integrated care in singapore: if not now, then when?
TRANSCRIPT
Dr Hector Upegui MD MSS PM OSHM
1
INTEGRATED CARE IN SINGAPORE IF NOT NOW THEN WHEN
DR HECTOR UPEGUI MD MSS PM OSHM
IBM CURAM RESEARCH INSTITUTE
Dr Hector Upegui MD MSS PM OSHM
Dr Hector Upegui MD MSS PM OSHM
3
What is the IBM CuacuteramResearch InstituteThe IBM Cuacuteram Research Institute is IBMrsquos social policy research arm
Research FocusThe Institutes research focuses on the cross-over from policy to service delivery with the aim of developing new social business models and the best practices that they encompass
MissionTo foster the development of best practice service delivery models and evidence-based solutions for social program organizations
The Cuacuteram Research Institute creates
cutting edge research in partnership
with
mdash Universities with a focus on new social trends
mdash Multi-lateral agencies
mdash Think Tanks
mdash Non-Governmental Organizations
Dr Hector Upegui MD MSS PM OSHM
4
The IBM Cuacuteram Research Institute publishes Thought Leadership papers
The IBM Cuacuteram Research Institutersquos research is categorized into the following sections
Industry Point of Views Published research undertaken with social enterprises national and international bodies and partner research organisations
Position Papers Published papers that describe a specific industry issue and provide opinion on best practices
Industry Consultations Input provided by the Cuacuteram Research Institute to public consultations on social policy related issuesthat reflect policy or service delivery reform objectives
Client AdviceAdvice provided by the Cuacuteram Research Instituteto clients on their reform agendas
Dr Hector Upegui MD MSS PM OSHM
5
SINGAPORE IS FACING
IMPORTANT CHALLENGES
IN THE HEALTH and SOCIAL
SECTOR
People living longer
alone facing increasing
costs and needs while
expecting more for less
Thus
bull Intersectorial coordination is
more important than ever
bull Technology has new capabilities
able to support the answer
INTEGRATED CARE
AS PART OF THE SOLUTION
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Our PoV
Dr Hector Upegui MD MSS PM OSHM
6
Definitions
Coordinated
Health care
Coordinated
Social care
Integrated Care
(Health and social)
means coordinated services across horizontal and vertical participants in the health sector This is for instance guaranteeing that if a patient moves from general practitioner to hospitalization the second one knows and can even interact with the first one so that the whole chain of health service delivery knows what is happening with that patient
means coordinated services across horizontal and vertical participants in the social services sector This is for instance guaranteeing that if a citizenresident moves from one social worker to another the second one knows and can even interact with the first one so that the whole chain of social service delivery knows what is happening with that citizenresident
Means an integral and coordinated view of service delivery managerial decisions of health services AND social services together This means for instance being able to coordinate social workerrsquos and physician interventions for a patient suffering from complications of diabetes but suffering form intra-familiar violence
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
7
Singapore is first world class in
healthcare and socialcare systems
11th place in
Human Development Index
3rd place in
Life Expectancy
First place in
Total health expenditure as
percentage of GDP
UN-2015 WHO
Worldbank-2014
1st place on the average of
annual growth
Human Development Index
UN-2015
WHO-2015
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
8
Worldwide Ongoing challenges in
the healthcare and socialcare sectors
bull Demographic changes
bull Chronic amp complex diseases
bull Increase of social needs
With the following environment
bull Citizenspatients with more access
to information
bull Less familycommunity support
bull Complexity of needs is higher
bull Service too fragmented vertically
and horizontally
bull Deinstitutionalization (in health as
well as in the social sector)
bull ICT - Technology is providing
- IoT
- Analytics
- Predictive analytics
- Continuum of care
WHAT WHY
bull More prevention
bull More efficiency
bull More social inclusion
bull Intersectorial coordination
bull Get closer to the user
bull Activate the person
family and community
ANSWERS
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
9
ChallengesMental
health and Obesity
Increasing
costs
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Additional specific challenges
Old age
dependency
ratio
Life styles changes
Users
involvement and
choices
Dr Hector Upegui MD MSS PM OSHM
10
Own calculations based on
httpdataworldbankorg World Bank Accessed in 2016
Variation from 1995-2014
Examples (increasing costs DR)
In 2015
Dependency ratio
Country NameOut of
Health
Expenses
Population
ages 65
and above
( of total)
Australia 17 30 24
European Union 1 21 28
Japan -1 54 79
New Zealand -32 59 25
Singapore 12 68 74
Spain -11 21 22
United Kingdom -23 36 10
World 4 17 26
Dr Hector Upegui MD MSS PM OSHM
11
Age Group
(Years)
2004 2014
Males Females Males Females
25-29 716 468 817 642
30-34 331 208 392 266
35-39 191 157 213 184
40-44 154 132 151 145
45-49 126 125 124 134
Proportion of Singles Among Resident
Population by Selected Age Group and Sex
This is an important
life style change that
certainly impacts
community strategies
11copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Examples (associated to exogenous
factors)
Dr Hector Upegui MD MSS PM OSHM12
Graphic from Thailand Business news -2014
Singapore
ranks 3rd in
Southeast
Asian
countries
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
In Singapore an estimated one in nine adults between
the ages of 18 and 69 has diabetes according to the
National Health Survey 2010
Examples (associated to exogenous
factors) -cont
Dr Hector Upegui MD MSS PM OSHM
13
httpwwwworkforcecomsection00article254691html
CONCLUSION Obesity in adolescence
may be associated with later depression in
young adulthood abdominal obesity
among male subjects may be closely
related to concomitant depression and
being overweightobese both in
adolescence and adulthood may be a risk
for depression among female subjects
13copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Examples (associated to exogenous
factors) -cont
Dr Hector Upegui MD MSS PM OSHM
Institution
Hospital
Other services
Diagnostics
Health
providers
Plans
Callcoordination center
NGOrsquos
Nutrition
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Why Integrated Care
Health care
sector
Dr Hector Upegui MD MSS PM OSHM
Buying
Provider
Counsellors
Work
Family
Social care
Aids
NGOrsquos
Case manager
Social
policies
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Social care
sector
Dr Hector Upegui MD MSS PM OSHM
Buying
Institution
Hospital
Provider
Counsellors
Work
Other services
Diagnostics
Health
providers
Family
Social care
Aids
Plans
Callcoordination center
NGOrsquos
Case manager
Social
policies
Nutrition
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Health care
sector
Social care
sector
Integrated care
market place
Prevention
Need of care
Need of
complex care
Social inclusion
Dr Hector Upegui MD MSS PM OSHM
17
Sharing some evidence
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Care for Older people
in Torbay UK (2004)
Diabetes care in
Bolton (1997)
Chronic Care
Management in Wales
Daily average number of
occupied beds from 750 in
19989 to 502 in 200910
emergency bed day use in
the population aged 65 and
over that is the lowest in
the region
Since 20078 144 fewer
people aged over 65 in
residential and nursing
homes with a
corresponding increase in
home care services
targeted at prevention and
low-level support
(Thistlethwaite 2011)
Patients and staff have
reported high levels of
satisfaction with the
service and in 20056
Bolton reported the
lowest number of
hospital bed days per
person with diabetes in
the Greater Manchester
area (Irani 2007)
reduction in the total number
of bed days for emergency
admissions for chronic illness
by 27 per cent 26 per cent
and 165 per cent respectively
between 2007 and 2009 This
represented an overall cost
reduction of pound2224201 (NHS
Wales 2010)
In Goodwin et Al Report to the Department of
Health and NHS Future Forum from The Kingrsquos
Fund and Nuffield Trust
Dr Hector Upegui MD MSS PM OSHM
18
bull Camden NJ research on
patients and emergency room
data reveals hotspots
bull Direct intervention with
individuals addressing their
medical and social needs
yielded significant results
‒Before one individual ndash 2
chronic conditions ndash 35 hospital
visits in 6 months
‒After holistic treatment same
individual - 2 hospital visits in 6
months
bull Outcomes 40-50 decrease in
visits and costs
18copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Catalan Healthcare system
bullUniversal system
bullGovernment is the
Payer
bullHealthcare Provider
for the region of
Catalonia
bull~7 million residents
served
bull$4 Billion annual
budget
httpswwwyoutubecomwatchv=J-9q5InjdrU
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
20
Sharing some evidence
Presented by Joan Carlos Contel 2015
Dr Hector Upegui MD MSS PM OSHM
21
A European healthcare provider collaborates across clinicians and social care teams to cut costs and improve outcomes
12 less re-admissions to emergency departments
10 less re-admissions to hospital acute care wards
8 less outpatient visits
Improvedpatient satisfaction and chronic disease treatment
Reducederrors from miscommunication or lack of coordination
results from the pilot 300 patients
several care coordinators and teams
Business Challenge Rising chronic diseases in an aging population where
25 of the individuals are over 65 years old were consuming 70 of resources
This provider aimed at improving adherence to care programs through better care
management and coordination amongst 20+ silos of data leading to enhanced
patient quality of life and satisfaction with the healthcare system and controlling
costs
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Dr Hector Upegui MD Martin Duggan bdquoIntegrated care The ongoing journey (to be published)
Isolated
Linked
The person is on its ownProviders donlsquot
communicate donlsquot share info
Neither the operator
The person might have an indication of how to use the
service but has to move the processes
Providers donlsquot share information The operator is
mainly responsible for guaranteeing a
basic network of providers
Articulated
Coordinated
The person has a better indication on how to use the
service however is still part of the process
not properly served by the model Providers and
operator share information amongst
them The operator interacts with the network but has
difficulties to coordinate services
Redundancies are still present
Integrated
The person starts to be in the center of the service
Coordination Is around health
services and social determinants for health start to be
considered Providers and
operator exchange more informationa and communicate
better amongst them
Operators Providers and users have
more information to take better decisions
and achieve better outcomes
The person is in the center of the service Coordination Is
about health and social care services
Social determinants are addressed Synergies amongst
health care and social care
organizations are in place Providers and operator(s)
exchange more information and
communicate better
Operators Providers
and users have more information to
take better decisions and achieve better and more
sustainable outcomes
22copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Maturity models for Integrated Care (Health and social)
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
23
Integrated Care
Linked
Articulated
Coordinated
Isolated
Linked
Articulated
Coordinated
Isolated
Health Care Sector Social Services Sector
What possible model for Integrated Care in Singapore
23
1 2
3
Integrated Care Commission Responsible for articulating the public
policy agenda define contents articulate coordination
Human resources strategy primary level integrated care centers
(physical or virtual) with healthcare and socialcare working together
Development of contentknowledge research and innovation
knowledge management integrated care pathways evidence based
models etccopy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
24
QampA
24copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
25copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
Dr Heacutector Upegui MD MSS PM OSHM
Mobile+49 172 407 01 31
E-Mail hectorupeguideibmcom
Hollerithstrasse 1
Munich 81829
Germany
26
httpswww-01ibmcomsoftwarecity-operationscuram-research-institute
Dr Hector Upegui MD MSS PM OSHM
Dr Hector Upegui MD MSS PM OSHM
3
What is the IBM CuacuteramResearch InstituteThe IBM Cuacuteram Research Institute is IBMrsquos social policy research arm
Research FocusThe Institutes research focuses on the cross-over from policy to service delivery with the aim of developing new social business models and the best practices that they encompass
MissionTo foster the development of best practice service delivery models and evidence-based solutions for social program organizations
The Cuacuteram Research Institute creates
cutting edge research in partnership
with
mdash Universities with a focus on new social trends
mdash Multi-lateral agencies
mdash Think Tanks
mdash Non-Governmental Organizations
Dr Hector Upegui MD MSS PM OSHM
4
The IBM Cuacuteram Research Institute publishes Thought Leadership papers
The IBM Cuacuteram Research Institutersquos research is categorized into the following sections
Industry Point of Views Published research undertaken with social enterprises national and international bodies and partner research organisations
Position Papers Published papers that describe a specific industry issue and provide opinion on best practices
Industry Consultations Input provided by the Cuacuteram Research Institute to public consultations on social policy related issuesthat reflect policy or service delivery reform objectives
Client AdviceAdvice provided by the Cuacuteram Research Instituteto clients on their reform agendas
Dr Hector Upegui MD MSS PM OSHM
5
SINGAPORE IS FACING
IMPORTANT CHALLENGES
IN THE HEALTH and SOCIAL
SECTOR
People living longer
alone facing increasing
costs and needs while
expecting more for less
Thus
bull Intersectorial coordination is
more important than ever
bull Technology has new capabilities
able to support the answer
INTEGRATED CARE
AS PART OF THE SOLUTION
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Our PoV
Dr Hector Upegui MD MSS PM OSHM
6
Definitions
Coordinated
Health care
Coordinated
Social care
Integrated Care
(Health and social)
means coordinated services across horizontal and vertical participants in the health sector This is for instance guaranteeing that if a patient moves from general practitioner to hospitalization the second one knows and can even interact with the first one so that the whole chain of health service delivery knows what is happening with that patient
