sharing platforms between stakeholders, andoffer complementary ´tele-services´ for older care recipients

ICT-enabled innovation and Integrated Care

27

Analysis of 14 in-depth Case

Studies in different welfare systems & PSSGI cross EU

ICT-enabled innovation & EU Social Protection Systems

28

The integration of care processes is enabled by a shared electronic patient record systemData analytics system to monitor and conduct foresight of health and wellbeing trendsBusiness intelligence model to enable providers predict demand and planning of future services

• 19% reduction of days in hospitals in General Psychiatry• 9% reduction of days in hospitals in Adolescent Psychiatry• Reduced incidence and prevalence of frailty and disability.• Increased capacity to manage self-care and independent living at home.• Support formal and informal carers

Background

Impact

Role of ICTs

31.000 beneficiaries (mainly diabetic patients and elderly people), out of the potential 132.000living in the territory of 9 municipalities in remote areas of Finland4.100 people employed with a budget of 370 million euros

Aim of the initiativeIntegrated health- and social

care services (family and welfare services, mainly for senior

citizens) based on a unified needs assessment

TelecareDevelopment

Program (TDP)

Badalona health and

social services

integration

South Karelia District of Social and

Health Services (EKSOTE)

ACTION

29

Thematic Analysis: Integrated Care

Misuraca G., et., al. 2016, JRC Science & Policy Report, forthcoming

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The initiative The Scottish Government developed an initiative between 2006 and 2011, in order to encourage the adoption of telecare by health and social care services. Target service users of the Telecare Development Programme (TDP) were vulnerable subgroups of individuals (65+) and with complex illnesses within the 32 communities across Scotland that wanted to be assisted at home. The Telecare Development Programme (TDP) was a patient-centred integrated care management process. Aim of the initiative The mission of the programme was double: to demonstrate how ICT technologies could contribute to the safety and quality of life of the elderly to reduce the cost of health and social care services provisioning. The main objectives of the initiative were: Increase the productivity of social protection systems and of the healthcare delivery, including formal and informal care Increase the sustainability of the social protection system Increase the quality of services for both patients and carers Support system integration Reduce incidence and prevalence of frailty and disability in the elderly, disease prevention, health promotion, and rehabilitation Facilitate hospital discharge Increase self-care and independent living at home Effects and results of the initiative The effects of TDP initiative was assessed by York Health Economics Consortium (YHEC) for all health and care partnerships. The monitoring activity was commissioned by the Scottish Government to measure performance of the initiative via a questionnaire for service users and another for informal carers. TDP discharged patients faster from hospital, reduced the number of hospital admissions, and avoided the number of admissions to care homes. Data concretely showed that, during 2006-2011: Over 2,400 delayed discharges were avoided as a result of telecare, leading to an estimated saving of over 27,000 bed days. Over 8,700 unplanned hospital admissions were avoided as a result of telecare, and duration of avoided admissions ranged from 2 days to 30 days. Over 109,000 hospital bed days were avoided through facilitated discharges and unplanned admissions avoided. 3,814 admissions to care homes had been avoided over the course of the programme. These were associated with the avoidance of a significant length of stay and a reduction in care home beds purchased, close to 546,000 bed days. The TDP generated cost-savings for the care sector. Taken as a whole, the gross value of TDP funded efficiencies over the period 2006-11 was approximately £78.6 million at 2011 prices. ICT role & future of WS TDP is a case of fully committed national government, that in rigorous collaboration with its national health system, has developed an integrated care approach with its own funds and capabilities that is currently being spread across the whole country, with significant mainstreamed examples and important achievements that in the short/medium-term perspective could lead to structural changes in the entire health care system of Scotland

ICTs enable developing a comprehensive, accessible-to-all-professionals health and socialcare record and personalized plan based on a harmonized complex needs assessmentThe integrated back office facilitates better management and alignment of multidisciplinary tasksThe unified front office serves the beneficiaries better and make services more effective

Increased satisfaction of end-users and better perceived quality of lifeEarly discharge from hospitals, for instance a patient's comprehensive care could becontinued at his/her home after only 5 days following a hip fracture surgery (11 days reduction)

Background

Impact

Role of ICTs

The local government of Badalona, Spain decided to merge health- and social services since2000. This resulted in full integration at organisational, administration and delivery channel levelUser-centred service provided by a multi-disciplinary team and ICT-enabled support systems

Aim of the initiativeTo fully integrate health and social care, and to improve the overall user experience as well as to make services more efficient,

effective and productive

TelecareDevelopment

Program (TDP)

Badalona Serveis

Assistencials(BSA)

South Karelia District of Social

and Health Services

(EKSOTE)

ACTION

30

Integrated Active Healthy Ageing

Misuraca G., et., al. 2016, JRC Science & Policy Report, forthcoming

ICTs play an important role in supporting sharing information and enablingintegration of services thus enhancing impact of social services delivery: Client pathways and focus on outcomes: more targeted and personalized

approach that enables clients with complex needs to receive coordinatedservices and evidence of demonstrable improvements in outcomes delivered

Greater coordination between different levels of government is essential toimprove system integrity, reducing duplication and gaps in service provision

Consolidation of the ´one-stop-shop/no-stop-shop approach´ where serviceusers are provided with a single entry point into the social protection systems

Increasing support for the notion that complex social problems are bestaddressed through coordinated local level interventions, including resourcesharing and joint social impact investment strategies

Partnerships and network integration bringing together stakeholders frompublic, private and not for profit sectors in formal networks to offer clientsseamless assistance and care, are emerging and proving their effectiveness

Conclusion: The role of ICTs for integrated services

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[email protected]

https://ec.europa.eu/jrc/iesi

Comments

Martin DugganIBM

esn-eu.org

Comments

Jukka LindbergProject Manager

OMA Häme

esn-eu.org

Integrated servicesFood for thought!

• Having heard the presentations & the interventions from the audience, what is in your opinion the role of central or local government in facilitating service integration?

• How can easy accessible technology facilitate integration of services?

• And what can citizens do alongside professionals?

Thank you!

Enjoy and make the most of the these days!

esn-eu.org

Esittäjä


John

enabling integrated care · alfonso lara montero, policy director, esn. esn-eu.org / ....

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