means coordinated services across horizontal and vertical participants in the social services sector This is for instance guaranteeing that if a citizenresident moves from one social worker to another the second one knows and can even interact with the first one so that the whole chain of social service delivery knows what is happening with that citizenresident
Means an integral and coordinated view of service delivery managerial decisions of health services AND social services together This means for instance being able to coordinate social workerrsquos and physician interventions for a patient suffering from complications of diabetes but suffering form intra-familiar violence
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
7
Singapore is first world class in
healthcare and socialcare systems
11th place in
Human Development Index
3rd place in
Life Expectancy
First place in
Total health expenditure as
percentage of GDP
UN-2015 WHO
Worldbank-2014
1st place on the average of
annual growth
Human Development Index
UN-2015
WHO-2015
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
8
Worldwide Ongoing challenges in
the healthcare and socialcare sectors
bull Demographic changes
bull Chronic amp complex diseases
bull Increase of social needs
With the following environment
bull Citizenspatients with more access
to information
bull Less familycommunity support
bull Complexity of needs is higher
bull Service too fragmented vertically
and horizontally
bull Deinstitutionalization (in health as
well as in the social sector)
bull ICT - Technology is providing
- IoT
- Analytics
- Predictive analytics
- Continuum of care
WHAT WHY
bull More prevention
bull More efficiency
bull More social inclusion
bull Intersectorial coordination
bull Get closer to the user
bull Activate the person
family and community
ANSWERS
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
9
ChallengesMental
health and Obesity
Increasing
costs
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Additional specific challenges
Old age
dependency
ratio
Life styles changes
Users
involvement and
choices
Dr Hector Upegui MD MSS PM OSHM
10
Own calculations based on
httpdataworldbankorg World Bank Accessed in 2016
Variation from 1995-2014
Examples (increasing costs DR)
In 2015
Dependency ratio
Country NameOut of
Health
Expenses
Population
ages 65
and above
( of total)
Australia 17 30 24
European Union 1 21 28
Japan -1 54 79
New Zealand -32 59 25
Singapore 12 68 74
Spain -11 21 22
United Kingdom -23 36 10
World 4 17 26
Dr Hector Upegui MD MSS PM OSHM
11
Age Group
(Years)
2004 2014
Males Females Males Females
25-29 716 468 817 642
30-34 331 208 392 266
35-39 191 157 213 184
40-44 154 132 151 145
45-49 126 125 124 134
Proportion of Singles Among Resident
Population by Selected Age Group and Sex
This is an important
life style change that
certainly impacts
community strategies
11copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Examples (associated to exogenous
factors)
Dr Hector Upegui MD MSS PM OSHM12
Graphic from Thailand Business news -2014
Singapore
ranks 3rd in
Southeast
Asian
countries
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
In Singapore an estimated one in nine adults between
the ages of 18 and 69 has diabetes according to the
National Health Survey 2010
Examples (associated to exogenous
factors) -cont
Dr Hector Upegui MD MSS PM OSHM
13
httpwwwworkforcecomsection00article254691html
CONCLUSION Obesity in adolescence
may be associated with later depression in
young adulthood abdominal obesity
among male subjects may be closely
related to concomitant depression and
being overweightobese both in
adolescence and adulthood may be a risk
for depression among female subjects
13copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Examples (associated to exogenous
factors) -cont
Dr Hector Upegui MD MSS PM OSHM
Institution
Hospital
Other services
Diagnostics
Health
providers
Plans
Callcoordination center
NGOrsquos
Nutrition
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Why Integrated Care
Health care
sector
Dr Hector Upegui MD MSS PM OSHM
Buying
Provider
Counsellors
Work
Family
Social care
Aids
NGOrsquos
Case manager
Social
policies
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Social care
sector
Dr Hector Upegui MD MSS PM OSHM
Buying
Institution
Hospital
Provider
Counsellors
Work
Other services
Diagnostics
Health
providers
Family
Social care
Aids
Plans
Callcoordination center
NGOrsquos
Case manager
Social
policies
Nutrition
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Health care
sector
Social care
sector
Integrated care
market place
Prevention
Need of care
Need of
complex care
Social inclusion
Dr Hector Upegui MD MSS PM OSHM
17
Sharing some evidence
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Care for Older people
in Torbay UK (2004)
Diabetes care in
Bolton (1997)
Chronic Care
Management in Wales
Daily average number of
occupied beds from 750 in
19989 to 502 in 200910
emergency bed day use in
the population aged 65 and
over that is the lowest in
the region
Since 20078 144 fewer
people aged over 65 in
residential and nursing
homes with a
corresponding increase in
home care services
targeted at prevention and
low-level support
(Thistlethwaite 2011)
Patients and staff have
reported high levels of
satisfaction with the
service and in 20056
Bolton reported the
lowest number of
hospital bed days per
person with diabetes in
the Greater Manchester
area (Irani 2007)
reduction in the total number
of bed days for emergency
admissions for chronic illness
by 27 per cent 26 per cent
and 165 per cent respectively
between 2007 and 2009 This
represented an overall cost
reduction of pound2224201 (NHS
Wales 2010)
In Goodwin et Al Report to the Department of
Health and NHS Future Forum from The Kingrsquos
Fund and Nuffield Trust
Dr Hector Upegui MD MSS PM OSHM
18
bull Camden NJ research on
patients and emergency room
data reveals hotspots
bull Direct intervention with
individuals addressing their
medical and social needs
yielded significant results
‒Before one individual ndash 2
chronic conditions ndash 35 hospital
visits in 6 months
‒After holistic treatment same
individual - 2 hospital visits in 6
months
bull Outcomes 40-50 decrease in
visits and costs
18copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Catalan Healthcare system
bullUniversal system
bullGovernment is the
Payer
bullHealthcare Provider
for the region of
Catalonia
bull~7 million residents
served
bull$4 Billion annual
budget
httpswwwyoutubecomwatchv=J-9q5InjdrU
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
20
Sharing some evidence
Presented by Joan Carlos Contel 2015
Dr Hector Upegui MD MSS PM OSHM
21
A European healthcare provider collaborates across clinicians and social care teams to cut costs and improve outcomes
12 less re-admissions to emergency departments
10 less re-admissions to hospital acute care wards
8 less outpatient visits
Improvedpatient satisfaction and chronic disease treatment
Reducederrors from miscommunication or lack of coordination
results from the pilot 300 patients
several care coordinators and teams
Business Challenge Rising chronic diseases in an aging population where
25 of the individuals are over 65 years old were consuming 70 of resources
This provider aimed at improving adherence to care programs through better care
management and coordination amongst 20+ silos of data leading to enhanced
patient quality of life and satisfaction with the healthcare system and controlling
costs
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Dr Hector Upegui MD Martin Duggan bdquoIntegrated care The ongoing journey (to be published)
Isolated
Linked
The person is on its ownProviders donlsquot
communicate donlsquot share info
Neither the operator
The person might have an indication of how to use the
service but has to move the processes
Providers donlsquot share information The operator is
mainly responsible for guaranteeing a
basic network of providers
Articulated
Coordinated
The person has a better indication on how to use the
service however is still part of the process
not properly served by the model Providers and
operator share information amongst
them The operator interacts with the network but has
difficulties to coordinate services
Redundancies are still present
Integrated
The person starts to be in the center of the service
Coordination Is around health
services and social determinants for health start to be
considered Providers and
operator exchange more informationa and communicate
better amongst them
Operators Providers and users have
more information to take better decisions
and achieve better outcomes
The person is in the center of the service Coordination Is
about health and social care services
Social determinants are addressed Synergies amongst
health care and social care
organizations are in place Providers and operator(s)
exchange more information and
communicate better
Operators Providers
and users have more information to
take better decisions and achieve better and more
sustainable outcomes
22copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Maturity models for Integrated Care (Health and social)
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
23
Integrated Care
Linked
Articulated
Coordinated
Isolated
Linked
Articulated
Coordinated
Isolated
Health Care Sector Social Services Sector
What possible model for Integrated Care in Singapore
23
1 2
3
Integrated Care Commission Responsible for articulating the public
policy agenda define contents articulate coordination
Human resources strategy primary level integrated care centers
(physical or virtual) with healthcare and socialcare working together
Development of contentknowledge research and innovation
knowledge management integrated care pathways evidence based
models etccopy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
24
QampA
24copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
25copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
Dr Heacutector Upegui MD MSS PM OSHM
Mobile+49 172 407 01 31
E-Mail hectorupeguideibmcom
Hollerithstrasse 1
Munich 81829
Germany
26
httpswww-01ibmcomsoftwarecity-operationscuram-research-institute
Dr Hector Upegui MD MSS PM OSHM
3
What is the IBM CuacuteramResearch InstituteThe IBM Cuacuteram Research Institute is IBMrsquos social policy research arm
Research FocusThe Institutes research focuses on the cross-over from policy to service delivery with the aim of developing new social business models and the best practices that they encompass
MissionTo foster the development of best practice service delivery models and evidence-based solutions for social program organizations
The Cuacuteram Research Institute creates
cutting edge research in partnership
with
mdash Universities with a focus on new social trends
mdash Multi-lateral agencies
mdash Think Tanks
mdash Non-Governmental Organizations
Dr Hector Upegui MD MSS PM OSHM
4
The IBM Cuacuteram Research Institute publishes Thought Leadership papers
The IBM Cuacuteram Research Institutersquos research is categorized into the following sections
Industry Point of Views Published research undertaken with social enterprises national and international bodies and partner research organisations
Position Papers Published papers that describe a specific industry issue and provide opinion on best practices
Industry Consultations Input provided by the Cuacuteram Research Institute to public consultations on social policy related issuesthat reflect policy or service delivery reform objectives
Client AdviceAdvice provided by the Cuacuteram Research Instituteto clients on their reform agendas
Dr Hector Upegui MD MSS PM OSHM
5
SINGAPORE IS FACING
IMPORTANT CHALLENGES
IN THE HEALTH and SOCIAL
SECTOR
People living longer
alone facing increasing
costs and needs while
expecting more for less
Thus
bull Intersectorial coordination is
more important than ever
bull Technology has new capabilities
able to support the answer
INTEGRATED CARE
AS PART OF THE SOLUTION
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Our PoV
Dr Hector Upegui MD MSS PM OSHM
6
Definitions
Coordinated
Health care
Coordinated
Social care
Integrated Care
(Health and social)
means coordinated services across horizontal and vertical participants in the health sector This is for instance guaranteeing that if a patient moves from general practitioner to hospitalization the second one knows and can even interact with the first one so that the whole chain of health service delivery knows what is happening with that patient
means coordinated services across horizontal and vertical participants in the social services sector This is for instance guaranteeing that if a citizenresident moves from one social worker to another the second one knows and can even interact with the first one so that the whole chain of social service delivery knows what is happening with that citizenresident
Means an integral and coordinated view of service delivery managerial decisions of health services AND social services together This means for instance being able to coordinate social workerrsquos and physician interventions for a patient suffering from complications of diabetes but suffering form intra-familiar violence
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
7
Singapore is first world class in
healthcare and socialcare systems
11th place in
Human Development Index
3rd place in
Life Expectancy
First place in
Total health expenditure as
percentage of GDP
UN-2015 WHO
Worldbank-2014
1st place on the average of
annual growth
Human Development Index
UN-2015
WHO-2015
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
8
Worldwide Ongoing challenges in
the healthcare and socialcare sectors
bull Demographic changes
bull Chronic amp complex diseases
bull Increase of social needs
With the following environment
bull Citizenspatients with more access
to information
bull Less familycommunity support
bull Complexity of needs is higher
bull Service too fragmented vertically
and horizontally
bull Deinstitutionalization (in health as
well as in the social sector)
bull ICT - Technology is providing
- IoT
- Analytics
- Predictive analytics
- Continuum of care
WHAT WHY
bull More prevention
bull More efficiency
bull More social inclusion
bull Intersectorial coordination
bull Get closer to the user
bull Activate the person
family and community
ANSWERS
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
9
ChallengesMental
health and Obesity
Increasing
costs
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Additional specific challenges
Old age
dependency
ratio
Life styles changes
Users
involvement and
choices
Dr Hector Upegui MD MSS PM OSHM
10
Own calculations based on
httpdataworldbankorg World Bank Accessed in 2016
Variation from 1995-2014
Examples (increasing costs DR)
In 2015
Dependency ratio
Country NameOut of
Health
Expenses
Population
ages 65
and above
( of total)
Australia 17 30 24
European Union 1 21 28
Japan -1 54 79
New Zealand -32 59 25
Singapore 12 68 74
Spain -11 21 22
United Kingdom -23 36 10
World 4 17 26
Dr Hector Upegui MD MSS PM OSHM
11
Age Group
(Years)
2004 2014
Males Females Males Females
25-29 716 468 817 642
30-34 331 208 392 266
35-39 191 157 213 184
40-44 154 132 151 145
45-49 126 125 124 134
Proportion of Singles Among Resident
Population by Selected Age Group and Sex
This is an important
life style change that
certainly impacts
community strategies
11copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Examples (associated to exogenous
factors)
Dr Hector Upegui MD MSS PM OSHM12
Graphic from Thailand Business news -2014
Singapore
ranks 3rd in
Southeast
Asian
countries
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
In Singapore an estimated one in nine adults between
the ages of 18 and 69 has diabetes according to the
National Health Survey 2010
Examples (associated to exogenous
factors) -cont
Dr Hector Upegui MD MSS PM OSHM
13
httpwwwworkforcecomsection00article254691html
CONCLUSION Obesity in adolescence
may be associated with later depression in
young adulthood abdominal obesity
among male subjects may be closely
related to concomitant depression and
being overweightobese both in
adolescence and adulthood may be a risk
for depression among female subjects
13copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Examples (associated to exogenous
factors) -cont
Dr Hector Upegui MD MSS PM OSHM
Institution
Hospital
Other services
Diagnostics
Health
providers
Plans
Callcoordination center
NGOrsquos
Nutrition
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Why Integrated Care
Health care
sector
Dr Hector Upegui MD MSS PM OSHM
Buying
Provider
Counsellors
Work
Family
Social care
Aids
NGOrsquos
Case manager
Social
policies
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Social care
sector
Dr Hector Upegui MD MSS PM OSHM
Buying
Institution
Hospital
Provider
Counsellors
Work
Other services
Diagnostics
Health
providers
Family
Social care
Aids
Plans
Callcoordination center
NGOrsquos
Case manager
Social
policies
Nutrition
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Health care
sector
Social care
sector
Integrated care
market place
Prevention
Need of care
Need of
complex care
Social inclusion
Dr Hector Upegui MD MSS PM OSHM
17
Sharing some evidence
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Care for Older people
in Torbay UK (2004)
Diabetes care in
Bolton (1997)
Chronic Care
Management in Wales
Daily average number of
occupied beds from 750 in
19989 to 502 in 200910
emergency bed day use in
the population aged 65 and
over that is the lowest in
the region
Since 20078 144 fewer
people aged over 65 in
residential and nursing
homes with a
corresponding increase in
home care services
targeted at prevention and
low-level support
(Thistlethwaite 2011)
Patients and staff have
reported high levels of
satisfaction with the
service and in 20056
Bolton reported the
lowest number of
hospital bed days per
person with diabetes in
the Greater Manchester
area (Irani 2007)
reduction in the total number
of bed days for emergency
admissions for chronic illness
by 27 per cent 26 per cent
and 165 per cent respectively
between 2007 and 2009 This
represented an overall cost
reduction of pound2224201 (NHS
Wales 2010)
In Goodwin et Al Report to the Department of
Health and NHS Future Forum from The Kingrsquos
Fund and Nuffield Trust
Dr Hector Upegui MD MSS PM OSHM
18
bull Camden NJ research on
patients and emergency room
data reveals hotspots
bull Direct intervention with
individuals addressing their
medical and social needs
yielded significant results
‒Before one individual ndash 2
chronic conditions ndash 35 hospital
visits in 6 months
‒After holistic treatment same
individual - 2 hospital visits in 6
months
bull Outcomes 40-50 decrease in
visits and costs
18copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Catalan Healthcare system
bullUniversal system
bullGovernment is the
Payer
bullHealthcare Provider
for the region of
Catalonia
bull~7 million residents
served
bull$4 Billion annual
budget
httpswwwyoutubecomwatchv=J-9q5InjdrU
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
20
Sharing some evidence
Presented by Joan Carlos Contel 2015
Dr Hector Upegui MD MSS PM OSHM
21
A European healthcare provider collaborates across clinicians and social care teams to cut costs and improve outcomes
12 less re-admissions to emergency departments
10 less re-admissions to hospital acute care wards
8 less outpatient visits
Improvedpatient satisfaction and chronic disease treatment
Reducederrors from miscommunication or lack of coordination
results from the pilot 300 patients
several care coordinators and teams
Business Challenge Rising chronic diseases in an aging population where
25 of the individuals are over 65 years old were consuming 70 of resources
This provider aimed at improving adherence to care programs through better care
management and coordination amongst 20+ silos of data leading to enhanced
patient quality of life and satisfaction with the healthcare system and controlling
costs
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Dr Hector Upegui MD Martin Duggan bdquoIntegrated care The ongoing journey (to be published)
Isolated
Linked
The person is on its ownProviders donlsquot
communicate donlsquot share info
Neither the operator
The person might have an indication of how to use the
service but has to move the processes
Providers donlsquot share information The operator is
mainly responsible for guaranteeing a
basic network of providers
Articulated
Coordinated
The person has a better indication on how to use the
service however is still part of the process
not properly served by the model Providers and
operator share information amongst
them The operator interacts with the network but has
difficulties to coordinate services
Redundancies are still present
Integrated
The person starts to be in the center of the service
Coordination Is around health
services and social determinants for health start to be
considered Providers and
operator exchange more informationa and communicate
better amongst them
Operators Providers and users have
more information to take better decisions
and achieve better outcomes
The person is in the center of the service Coordination Is
about health and social care services
Social determinants are addressed Synergies amongst
health care and social care
organizations are in place Providers and operator(s)
exchange more information and
communicate better
Operators Providers
and users have more information to
take better decisions and achieve better and more
sustainable outcomes
22copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Maturity models for Integrated Care (Health and social)
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
23
Integrated Care
Linked
Articulated
Coordinated
Isolated
Linked
Articulated
Coordinated
Isolated
Health Care Sector Social Services Sector
What possible model for Integrated Care in Singapore
23
1 2
3
Integrated Care Commission Responsible for articulating the public
policy agenda define contents articulate coordination
Human resources strategy primary level integrated care centers
(physical or virtual) with healthcare and socialcare working together
Development of contentknowledge research and innovation
knowledge management integrated care pathways evidence based
models etccopy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
24
QampA
24copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
25copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
Dr Heacutector Upegui MD MSS PM OSHM
Mobile+49 172 407 01 31
E-Mail hectorupeguideibmcom
Hollerithstrasse 1
Munich 81829
Germany
26
httpswww-01ibmcomsoftwarecity-operationscuram-research-institute
Dr Hector Upegui MD MSS PM OSHM
4
The IBM Cuacuteram Research Institute publishes Thought Leadership papers
The IBM Cuacuteram Research Institutersquos research is categorized into the following sections
Industry Point of Views Published research undertaken with social enterprises national and international bodies and partner research organisations
Position Papers Published papers that describe a specific industry issue and provide opinion on best practices
Industry Consultations Input provided by the Cuacuteram Research Institute to public consultations on social policy related issuesthat reflect policy or service delivery reform objectives
Client AdviceAdvice provided by the Cuacuteram Research Instituteto clients on their reform agendas
Dr Hector Upegui MD MSS PM OSHM
5
SINGAPORE IS FACING
IMPORTANT CHALLENGES
IN THE HEALTH and SOCIAL
SECTOR
People living longer
alone facing increasing
costs and needs while
expecting more for less
Thus
bull Intersectorial coordination is
more important than ever
bull Technology has new capabilities
able to support the answer
INTEGRATED CARE
AS PART OF THE SOLUTION
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Our PoV
Dr Hector Upegui MD MSS PM OSHM
6
Definitions
Coordinated
Health care
Coordinated
Social care
Integrated Care
(Health and social)
means coordinated services across horizontal and vertical participants in the health sector This is for instance guaranteeing that if a patient moves from general practitioner to hospitalization the second one knows and can even interact with the first one so that the whole chain of health service delivery knows what is happening with that patient
means coordinated services across horizontal and vertical participants in the social services sector This is for instance guaranteeing that if a citizenresident moves from one social worker to another the second one knows and can even interact with the first one so that the whole chain of social service delivery knows what is happening with that citizenresident
Means an integral and coordinated view of service delivery managerial decisions of health services AND social services together This means for instance being able to coordinate social workerrsquos and physician interventions for a patient suffering from complications of diabetes but suffering form intra-familiar violence
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
7
Singapore is first world class in
healthcare and socialcare systems
11th place in
Human Development Index
3rd place in
Life Expectancy
First place in
Total health expenditure as
percentage of GDP
UN-2015 WHO
Worldbank-2014
1st place on the average of
annual growth
Human Development Index
UN-2015
WHO-2015
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
8
Worldwide Ongoing challenges in
the healthcare and socialcare sectors
bull Demographic changes
bull Chronic amp complex diseases
bull Increase of social needs
With the following environment
bull Citizenspatients with more access
to information
bull Less familycommunity support
bull Complexity of needs is higher
bull Service too fragmented vertically
and horizontally
bull Deinstitutionalization (in health as
well as in the social sector)
bull ICT - Technology is providing
- IoT
- Analytics
- Predictive analytics
- Continuum of care
WHAT WHY
bull More prevention
bull More efficiency
bull More social inclusion
bull Intersectorial coordination
bull Get closer to the user
bull Activate the person
family and community
ANSWERS
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
9
ChallengesMental
health and Obesity
Increasing
costs
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Additional specific challenges
Old age
dependency
ratio
Life styles changes
Users
involvement and
choices
Dr Hector Upegui MD MSS PM OSHM
10
Own calculations based on
httpdataworldbankorg World Bank Accessed in 2016
Variation from 1995-2014
Examples (increasing costs DR)
In 2015
Dependency ratio
Country NameOut of
Health
Expenses
Population
ages 65
and above
( of total)
Australia 17 30 24
European Union 1 21 28
Japan -1 54 79
New Zealand -32 59 25
Singapore 12 68 74
Spain -11 21 22
United Kingdom -23 36 10
World 4 17 26
Dr Hector Upegui MD MSS PM OSHM
11
Age Group
(Years)
2004 2014
Males Females Males Females
25-29 716 468 817 642
30-34 331 208 392 266
35-39 191 157 213 184
40-44 154 132 151 145
45-49 126 125 124 134
Proportion of Singles Among Resident
Population by Selected Age Group and Sex
This is an important
life style change that
certainly impacts
community strategies
11copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Examples (associated to exogenous
factors)
Dr Hector Upegui MD MSS PM OSHM12
Graphic from Thailand Business news -2014
Singapore
ranks 3rd in
Southeast
Asian
countries
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
In Singapore an estimated one in nine adults between
the ages of 18 and 69 has diabetes according to the
National Health Survey 2010
Examples (associated to exogenous
factors) -cont
Dr Hector Upegui MD MSS PM OSHM
13
httpwwwworkforcecomsection00article254691html
CONCLUSION Obesity in adolescence
may be associated with later depression in
young adulthood abdominal obesity
among male subjects may be closely
related to concomitant depression and
being overweightobese both in
adolescence and adulthood may be a risk
for depression among female subjects
13copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Examples (associated to exogenous
factors) -cont
Dr Hector Upegui MD MSS PM OSHM
Institution
Hospital
Other services
Diagnostics
Health
providers
Plans
Callcoordination center
NGOrsquos
Nutrition
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Why Integrated Care
Health care
sector
Dr Hector Upegui MD MSS PM OSHM
Buying
Provider
Counsellors
Work
Family
Social care
Aids
NGOrsquos
Case manager
Social
policies
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Social care
sector
Dr Hector Upegui MD MSS PM OSHM
Buying
Institution
Hospital
Provider
Counsellors
Work
Other services
Diagnostics
Health
providers
Family
Social care
Aids
Plans
Callcoordination center
NGOrsquos
Case manager
Social
policies
Nutrition
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Health care
sector
Social care
sector
Integrated care
market place
Prevention
Need of care
Need of
complex care
Social inclusion
Dr Hector Upegui MD MSS PM OSHM
17
Sharing some evidence
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Care for Older people
in Torbay UK (2004)
Diabetes care in
Bolton (1997)
Chronic Care
Management in Wales
Daily average number of
occupied beds from 750 in
19989 to 502 in 200910
emergency bed day use in
the population aged 65 and
over that is the lowest in
the region
Since 20078 144 fewer
people aged over 65 in
residential and nursing
homes with a
corresponding increase in
home care services
targeted at prevention and
low-level support
(Thistlethwaite 2011)
Patients and staff have
reported high levels of
satisfaction with the
service and in 20056
Bolton reported the
lowest number of
hospital bed days per
person with diabetes in
the Greater Manchester
area (Irani 2007)
reduction in the total number
of bed days for emergency
admissions for chronic illness
by 27 per cent 26 per cent
and 165 per cent respectively
between 2007 and 2009 This
represented an overall cost
reduction of pound2224201 (NHS
Wales 2010)
In Goodwin et Al Report to the Department of
Health and NHS Future Forum from The Kingrsquos
Fund and Nuffield Trust
Dr Hector Upegui MD MSS PM OSHM
18
bull Camden NJ research on
patients and emergency room
data reveals hotspots
bull Direct intervention with
individuals addressing their
medical and social needs
yielded significant results
‒Before one individual ndash 2
chronic conditions ndash 35 hospital
visits in 6 months
‒After holistic treatment same
individual - 2 hospital visits in 6
months
bull Outcomes 40-50 decrease in
visits and costs
18copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Catalan Healthcare system
bullUniversal system
bullGovernment is the
Payer
bullHealthcare Provider
for the region of
Catalonia
bull~7 million residents
served
bull$4 Billion annual
budget
httpswwwyoutubecomwatchv=J-9q5InjdrU
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
20
Sharing some evidence
Presented by Joan Carlos Contel 2015
Dr Hector Upegui MD MSS PM OSHM
21
A European healthcare provider collaborates across clinicians and social care teams to cut costs and improve outcomes
12 less re-admissions to emergency departments
10 less re-admissions to hospital acute care wards
8 less outpatient visits
Improvedpatient satisfaction and chronic disease treatment
Reducederrors from miscommunication or lack of coordination
results from the pilot 300 patients
several care coordinators and teams
Business Challenge Rising chronic diseases in an aging population where
25 of the individuals are over 65 years old were consuming 70 of resources
This provider aimed at improving adherence to care programs through better care
management and coordination amongst 20+ silos of data leading to enhanced
patient quality of life and satisfaction with the healthcare system and controlling
costs
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Dr Hector Upegui MD Martin Duggan bdquoIntegrated care The ongoing journey (to be published)
Isolated
Linked
The person is on its ownProviders donlsquot
communicate donlsquot share info
Neither the operator
The person might have an indication of how to use the
service but has to move the processes
Providers donlsquot share information The operator is
mainly responsible for guaranteeing a
basic network of providers
Articulated
Coordinated
The person has a better indication on how to use the
service however is still part of the process
not properly served by the model Providers and
operator share information amongst
them The operator interacts with the network but has
difficulties to coordinate services
Redundancies are still present
Integrated
The person starts to be in the center of the service
Coordination Is around health
services and social determinants for health start to be
considered Providers and
operator exchange more informationa and communicate
better amongst them
Operators Providers and users have
more information to take better decisions
and achieve better outcomes
The person is in the center of the service Coordination Is
about health and social care services
Social determinants are addressed Synergies amongst
health care and social care
organizations are in place Providers and operator(s)
exchange more information and
communicate better
Operators Providers
and users have more information to
take better decisions and achieve better and more
sustainable outcomes
22copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Maturity models for Integrated Care (Health and social)
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
23
Integrated Care
Linked
Articulated
Coordinated
Isolated
Linked
Articulated
Coordinated
Isolated
Health Care Sector Social Services Sector
What possible model for Integrated Care in Singapore
23
1 2
3
Integrated Care Commission Responsible for articulating the public
policy agenda define contents articulate coordination
Human resources strategy primary level integrated care centers
(physical or virtual) with healthcare and socialcare working together
Development of contentknowledge research and innovation
knowledge management integrated care pathways evidence based
models etccopy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
24
QampA
24copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
25copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
Dr Heacutector Upegui MD MSS PM OSHM
Mobile+49 172 407 01 31
E-Mail hectorupeguideibmcom
Hollerithstrasse 1
Munich 81829
Germany
26
httpswww-01ibmcomsoftwarecity-operationscuram-research-institute
Dr Hector Upegui MD MSS PM OSHM
5
SINGAPORE IS FACING
IMPORTANT CHALLENGES
IN THE HEALTH and SOCIAL
SECTOR
People living longer
alone facing increasing
costs and needs while
expecting more for less
Thus
bull Intersectorial coordination is
more important than ever
bull Technology has new capabilities
able to support the answer
INTEGRATED CARE
AS PART OF THE SOLUTION
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Our PoV
Dr Hector Upegui MD MSS PM OSHM
6
Definitions
Coordinated
Health care
Coordinated
Social care
Integrated Care
(Health and social)
means coordinated services across horizontal and vertical participants in the health sector This is for instance guaranteeing that if a patient moves from general practitioner to hospitalization the second one knows and can even interact with the first one so that the whole chain of health service delivery knows what is happening with that patient
means coordinated services across horizontal and vertical participants in the social services sector This is for instance guaranteeing that if a citizenresident moves from one social worker to another the second one knows and can even interact with the first one so that the whole chain of social service delivery knows what is happening with that citizenresident
Means an integral and coordinated view of service delivery managerial decisions of health services AND social services together This means for instance being able to coordinate social workerrsquos and physician interventions for a patient suffering from complications of diabetes but suffering form intra-familiar violence
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
7
Singapore is first world class in
healthcare and socialcare systems
11th place in
Human Development Index
3rd place in
Life Expectancy
First place in
Total health expenditure as
percentage of GDP
UN-2015 WHO
Worldbank-2014
1st place on the average of
annual growth
Human Development Index
UN-2015
WHO-2015
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
8
Worldwide Ongoing challenges in
the healthcare and socialcare sectors
bull Demographic changes
bull Chronic amp complex diseases
bull Increase of social needs
With the following environment
bull Citizenspatients with more access
to information
bull Less familycommunity support
bull Complexity of needs is higher
bull Service too fragmented vertically
and horizontally
bull Deinstitutionalization (in health as
well as in the social sector)
bull ICT - Technology is providing
- IoT
- Analytics
- Predictive analytics
- Continuum of care
WHAT WHY
bull More prevention
bull More efficiency
bull More social inclusion
bull Intersectorial coordination
bull Get closer to the user
bull Activate the person
family and community
ANSWERS
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
9
ChallengesMental
health and Obesity
Increasing
costs
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Additional specific challenges
Old age
dependency
ratio
Life styles changes
Users
involvement and
choices
Dr Hector Upegui MD MSS PM OSHM
10
Own calculations based on
httpdataworldbankorg World Bank Accessed in 2016
Variation from 1995-2014
Examples (increasing costs DR)
In 2015
Dependency ratio
Country NameOut of
Health
Expenses
Population
ages 65
and above
( of total)
Australia 17 30 24
European Union 1 21 28
Japan -1 54 79
New Zealand -32 59 25
Singapore 12 68 74
Spain -11 21 22
United Kingdom -23 36 10
World 4 17 26
Dr Hector Upegui MD MSS PM OSHM
11
Age Group
(Years)
2004 2014
Males Females Males Females
25-29 716 468 817 642
30-34 331 208 392 266
35-39 191 157 213 184
40-44 154 132 151 145
45-49 126 125 124 134
Proportion of Singles Among Resident
Population by Selected Age Group and Sex
This is an important
life style change that
certainly impacts
community strategies
11copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Examples (associated to exogenous
factors)
Dr Hector Upegui MD MSS PM OSHM12
Graphic from Thailand Business news -2014
Singapore
ranks 3rd in
Southeast
Asian
countries
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
In Singapore an estimated one in nine adults between
the ages of 18 and 69 has diabetes according to the
National Health Survey 2010
Examples (associated to exogenous
factors) -cont
Dr Hector Upegui MD MSS PM OSHM
13
httpwwwworkforcecomsection00article254691html
CONCLUSION Obesity in adolescence
may be associated with later depression in
young adulthood abdominal obesity
among male subjects may be closely
related to concomitant depression and
being overweightobese both in
adolescence and adulthood may be a risk
for depression among female subjects
13copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Examples (associated to exogenous
factors) -cont
Dr Hector Upegui MD MSS PM OSHM
Institution
Hospital
Other services
Diagnostics
Health
providers
Plans
Callcoordination center
NGOrsquos
Nutrition
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Why Integrated Care
Health care
sector
Dr Hector Upegui MD MSS PM OSHM
Buying
Provider
Counsellors
Work
Family
Social care
Aids
NGOrsquos
Case manager
Social
policies
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Social care
sector
Dr Hector Upegui MD MSS PM OSHM
Buying
Institution
Hospital
Provider
Counsellors
Work
Other services
Diagnostics
Health
providers
Family
Social care
Aids
Plans
Callcoordination center
NGOrsquos
Case manager
Social
policies
Nutrition
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Health care
sector
Social care
sector
Integrated care
market place
Prevention
Need of care
Need of
complex care
Social inclusion
Dr Hector Upegui MD MSS PM OSHM
17
Sharing some evidence
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Care for Older people
in Torbay UK (2004)
Diabetes care in
Bolton (1997)
Chronic Care
Management in Wales
Daily average number of
occupied beds from 750 in
19989 to 502 in 200910
emergency bed day use in
the population aged 65 and
over that is the lowest in
the region
Since 20078 144 fewer
people aged over 65 in
residential and nursing
homes with a
corresponding increase in
home care services
targeted at prevention and
low-level support
(Thistlethwaite 2011)
Patients and staff have
reported high levels of
satisfaction with the
service and in 20056
Bolton reported the
lowest number of
hospital bed days per
person with diabetes in
the Greater Manchester
area (Irani 2007)
reduction in the total number
of bed days for emergency
admissions for chronic illness
by 27 per cent 26 per cent
and 165 per cent respectively
between 2007 and 2009 This
represented an overall cost
reduction of pound2224201 (NHS
Wales 2010)
In Goodwin et Al Report to the Department of
Health and NHS Future Forum from The Kingrsquos
Fund and Nuffield Trust
Dr Hector Upegui MD MSS PM OSHM
18
bull Camden NJ research on
patients and emergency room
data reveals hotspots
bull Direct intervention with
individuals addressing their
medical and social needs
yielded significant results
‒Before one individual ndash 2
chronic conditions ndash 35 hospital
visits in 6 months
‒After holistic treatment same
individual - 2 hospital visits in 6
months
bull Outcomes 40-50 decrease in
visits and costs
18copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Catalan Healthcare system
bullUniversal system
bullGovernment is the
Payer
bullHealthcare Provider
for the region of
Catalonia
bull~7 million residents
served
bull$4 Billion annual
budget
httpswwwyoutubecomwatchv=J-9q5InjdrU
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
20
Sharing some evidence
Presented by Joan Carlos Contel 2015
Dr Hector Upegui MD MSS PM OSHM
21
A European healthcare provider collaborates across clinicians and social care teams to cut costs and improve outcomes
12 less re-admissions to emergency departments
10 less re-admissions to hospital acute care wards
8 less outpatient visits
Improvedpatient satisfaction and chronic disease treatment
Reducederrors from miscommunication or lack of coordination
results from the pilot 300 patients
several care coordinators and teams
Business Challenge Rising chronic diseases in an aging population where
25 of the individuals are over 65 years old were consuming 70 of resources
This provider aimed at improving adherence to care programs through better care
management and coordination amongst 20+ silos of data leading to enhanced
patient quality of life and satisfaction with the healthcare system and controlling
costs
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Dr Hector Upegui MD Martin Duggan bdquoIntegrated care The ongoing journey (to be published)
Isolated
Linked
The person is on its ownProviders donlsquot
communicate donlsquot share info
Neither the operator
The person might have an indication of how to use the
service but has to move the processes
Providers donlsquot share information The operator is
mainly responsible for guaranteeing a
basic network of providers
Articulated
Coordinated
The person has a better indication on how to use the
service however is still part of the process
not properly served by the model Providers and
operator share information amongst
them The operator interacts with the network but has
difficulties to coordinate services
Redundancies are still present
Integrated
The person starts to be in the center of the service
Coordination Is around health
services and social determinants for health start to be
considered Providers and
operator exchange more informationa and communicate
better amongst them
Operators Providers and users have
more information to take better decisions
and achieve better outcomes
The person is in the center of the service Coordination Is
about health and social care services
Social determinants are addressed Synergies amongst
health care and social care
organizations are in place Providers and operator(s)
exchange more information and
communicate better
Operators Providers
and users have more information to
take better decisions and achieve better and more
sustainable outcomes
22copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Maturity models for Integrated Care (Health and social)
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
23
Integrated Care
Linked
Articulated
Coordinated
Isolated
Linked
Articulated
Coordinated
Isolated
Health Care Sector Social Services Sector
What possible model for Integrated Care in Singapore
23
1 2
3
Integrated Care Commission Responsible for articulating the public
policy agenda define contents articulate coordination
Human resources strategy primary level integrated care centers
(physical or virtual) with healthcare and socialcare working together
Development of contentknowledge research and innovation
knowledge management integrated care pathways evidence based
models etccopy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
24
QampA
24copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
25copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
Dr Heacutector Upegui MD MSS PM OSHM
Mobile+49 172 407 01 31
E-Mail hectorupeguideibmcom
Hollerithstrasse 1
Munich 81829
Germany
26
httpswww-01ibmcomsoftwarecity-operationscuram-research-institute
Dr Hector Upegui MD MSS PM OSHM
6
Definitions
Coordinated
Health care
Coordinated
Social care
Integrated Care
(Health and social)
means coordinated services across horizontal and vertical participants in the health sector This is for instance guaranteeing that if a patient moves from general practitioner to hospitalization the second one knows and can even interact with the first one so that the whole chain of health service delivery knows what is happening with that patient
means coordinated services across horizontal and vertical participants in the social services sector This is for instance guaranteeing that if a citizenresident moves from one social worker to another the second one knows and can even interact with the first one so that the whole chain of social service delivery knows what is happening with that citizenresident
Means an integral and coordinated view of service delivery managerial decisions of health services AND social services together This means for instance being able to coordinate social workerrsquos and physician interventions for a patient suffering from complications of diabetes but suffering form intra-familiar violence
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
7
Singapore is first world class in
healthcare and socialcare systems
11th place in
Human Development Index
3rd place in
Life Expectancy
First place in
Total health expenditure as
percentage of GDP
UN-2015 WHO
Worldbank-2014
1st place on the average of
annual growth
Human Development Index
UN-2015
WHO-2015
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
8
Worldwide Ongoing challenges in
the healthcare and socialcare sectors
bull Demographic changes
bull Chronic amp complex diseases
bull Increase of social needs
With the following environment
bull Citizenspatients with more access
to information
bull Less familycommunity support
bull Complexity of needs is higher
bull Service too fragmented vertically
and horizontally
bull Deinstitutionalization (in health as
well as in the social sector)
bull ICT - Technology is providing
- IoT
- Analytics
- Predictive analytics
- Continuum of care
WHAT WHY
bull More prevention
bull More efficiency
bull More social inclusion
bull Intersectorial coordination
bull Get closer to the user
bull Activate the person
family and community
ANSWERS
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
9
ChallengesMental
health and Obesity
Increasing
costs
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Additional specific challenges
Old age
dependency
ratio
Life styles changes
Users
involvement and
choices
Dr Hector Upegui MD MSS PM OSHM
10
Own calculations based on
httpdataworldbankorg World Bank Accessed in 2016
Variation from 1995-2014
Examples (increasing costs DR)
In 2015
Dependency ratio
Country NameOut of
Health
Expenses
Population
ages 65
and above
( of total)
Australia 17 30 24
European Union 1 21 28
Japan -1 54 79
New Zealand -32 59 25
Singapore 12 68 74
Spain -11 21 22
United Kingdom -23 36 10
World 4 17 26
Dr Hector Upegui MD MSS PM OSHM
11
Age Group
(Years)
2004 2014
Males Females Males Females
25-29 716 468 817 642
30-34 331 208 392 266
35-39 191 157 213 184
40-44 154 132 151 145
45-49 126 125 124 134
Proportion of Singles Among Resident
Population by Selected Age Group and Sex
This is an important
life style change that
certainly impacts
community strategies
11copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Examples (associated to exogenous
factors)
Dr Hector Upegui MD MSS PM OSHM12
Graphic from Thailand Business news -2014
Singapore
ranks 3rd in
Southeast
Asian
countries
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
In Singapore an estimated one in nine adults between
the ages of 18 and 69 has diabetes according to the
National Health Survey 2010
Examples (associated to exogenous
factors) -cont
Dr Hector Upegui MD MSS PM OSHM
13
httpwwwworkforcecomsection00article254691html
CONCLUSION Obesity in adolescence
may be associated with later depression in
young adulthood abdominal obesity
among male subjects may be closely
related to concomitant depression and
being overweightobese both in
adolescence and adulthood may be a risk
for depression among female subjects
13copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Examples (associated to exogenous
factors) -cont
Dr Hector Upegui MD MSS PM OSHM
Institution
Hospital
Other services
Diagnostics
Health
providers
Plans
Callcoordination center
NGOrsquos
Nutrition
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Why Integrated Care
Health care
sector
Dr Hector Upegui MD MSS PM OSHM
Buying
Provider
Counsellors
Work
Family
Social care
Aids
NGOrsquos
Case manager
Social
policies
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Social care
sector
Dr Hector Upegui MD MSS PM OSHM
Buying
Institution
Hospital
Provider
Counsellors
Work
Other services
Diagnostics
Health
providers
Family
Social care
Aids
Plans
Callcoordination center
NGOrsquos
Case manager
Social
policies
Nutrition
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Health care
sector
Social care
sector
Integrated care
market place
Prevention
Need of care
Need of
complex care
Social inclusion
Dr Hector Upegui MD MSS PM OSHM
17
Sharing some evidence
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Care for Older people
in Torbay UK (2004)
Diabetes care in
Bolton (1997)
Chronic Care
Management in Wales
Daily average number of
occupied beds from 750 in
19989 to 502 in 200910
emergency bed day use in
the population aged 65 and
over that is the lowest in
the region
Since 20078 144 fewer
people aged over 65 in
residential and nursing
homes with a
corresponding increase in
home care services
targeted at prevention and
low-level support
(Thistlethwaite 2011)
Patients and staff have
reported high levels of
satisfaction with the
service and in 20056
Bolton reported the
lowest number of
hospital bed days per
person with diabetes in
the Greater Manchester
area (Irani 2007)
reduction in the total number
of bed days for emergency
admissions for chronic illness
by 27 per cent 26 per cent
and 165 per cent respectively
between 2007 and 2009 This
represented an overall cost
reduction of pound2224201 (NHS
Wales 2010)
In Goodwin et Al Report to the Department of
Health and NHS Future Forum from The Kingrsquos
Fund and Nuffield Trust
Dr Hector Upegui MD MSS PM OSHM
18
bull Camden NJ research on
patients and emergency room
data reveals hotspots
bull Direct intervention with
individuals addressing their
medical and social needs
yielded significant results
‒Before one individual ndash 2
chronic conditions ndash 35 hospital
visits in 6 months
‒After holistic treatment same
individual - 2 hospital visits in 6
months
bull Outcomes 40-50 decrease in
visits and costs
18copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Catalan Healthcare system
bullUniversal system
bullGovernment is the
Payer
bullHealthcare Provider
for the region of
Catalonia
bull~7 million residents
served
bull$4 Billion annual
budget
httpswwwyoutubecomwatchv=J-9q5InjdrU
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
20
Sharing some evidence
Presented by Joan Carlos Contel 2015
Dr Hector Upegui MD MSS PM OSHM
21
A European healthcare provider collaborates across clinicians and social care teams to cut costs and improve outcomes
12 less re-admissions to emergency departments
10 less re-admissions to hospital acute care wards
8 less outpatient visits
Improvedpatient satisfaction and chronic disease treatment
Reducederrors from miscommunication or lack of coordination
results from the pilot 300 patients
several care coordinators and teams
Business Challenge Rising chronic diseases in an aging population where
25 of the individuals are over 65 years old were consuming 70 of resources
This provider aimed at improving adherence to care programs through better care
management and coordination amongst 20+ silos of data leading to enhanced
patient quality of life and satisfaction with the healthcare system and controlling
costs
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Dr Hector Upegui MD Martin Duggan bdquoIntegrated care The ongoing journey (to be published)
Isolated
Linked
The person is on its ownProviders donlsquot
communicate donlsquot share info
Neither the operator
The person might have an indication of how to use the
service but has to move the processes
Providers donlsquot share information The operator is
mainly responsible for guaranteeing a
basic network of providers
Articulated
Coordinated
The person has a better indication on how to use the
service however is still part of the process
not properly served by the model Providers and
operator share information amongst
them The operator interacts with the network but has
difficulties to coordinate services
Redundancies are still present
Integrated
The person starts to be in the center of the service
Coordination Is around health
services and social determinants for health start to be
considered Providers and
operator exchange more informationa and communicate
better amongst them
Operators Providers and users have
more information to take better decisions
and achieve better outcomes
The person is in the center of the service Coordination Is
about health and social care services
Social determinants are addressed Synergies amongst
health care and social care
organizations are in place Providers and operator(s)
exchange more information and
communicate better
Operators Providers
and users have more information to
take better decisions and achieve better and more
sustainable outcomes
22copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Maturity models for Integrated Care (Health and social)
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
23
Integrated Care
Linked
Articulated
Coordinated
Isolated
Linked
Articulated
Coordinated
Isolated
Health Care Sector Social Services Sector
What possible model for Integrated Care in Singapore
23
1 2
3
Integrated Care Commission Responsible for articulating the public
policy agenda define contents articulate coordination
Human resources strategy primary level integrated care centers
(physical or virtual) with healthcare and socialcare working together
Development of contentknowledge research and innovation
knowledge management integrated care pathways evidence based
models etccopy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
24
QampA
24copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
25copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
Dr Heacutector Upegui MD MSS PM OSHM
Mobile+49 172 407 01 31
E-Mail hectorupeguideibmcom
Hollerithstrasse 1
Munich 81829
Germany
26
httpswww-01ibmcomsoftwarecity-operationscuram-research-institute
Dr Hector Upegui MD MSS PM OSHM
7
Singapore is first world class in
healthcare and socialcare systems
11th place in
Human Development Index
3rd place in
Life Expectancy
First place in
Total health expenditure as
percentage of GDP
UN-2015 WHO
Worldbank-2014
1st place on the average of
annual growth
Human Development Index
UN-2015
WHO-2015
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
8
Worldwide Ongoing challenges in
the healthcare and socialcare sectors
bull Demographic changes
bull Chronic amp complex diseases
bull Increase of social needs
With the following environment
bull Citizenspatients with more access
to information
bull Less familycommunity support
bull Complexity of needs is higher
bull Service too fragmented vertically
and horizontally
bull Deinstitutionalization (in health as
well as in the social sector)
bull ICT - Technology is providing
- IoT
- Analytics
- Predictive analytics
- Continuum of care
WHAT WHY
bull More prevention
bull More efficiency
bull More social inclusion
bull Intersectorial coordination
bull Get closer to the user
bull Activate the person
family and community
ANSWERS
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
9
ChallengesMental
health and Obesity
Increasing
costs
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Additional specific challenges
Old age
dependency
ratio
Life styles changes
Users
involvement and
choices
Dr Hector Upegui MD MSS PM OSHM
10
Own calculations based on
httpdataworldbankorg World Bank Accessed in 2016
Variation from 1995-2014
Examples (increasing costs DR)
In 2015
Dependency ratio
Country NameOut of
Health
Expenses
Population
ages 65
and above
( of total)
Australia 17 30 24
European Union 1 21 28
Japan -1 54 79
New Zealand -32 59 25
Singapore 12 68 74
Spain -11 21 22
United Kingdom -23 36 10
World 4 17 26
Dr Hector Upegui MD MSS PM OSHM
11
Age Group
(Years)
2004 2014
Males Females Males Females
25-29 716 468 817 642
30-34 331 208 392 266
35-39 191 157 213 184
40-44 154 132 151 145
45-49 126 125 124 134
Proportion of Singles Among Resident
Population by Selected Age Group and Sex
This is an important
life style change that
certainly impacts
community strategies
11copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Examples (associated to exogenous
factors)
Dr Hector Upegui MD MSS PM OSHM12
Graphic from Thailand Business news -2014
Singapore
ranks 3rd in
Southeast
Asian
countries
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
In Singapore an estimated one in nine adults between
the ages of 18 and 69 has diabetes according to the
National Health Survey 2010
Examples (associated to exogenous
factors) -cont
Dr Hector Upegui MD MSS PM OSHM
13
httpwwwworkforcecomsection00article254691html
CONCLUSION Obesity in adolescence
may be associated with later depression in
young adulthood abdominal obesity
among male subjects may be closely
related to concomitant depression and
being overweightobese both in
adolescence and adulthood may be a risk
for depression among female subjects
13copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Examples (associated to exogenous
factors) -cont
Dr Hector Upegui MD MSS PM OSHM
Institution
Hospital
Other services
Diagnostics
Health
providers
Plans
Callcoordination center
NGOrsquos
Nutrition
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Why Integrated Care
Health care
sector
Dr Hector Upegui MD MSS PM OSHM
Buying
Provider
Counsellors
Work
Family
Social care
Aids
NGOrsquos
Case manager
Social
policies
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Social care
sector
Dr Hector Upegui MD MSS PM OSHM
Buying
Institution
Hospital
Provider
Counsellors
Work
Other services
Diagnostics
Health
providers
Family
Social care
Aids
Plans
Callcoordination center
NGOrsquos
Case manager
Social
policies
Nutrition
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Health care
sector
Social care
sector
Integrated care
market place
Prevention
Need of care
Need of
complex care
Social inclusion
Dr Hector Upegui MD MSS PM OSHM
17
Sharing some evidence
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Care for Older people
in Torbay UK (2004)
Diabetes care in
Bolton (1997)
Chronic Care
Management in Wales
Daily average number of
occupied beds from 750 in
19989 to 502 in 200910
emergency bed day use in
the population aged 65 and
over that is the lowest in
the region
Since 20078 144 fewer
people aged over 65 in
residential and nursing
homes with a
corresponding increase in
home care services
targeted at prevention and
low-level support
(Thistlethwaite 2011)
Patients and staff have
reported high levels of
satisfaction with the
service and in 20056
Bolton reported the
lowest number of
hospital bed days per
person with diabetes in
the Greater Manchester
area (Irani 2007)
reduction in the total number
of bed days for emergency
admissions for chronic illness
by 27 per cent 26 per cent
and 165 per cent respectively
between 2007 and 2009 This
represented an overall cost
reduction of pound2224201 (NHS
Wales 2010)
In Goodwin et Al Report to the Department of
Health and NHS Future Forum from The Kingrsquos
Fund and Nuffield Trust
Dr Hector Upegui MD MSS PM OSHM
18
bull Camden NJ research on
patients and emergency room
data reveals hotspots
bull Direct intervention with
individuals addressing their
medical and social needs
yielded significant results
‒Before one individual ndash 2
chronic conditions ndash 35 hospital
visits in 6 months
‒After holistic treatment same
individual - 2 hospital visits in 6
months
bull Outcomes 40-50 decrease in
visits and costs
18copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Catalan Healthcare system
bullUniversal system
bullGovernment is the
Payer
bullHealthcare Provider
for the region of
Catalonia
bull~7 million residents
served
bull$4 Billion annual
budget
httpswwwyoutubecomwatchv=J-9q5InjdrU
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
20
Sharing some evidence
Presented by Joan Carlos Contel 2015
Dr Hector Upegui MD MSS PM OSHM
21
A European healthcare provider collaborates across clinicians and social care teams to cut costs and improve outcomes
12 less re-admissions to emergency departments
10 less re-admissions to hospital acute care wards
8 less outpatient visits
Improvedpatient satisfaction and chronic disease treatment
Reducederrors from miscommunication or lack of coordination
results from the pilot 300 patients
several care coordinators and teams
Business Challenge Rising chronic diseases in an aging population where
25 of the individuals are over 65 years old were consuming 70 of resources
This provider aimed at improving adherence to care programs through better care
management and coordination amongst 20+ silos of data leading to enhanced
patient quality of life and satisfaction with the healthcare system and controlling
costs
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Dr Hector Upegui MD Martin Duggan bdquoIntegrated care The ongoing journey (to be published)
Isolated
Linked
The person is on its ownProviders donlsquot
communicate donlsquot share info
Neither the operator
The person might have an indication of how to use the
service but has to move the processes
Providers donlsquot share information The operator is
mainly responsible for guaranteeing a
basic network of providers
Articulated
Coordinated
The person has a better indication on how to use the
service however is still part of the process
not properly served by the model Providers and
operator share information amongst
them The operator interacts with the network but has
difficulties to coordinate services
Redundancies are still present
Integrated
The person starts to be in the center of the service
Coordination Is around health
services and social determinants for health start to be
considered Providers and
operator exchange more informationa and communicate
better amongst them
Operators Providers and users have
more information to take better decisions
and achieve better outcomes
The person is in the center of the service Coordination Is
about health and social care services
Social determinants are addressed Synergies amongst
health care and social care
organizations are in place Providers and operator(s)
exchange more information and
communicate better
Operators Providers
and users have more information to
take better decisions and achieve better and more
sustainable outcomes
22copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Maturity models for Integrated Care (Health and social)
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
23
Integrated Care
Linked
Articulated
Coordinated
Isolated
Linked
Articulated
Coordinated
Isolated
Health Care Sector Social Services Sector
What possible model for Integrated Care in Singapore
23
1 2
3
Integrated Care Commission Responsible for articulating the public
policy agenda define contents articulate coordination
Human resources strategy primary level integrated care centers
(physical or virtual) with healthcare and socialcare working together
Development of contentknowledge research and innovation
knowledge management integrated care pathways evidence based
models etccopy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
24
QampA
24copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
25copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
Dr Heacutector Upegui MD MSS PM OSHM
Mobile+49 172 407 01 31
E-Mail hectorupeguideibmcom
Hollerithstrasse 1
Munich 81829
Germany
26
httpswww-01ibmcomsoftwarecity-operationscuram-research-institute
Dr Hector Upegui MD MSS PM OSHM
8
Worldwide Ongoing challenges in
the healthcare and socialcare sectors
bull Demographic changes
bull Chronic amp complex diseases
bull Increase of social needs
With the following environment
bull Citizenspatients with more access
to information
bull Less familycommunity support
bull Complexity of needs is higher
bull Service too fragmented vertically
and horizontally
bull Deinstitutionalization (in health as
well as in the social sector)
bull ICT - Technology is providing
- IoT
- Analytics
- Predictive analytics
- Continuum of care
WHAT WHY
bull More prevention
bull More efficiency
bull More social inclusion
bull Intersectorial coordination
bull Get closer to the user
bull Activate the person
family and community
ANSWERS
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
9
ChallengesMental
health and Obesity
Increasing
costs
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Additional specific challenges
Old age
dependency
ratio
Life styles changes
Users
involvement and
choices
Dr Hector Upegui MD MSS PM OSHM
10
Own calculations based on
httpdataworldbankorg World Bank Accessed in 2016
Variation from 1995-2014
Examples (increasing costs DR)
In 2015
Dependency ratio
Country NameOut of
Health
Expenses
Population
ages 65
and above
( of total)
Australia 17 30 24
European Union 1 21 28
Japan -1 54 79
New Zealand -32 59 25
Singapore 12 68 74
Spain -11 21 22
United Kingdom -23 36 10
World 4 17 26
Dr Hector Upegui MD MSS PM OSHM
11
Age Group
(Years)
2004 2014
Males Females Males Females
25-29 716 468 817 642
30-34 331 208 392 266
35-39 191 157 213 184
40-44 154 132 151 145
45-49 126 125 124 134
Proportion of Singles Among Resident
Population by Selected Age Group and Sex
This is an important
life style change that
certainly impacts
community strategies
11copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Examples (associated to exogenous
factors)
Dr Hector Upegui MD MSS PM OSHM12
Graphic from Thailand Business news -2014
Singapore
ranks 3rd in
Southeast
Asian
countries
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
In Singapore an estimated one in nine adults between
the ages of 18 and 69 has diabetes according to the
National Health Survey 2010
Examples (associated to exogenous
factors) -cont
Dr Hector Upegui MD MSS PM OSHM
13
httpwwwworkforcecomsection00article254691html
CONCLUSION Obesity in adolescence
may be associated with later depression in
young adulthood abdominal obesity
among male subjects may be closely
related to concomitant depression and
being overweightobese both in
adolescence and adulthood may be a risk
for depression among female subjects
13copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Examples (associated to exogenous
factors) -cont
Dr Hector Upegui MD MSS PM OSHM
Institution
Hospital
Other services
Diagnostics
Health
providers
Plans
Callcoordination center
NGOrsquos
Nutrition
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Why Integrated Care
Health care
sector
Dr Hector Upegui MD MSS PM OSHM
Buying
Provider
Counsellors
Work
Family
Social care
Aids
NGOrsquos
Case manager
Social
policies
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Social care
sector
Dr Hector Upegui MD MSS PM OSHM
Buying
Institution
Hospital
Provider
Counsellors
Work
Other services
Diagnostics
Health
providers
Family
Social care
Aids
Plans
Callcoordination center
NGOrsquos
Case manager
Social
policies
Nutrition
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Health care
sector
Social care
sector
Integrated care
market place
Prevention
Need of care
Need of
complex care
Social inclusion
Dr Hector Upegui MD MSS PM OSHM
17
Sharing some evidence
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Care for Older people
in Torbay UK (2004)
Diabetes care in
Bolton (1997)
Chronic Care
Management in Wales
Daily average number of
occupied beds from 750 in
19989 to 502 in 200910
emergency bed day use in
the population aged 65 and
over that is the lowest in
the region
Since 20078 144 fewer
people aged over 65 in
residential and nursing
homes with a
corresponding increase in
home care services
targeted at prevention and
low-level support
(Thistlethwaite 2011)
Patients and staff have
reported high levels of
satisfaction with the
service and in 20056
Bolton reported the
lowest number of
hospital bed days per
person with diabetes in
the Greater Manchester
area (Irani 2007)
reduction in the total number
of bed days for emergency
admissions for chronic illness
by 27 per cent 26 per cent
and 165 per cent respectively
between 2007 and 2009 This
represented an overall cost
reduction of pound2224201 (NHS
Wales 2010)
In Goodwin et Al Report to the Department of
Health and NHS Future Forum from The Kingrsquos
Fund and Nuffield Trust
Dr Hector Upegui MD MSS PM OSHM
18
bull Camden NJ research on
patients and emergency room
data reveals hotspots
bull Direct intervention with
individuals addressing their
medical and social needs
yielded significant results
‒Before one individual ndash 2
chronic conditions ndash 35 hospital
visits in 6 months
‒After holistic treatment same
individual - 2 hospital visits in 6
months
bull Outcomes 40-50 decrease in
visits and costs
18copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Catalan Healthcare system
bullUniversal system
bullGovernment is the
Payer
bullHealthcare Provider
for the region of
Catalonia
bull~7 million residents
served
bull$4 Billion annual
budget
httpswwwyoutubecomwatchv=J-9q5InjdrU
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
20
Sharing some evidence
Presented by Joan Carlos Contel 2015
Dr Hector Upegui MD MSS PM OSHM
21
A European healthcare provider collaborates across clinicians and social care teams to cut costs and improve outcomes
12 less re-admissions to emergency departments
10 less re-admissions to hospital acute care wards
8 less outpatient visits
Improvedpatient satisfaction and chronic disease treatment
Reducederrors from miscommunication or lack of coordination
results from the pilot 300 patients
several care coordinators and teams
Business Challenge Rising chronic diseases in an aging population where
25 of the individuals are over 65 years old were consuming 70 of resources
This provider aimed at improving adherence to care programs through better care
management and coordination amongst 20+ silos of data leading to enhanced
patient quality of life and satisfaction with the healthcare system and controlling
costs
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Dr Hector Upegui MD Martin Duggan bdquoIntegrated care The ongoing journey (to be published)
Isolated
Linked
The person is on its ownProviders donlsquot
communicate donlsquot share info
Neither the operator
The person might have an indication of how to use the
service but has to move the processes
Providers donlsquot share information The operator is
mainly responsible for guaranteeing a
basic network of providers
Articulated
Coordinated
The person has a better indication on how to use the
service however is still part of the process
not properly served by the model Providers and
operator share information amongst
them The operator interacts with the network but has
difficulties to coordinate services
Redundancies are still present
Integrated
The person starts to be in the center of the service
Coordination Is around health
services and social determinants for health start to be
considered Providers and
operator exchange more informationa and communicate
better amongst them
Operators Providers and users have
more information to take better decisions
and achieve better outcomes
The person is in the center of the service Coordination Is
about health and social care services
Social determinants are addressed Synergies amongst
health care and social care
organizations are in place Providers and operator(s)
exchange more information and
communicate better
Operators Providers
and users have more information to
take better decisions and achieve better and more
sustainable outcomes
22copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Maturity models for Integrated Care (Health and social)
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
23
Integrated Care
Linked
Articulated
Coordinated
Isolated
Linked
Articulated
Coordinated
Isolated
Health Care Sector Social Services Sector
What possible model for Integrated Care in Singapore
23
1 2
3
Integrated Care Commission Responsible for articulating the public
policy agenda define contents articulate coordination
Human resources strategy primary level integrated care centers
(physical or virtual) with healthcare and socialcare working together
Development of contentknowledge research and innovation
knowledge management integrated care pathways evidence based
models etccopy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
24
QampA
24copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
25copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
Dr Heacutector Upegui MD MSS PM OSHM
Mobile+49 172 407 01 31
E-Mail hectorupeguideibmcom
Hollerithstrasse 1
Munich 81829
Germany
26
httpswww-01ibmcomsoftwarecity-operationscuram-research-institute
Dr Hector Upegui MD MSS PM OSHM
9
ChallengesMental
health and Obesity
Increasing
costs
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Additional specific challenges
Old age
dependency
ratio
Life styles changes
Users
involvement and
choices
Dr Hector Upegui MD MSS PM OSHM
10
Own calculations based on
httpdataworldbankorg World Bank Accessed in 2016
Variation from 1995-2014
Examples (increasing costs DR)
In 2015
Dependency ratio
Country NameOut of
Health
Expenses
Population
ages 65
and above
( of total)
Australia 17 30 24
European Union 1 21 28
Japan -1 54 79
New Zealand -32 59 25
Singapore 12 68 74
Spain -11 21 22
United Kingdom -23 36 10
World 4 17 26
Dr Hector Upegui MD MSS PM OSHM
11
Age Group
(Years)
2004 2014
Males Females Males Females
25-29 716 468 817 642
30-34 331 208 392 266
35-39 191 157 213 184
40-44 154 132 151 145
45-49 126 125 124 134
Proportion of Singles Among Resident
Population by Selected Age Group and Sex
This is an important
life style change that
certainly impacts
community strategies
11copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Examples (associated to exogenous
factors)
Dr Hector Upegui MD MSS PM OSHM12
Graphic from Thailand Business news -2014
Singapore
ranks 3rd in
Southeast
Asian
countries
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
In Singapore an estimated one in nine adults between
the ages of 18 and 69 has diabetes according to the
National Health Survey 2010
Examples (associated to exogenous
factors) -cont
Dr Hector Upegui MD MSS PM OSHM
13
httpwwwworkforcecomsection00article254691html
CONCLUSION Obesity in adolescence
may be associated with later depression in
young adulthood abdominal obesity
among male subjects may be closely
related to concomitant depression and
being overweightobese both in
adolescence and adulthood may be a risk
for depression among female subjects
13copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Examples (associated to exogenous
factors) -cont
Dr Hector Upegui MD MSS PM OSHM
Institution
Hospital
Other services
Diagnostics
Health
providers
Plans
Callcoordination center
NGOrsquos
Nutrition
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Why Integrated Care
Health care
sector
Dr Hector Upegui MD MSS PM OSHM
Buying
Provider
Counsellors
Work
Family
Social care
Aids
NGOrsquos
Case manager
Social
policies
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Social care
sector
Dr Hector Upegui MD MSS PM OSHM
Buying
Institution
Hospital
Provider
Counsellors
Work
Other services
Diagnostics
Health
providers
Family
Social care
Aids
Plans
Callcoordination center
NGOrsquos
Case manager
Social
policies
Nutrition
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Health care
sector
Social care
sector
Integrated care
market place
Prevention
Need of care
Need of
complex care
Social inclusion
Dr Hector Upegui MD MSS PM OSHM
17
Sharing some evidence
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Care for Older people
in Torbay UK (2004)
Diabetes care in
Bolton (1997)
Chronic Care
Management in Wales
Daily average number of
occupied beds from 750 in
19989 to 502 in 200910
emergency bed day use in
the population aged 65 and
over that is the lowest in
the region
Since 20078 144 fewer
people aged over 65 in
residential and nursing
homes with a
corresponding increase in
home care services
targeted at prevention and
low-level support
(Thistlethwaite 2011)
Patients and staff have
reported high levels of
satisfaction with the
service and in 20056
Bolton reported the
lowest number of
hospital bed days per
person with diabetes in
the Greater Manchester
area (Irani 2007)
reduction in the total number
of bed days for emergency
admissions for chronic illness
by 27 per cent 26 per cent
and 165 per cent respectively
between 2007 and 2009 This
represented an overall cost
reduction of pound2224201 (NHS
Wales 2010)
In Goodwin et Al Report to the Department of
Health and NHS Future Forum from The Kingrsquos
Fund and Nuffield Trust
Dr Hector Upegui MD MSS PM OSHM
18
bull Camden NJ research on
patients and emergency room
data reveals hotspots
bull Direct intervention with
individuals addressing their
medical and social needs
yielded significant results
‒Before one individual ndash 2
chronic conditions ndash 35 hospital
visits in 6 months
‒After holistic treatment same
individual - 2 hospital visits in 6
months
bull Outcomes 40-50 decrease in
visits and costs
18copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Catalan Healthcare system
bullUniversal system
bullGovernment is the
Payer
bullHealthcare Provider
for the region of
Catalonia
bull~7 million residents
served
bull$4 Billion annual
budget
httpswwwyoutubecomwatchv=J-9q5InjdrU
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
20
Sharing some evidence
Presented by Joan Carlos Contel 2015
Dr Hector Upegui MD MSS PM OSHM
21
A European healthcare provider collaborates across clinicians and social care teams to cut costs and improve outcomes
12 less re-admissions to emergency departments
10 less re-admissions to hospital acute care wards
8 less outpatient visits
Improvedpatient satisfaction and chronic disease treatment
Reducederrors from miscommunication or lack of coordination
results from the pilot 300 patients
several care coordinators and teams
Business Challenge Rising chronic diseases in an aging population where
25 of the individuals are over 65 years old were consuming 70 of resources
This provider aimed at improving adherence to care programs through better care
management and coordination amongst 20+ silos of data leading to enhanced
patient quality of life and satisfaction with the healthcare system and controlling
costs
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Dr Hector Upegui MD Martin Duggan bdquoIntegrated care The ongoing journey (to be published)
Isolated
Linked
The person is on its ownProviders donlsquot
communicate donlsquot share info
Neither the operator
The person might have an indication of how to use the
service but has to move the processes
Providers donlsquot share information The operator is
mainly responsible for guaranteeing a
basic network of providers
Articulated
Coordinated
The person has a better indication on how to use the
service however is still part of the process
not properly served by the model Providers and
operator share information amongst
them The operator interacts with the network but has
difficulties to coordinate services
Redundancies are still present
Integrated
The person starts to be in the center of the service
Coordination Is around health
services and social determinants for health start to be
considered Providers and
operator exchange more informationa and communicate
better amongst them
Operators Providers and users have
more information to take better decisions
and achieve better outcomes
The person is in the center of the service Coordination Is
about health and social care services
Social determinants are addressed Synergies amongst
health care and social care
organizations are in place Providers and operator(s)
exchange more information and
communicate better
Operators Providers
and users have more information to
take better decisions and achieve better and more
sustainable outcomes
22copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Maturity models for Integrated Care (Health and social)
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
23
Integrated Care
Linked
Articulated
Coordinated
Isolated
Linked
Articulated
Coordinated
Isolated
Health Care Sector Social Services Sector
What possible model for Integrated Care in Singapore
23
1 2
3
Integrated Care Commission Responsible for articulating the public
policy agenda define contents articulate coordination
Human resources strategy primary level integrated care centers
(physical or virtual) with healthcare and socialcare working together
Development of contentknowledge research and innovation
knowledge management integrated care pathways evidence based
models etccopy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
24
QampA
24copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
25copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
Dr Heacutector Upegui MD MSS PM OSHM
Mobile+49 172 407 01 31
E-Mail hectorupeguideibmcom
Hollerithstrasse 1
Munich 81829
Germany
26
httpswww-01ibmcomsoftwarecity-operationscuram-research-institute
Dr Hector Upegui MD MSS PM OSHM
10
Own calculations based on
httpdataworldbankorg World Bank Accessed in 2016
Variation from 1995-2014
Examples (increasing costs DR)
In 2015
Dependency ratio
Country NameOut of
Health
Expenses
Population
ages 65
and above
( of total)
Australia 17 30 24
European Union 1 21 28
Japan -1 54 79
New Zealand -32 59 25
Singapore 12 68 74
Spain -11 21 22
United Kingdom -23 36 10
World 4 17 26
Dr Hector Upegui MD MSS PM OSHM
11
Age Group
(Years)
2004 2014
Males Females Males Females
25-29 716 468 817 642
30-34 331 208 392 266
35-39 191 157 213 184
40-44 154 132 151 145
45-49 126 125 124 134
Proportion of Singles Among Resident
Population by Selected Age Group and Sex
This is an important
life style change that
certainly impacts
community strategies
11copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Examples (associated to exogenous
factors)
Dr Hector Upegui MD MSS PM OSHM12
Graphic from Thailand Business news -2014
Singapore
ranks 3rd in
Southeast
Asian
countries
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
In Singapore an estimated one in nine adults between
the ages of 18 and 69 has diabetes according to the
National Health Survey 2010
Examples (associated to exogenous
factors) -cont
Dr Hector Upegui MD MSS PM OSHM
13
httpwwwworkforcecomsection00article254691html
CONCLUSION Obesity in adolescence
may be associated with later depression in
young adulthood abdominal obesity
among male subjects may be closely
related to concomitant depression and
being overweightobese both in
adolescence and adulthood may be a risk
for depression among female subjects
13copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Examples (associated to exogenous
factors) -cont
Dr Hector Upegui MD MSS PM OSHM
Institution
Hospital
Other services
Diagnostics
Health
providers
Plans
Callcoordination center
NGOrsquos
Nutrition
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Why Integrated Care
Health care
sector
Dr Hector Upegui MD MSS PM OSHM
Buying
Provider
Counsellors
Work
Family
Social care
Aids
NGOrsquos
Case manager
Social
policies
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Social care
sector
Dr Hector Upegui MD MSS PM OSHM
Buying
Institution
Hospital
Provider
Counsellors
Work
Other services
Diagnostics
Health
providers
Family
Social care
Aids
Plans
Callcoordination center
NGOrsquos
Case manager
Social
policies
Nutrition
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Health care
sector
Social care
sector
Integrated care
market place
Prevention
Need of care
Need of
complex care
Social inclusion
Dr Hector Upegui MD MSS PM OSHM
17
Sharing some evidence
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Care for Older people
in Torbay UK (2004)
Diabetes care in
Bolton (1997)
Chronic Care
Management in Wales
Daily average number of
occupied beds from 750 in
19989 to 502 in 200910
emergency bed day use in
the population aged 65 and
over that is the lowest in
the region
Since 20078 144 fewer
people aged over 65 in
residential and nursing
homes with a
corresponding increase in
home care services
targeted at prevention and
low-level support
(Thistlethwaite 2011)
Patients and staff have
reported high levels of
satisfaction with the
service and in 20056
Bolton reported the
lowest number of
hospital bed days per
person with diabetes in
the Greater Manchester
area (Irani 2007)
reduction in the total number
of bed days for emergency
admissions for chronic illness
by 27 per cent 26 per cent
and 165 per cent respectively
between 2007 and 2009 This
represented an overall cost
reduction of pound2224201 (NHS
Wales 2010)
In Goodwin et Al Report to the Department of
Health and NHS Future Forum from The Kingrsquos
Fund and Nuffield Trust
Dr Hector Upegui MD MSS PM OSHM
18
bull Camden NJ research on
patients and emergency room
data reveals hotspots
bull Direct intervention with
individuals addressing their
medical and social needs
yielded significant results
‒Before one individual ndash 2
chronic conditions ndash 35 hospital
visits in 6 months
‒After holistic treatment same
individual - 2 hospital visits in 6
months
bull Outcomes 40-50 decrease in
visits and costs
18copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Catalan Healthcare system
bullUniversal system
bullGovernment is the
Payer
bullHealthcare Provider
for the region of
Catalonia
bull~7 million residents
served
bull$4 Billion annual
budget
httpswwwyoutubecomwatchv=J-9q5InjdrU
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
20
Sharing some evidence
Presented by Joan Carlos Contel 2015
Dr Hector Upegui MD MSS PM OSHM
21
A European healthcare provider collaborates across clinicians and social care teams to cut costs and improve outcomes
12 less re-admissions to emergency departments
10 less re-admissions to hospital acute care wards
8 less outpatient visits
Improvedpatient satisfaction and chronic disease treatment
Reducederrors from miscommunication or lack of coordination
results from the pilot 300 patients
several care coordinators and teams
Business Challenge Rising chronic diseases in an aging population where
25 of the individuals are over 65 years old were consuming 70 of resources
This provider aimed at improving adherence to care programs through better care
management and coordination amongst 20+ silos of data leading to enhanced
patient quality of life and satisfaction with the healthcare system and controlling
costs
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Dr Hector Upegui MD Martin Duggan bdquoIntegrated care The ongoing journey (to be published)
Isolated
Linked
The person is on its ownProviders donlsquot
communicate donlsquot share info
Neither the operator
The person might have an indication of how to use the
service but has to move the processes
Providers donlsquot share information The operator is
mainly responsible for guaranteeing a
basic network of providers
Articulated
Coordinated
The person has a better indication on how to use the
service however is still part of the process
not properly served by the model Providers and
operator share information amongst
them The operator interacts with the network but has
difficulties to coordinate services
Redundancies are still present
Integrated
The person starts to be in the center of the service
Coordination Is around health
services and social determinants for health start to be
considered Providers and
operator exchange more informationa and communicate
better amongst them
Operators Providers and users have
more information to take better decisions
and achieve better outcomes
The person is in the center of the service Coordination Is
about health and social care services
Social determinants are addressed Synergies amongst
health care and social care
organizations are in place Providers and operator(s)
exchange more information and
communicate better
Operators Providers
and users have more information to
take better decisions and achieve better and more
sustainable outcomes
22copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Maturity models for Integrated Care (Health and social)
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
23
Integrated Care
Linked
Articulated
Coordinated
Isolated
Linked
Articulated
Coordinated
Isolated
Health Care Sector Social Services Sector
What possible model for Integrated Care in Singapore
23
1 2
3
Integrated Care Commission Responsible for articulating the public
policy agenda define contents articulate coordination
Human resources strategy primary level integrated care centers
(physical or virtual) with healthcare and socialcare working together
Development of contentknowledge research and innovation
knowledge management integrated care pathways evidence based
models etccopy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
24
QampA
24copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
25copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
Dr Heacutector Upegui MD MSS PM OSHM
Mobile+49 172 407 01 31
E-Mail hectorupeguideibmcom
Hollerithstrasse 1
Munich 81829
Germany
26
httpswww-01ibmcomsoftwarecity-operationscuram-research-institute
Dr Hector Upegui MD MSS PM OSHM
11
Age Group
(Years)
2004 2014
Males Females Males Females
25-29 716 468 817 642
30-34 331 208 392 266
35-39 191 157 213 184
40-44 154 132 151 145
45-49 126 125 124 134
Proportion of Singles Among Resident
Population by Selected Age Group and Sex
This is an important
life style change that
certainly impacts
community strategies
11copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Examples (associated to exogenous
factors)
Dr Hector Upegui MD MSS PM OSHM12
Graphic from Thailand Business news -2014
Singapore
ranks 3rd in
Southeast
Asian
countries
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
In Singapore an estimated one in nine adults between
the ages of 18 and 69 has diabetes according to the
National Health Survey 2010
Examples (associated to exogenous
factors) -cont
Dr Hector Upegui MD MSS PM OSHM
13
httpwwwworkforcecomsection00article254691html
CONCLUSION Obesity in adolescence
may be associated with later depression in
young adulthood abdominal obesity
among male subjects may be closely
related to concomitant depression and
being overweightobese both in
adolescence and adulthood may be a risk
for depression among female subjects
13copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Examples (associated to exogenous
factors) -cont
Dr Hector Upegui MD MSS PM OSHM
Institution
Hospital
Other services
Diagnostics
Health
providers
Plans
Callcoordination center
NGOrsquos
Nutrition
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Why Integrated Care
Health care
sector
Dr Hector Upegui MD MSS PM OSHM
Buying
Provider
Counsellors
Work
Family
Social care
Aids
NGOrsquos
Case manager
Social
policies
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Social care
sector
Dr Hector Upegui MD MSS PM OSHM
Buying
Institution
Hospital
Provider
Counsellors
Work
Other services
Diagnostics
Health
providers
Family
Social care
Aids
Plans
Callcoordination center
NGOrsquos
Case manager
Social
policies
Nutrition
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Health care
sector
Social care
sector
Integrated care
market place
Prevention
Need of care
Need of
complex care
Social inclusion
Dr Hector Upegui MD MSS PM OSHM
17
Sharing some evidence
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Care for Older people
in Torbay UK (2004)
Diabetes care in
Bolton (1997)
Chronic Care
Management in Wales
Daily average number of
occupied beds from 750 in
19989 to 502 in 200910
emergency bed day use in
the population aged 65 and
over that is the lowest in
the region
Since 20078 144 fewer
people aged over 65 in
residential and nursing
homes with a
corresponding increase in
home care services
targeted at prevention and
low-level support
(Thistlethwaite 2011)
Patients and staff have
reported high levels of
satisfaction with the
service and in 20056
Bolton reported the
lowest number of
hospital bed days per
person with diabetes in
the Greater Manchester
area (Irani 2007)
reduction in the total number
of bed days for emergency
admissions for chronic illness
by 27 per cent 26 per cent
and 165 per cent respectively
between 2007 and 2009 This
represented an overall cost
reduction of pound2224201 (NHS
Wales 2010)
In Goodwin et Al Report to the Department of
Health and NHS Future Forum from The Kingrsquos
Fund and Nuffield Trust
Dr Hector Upegui MD MSS PM OSHM
18
bull Camden NJ research on
patients and emergency room
data reveals hotspots
bull Direct intervention with
individuals addressing their
medical and social needs
yielded significant results
‒Before one individual ndash 2
chronic conditions ndash 35 hospital
visits in 6 months
‒After holistic treatment same
individual - 2 hospital visits in 6
months
bull Outcomes 40-50 decrease in
visits and costs
18copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Catalan Healthcare system
bullUniversal system
bullGovernment is the
Payer
bullHealthcare Provider
for the region of
Catalonia
bull~7 million residents
served
bull$4 Billion annual
budget
httpswwwyoutubecomwatchv=J-9q5InjdrU
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
20
Sharing some evidence
Presented by Joan Carlos Contel 2015
Dr Hector Upegui MD MSS PM OSHM
21
A European healthcare provider collaborates across clinicians and social care teams to cut costs and improve outcomes
12 less re-admissions to emergency departments
10 less re-admissions to hospital acute care wards
8 less outpatient visits
Improvedpatient satisfaction and chronic disease treatment
Reducederrors from miscommunication or lack of coordination
results from the pilot 300 patients
several care coordinators and teams
Business Challenge Rising chronic diseases in an aging population where
25 of the individuals are over 65 years old were consuming 70 of resources
This provider aimed at improving adherence to care programs through better care
management and coordination amongst 20+ silos of data leading to enhanced
patient quality of life and satisfaction with the healthcare system and controlling
costs
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Dr Hector Upegui MD Martin Duggan bdquoIntegrated care The ongoing journey (to be published)
Isolated
Linked
The person is on its ownProviders donlsquot
communicate donlsquot share info
Neither the operator
The person might have an indication of how to use the
service but has to move the processes
Providers donlsquot share information The operator is
mainly responsible for guaranteeing a
basic network of providers
Articulated
Coordinated
The person has a better indication on how to use the
service however is still part of the process
not properly served by the model Providers and
operator share information amongst
them The operator interacts with the network but has
difficulties to coordinate services
Redundancies are still present
Integrated
The person starts to be in the center of the service
Coordination Is around health
services and social determinants for health start to be
considered Providers and
operator exchange more informationa and communicate
better amongst them
Operators Providers and users have
more information to take better decisions
and achieve better outcomes
The person is in the center of the service Coordination Is
about health and social care services
Social determinants are addressed Synergies amongst
health care and social care
organizations are in place Providers and operator(s)
exchange more information and
communicate better
Operators Providers
and users have more information to
take better decisions and achieve better and more
sustainable outcomes
22copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Maturity models for Integrated Care (Health and social)
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
23
Integrated Care
Linked
Articulated
Coordinated
Isolated
Linked
Articulated
Coordinated
Isolated
Health Care Sector Social Services Sector
What possible model for Integrated Care in Singapore
23
1 2
3
Integrated Care Commission Responsible for articulating the public
policy agenda define contents articulate coordination
Human resources strategy primary level integrated care centers
(physical or virtual) with healthcare and socialcare working together
Development of contentknowledge research and innovation
knowledge management integrated care pathways evidence based
models etccopy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
24
QampA
24copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
25copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
Dr Heacutector Upegui MD MSS PM OSHM
Mobile+49 172 407 01 31
E-Mail hectorupeguideibmcom
Hollerithstrasse 1
Munich 81829
Germany
26
httpswww-01ibmcomsoftwarecity-operationscuram-research-institute
Dr Hector Upegui MD MSS PM OSHM12
Graphic from Thailand Business news -2014
Singapore
ranks 3rd in
Southeast
Asian
countries
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
In Singapore an estimated one in nine adults between
the ages of 18 and 69 has diabetes according to the
National Health Survey 2010
Examples (associated to exogenous
factors) -cont
Dr Hector Upegui MD MSS PM OSHM
13
httpwwwworkforcecomsection00article254691html
CONCLUSION Obesity in adolescence
may be associated with later depression in
young adulthood abdominal obesity
among male subjects may be closely
related to concomitant depression and
being overweightobese both in
adolescence and adulthood may be a risk
for depression among female subjects
13copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Examples (associated to exogenous
factors) -cont
Dr Hector Upegui MD MSS PM OSHM
Institution
Hospital
Other services
Diagnostics
Health
providers
Plans
Callcoordination center
NGOrsquos
Nutrition
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Why Integrated Care
Health care
sector
Dr Hector Upegui MD MSS PM OSHM
Buying
Provider
Counsellors
Work
Family
Social care
Aids
NGOrsquos
Case manager
Social
policies
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Social care
sector
Dr Hector Upegui MD MSS PM OSHM
Buying
Institution
Hospital
Provider
Counsellors
Work
Other services
Diagnostics
Health
providers
Family
Social care
Aids
Plans
Callcoordination center
NGOrsquos
Case manager
Social
policies
Nutrition
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Health care
sector
Social care
sector
Integrated care
market place
Prevention
Need of care
Need of
complex care
Social inclusion
Dr Hector Upegui MD MSS PM OSHM
17
Sharing some evidence
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Care for Older people
in Torbay UK (2004)
Diabetes care in
Bolton (1997)
Chronic Care
Management in Wales
Daily average number of
occupied beds from 750 in
19989 to 502 in 200910
emergency bed day use in
the population aged 65 and
over that is the lowest in
the region
Since 20078 144 fewer
people aged over 65 in
residential and nursing
homes with a
corresponding increase in
home care services
targeted at prevention and
low-level support
(Thistlethwaite 2011)
Patients and staff have
reported high levels of
satisfaction with the
service and in 20056
Bolton reported the
lowest number of
hospital bed days per
person with diabetes in
the Greater Manchester
area (Irani 2007)
reduction in the total number
of bed days for emergency
admissions for chronic illness
by 27 per cent 26 per cent
and 165 per cent respectively
between 2007 and 2009 This
represented an overall cost
reduction of pound2224201 (NHS
Wales 2010)
In Goodwin et Al Report to the Department of
Health and NHS Future Forum from The Kingrsquos
Fund and Nuffield Trust
Dr Hector Upegui MD MSS PM OSHM
18
bull Camden NJ research on
patients and emergency room
data reveals hotspots
bull Direct intervention with
individuals addressing their
medical and social needs
yielded significant results
‒Before one individual ndash 2
chronic conditions ndash 35 hospital
visits in 6 months
‒After holistic treatment same
individual - 2 hospital visits in 6
months
bull Outcomes 40-50 decrease in
visits and costs
18copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Catalan Healthcare system
bullUniversal system
bullGovernment is the
Payer
bullHealthcare Provider
for the region of
Catalonia
bull~7 million residents
served
bull$4 Billion annual
budget
httpswwwyoutubecomwatchv=J-9q5InjdrU
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
20
Sharing some evidence
Presented by Joan Carlos Contel 2015
Dr Hector Upegui MD MSS PM OSHM
21
A European healthcare provider collaborates across clinicians and social care teams to cut costs and improve outcomes
12 less re-admissions to emergency departments
10 less re-admissions to hospital acute care wards
8 less outpatient visits
Improvedpatient satisfaction and chronic disease treatment
Reducederrors from miscommunication or lack of coordination
results from the pilot 300 patients
several care coordinators and teams
Business Challenge Rising chronic diseases in an aging population where
25 of the individuals are over 65 years old were consuming 70 of resources
This provider aimed at improving adherence to care programs through better care
management and coordination amongst 20+ silos of data leading to enhanced
patient quality of life and satisfaction with the healthcare system and controlling
costs
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Dr Hector Upegui MD Martin Duggan bdquoIntegrated care The ongoing journey (to be published)
Isolated
Linked
The person is on its ownProviders donlsquot
communicate donlsquot share info
Neither the operator
The person might have an indication of how to use the
service but has to move the processes
Providers donlsquot share information The operator is
mainly responsible for guaranteeing a
basic network of providers
Articulated
Coordinated
The person has a better indication on how to use the
service however is still part of the process
not properly served by the model Providers and
operator share information amongst
them The operator interacts with the network but has
difficulties to coordinate services
Redundancies are still present
Integrated
The person starts to be in the center of the service
Coordination Is around health
services and social determinants for health start to be
considered Providers and
operator exchange more informationa and communicate
better amongst them
Operators Providers and users have
more information to take better decisions
and achieve better outcomes
The person is in the center of the service Coordination Is
about health and social care services
Social determinants are addressed Synergies amongst
health care and social care
organizations are in place Providers and operator(s)
exchange more information and
communicate better
Operators Providers
and users have more information to
take better decisions and achieve better and more
sustainable outcomes
22copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Maturity models for Integrated Care (Health and social)
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
23
Integrated Care
Linked
Articulated
Coordinated
Isolated
Linked
Articulated
Coordinated
Isolated
Health Care Sector Social Services Sector
What possible model for Integrated Care in Singapore
23
1 2
3
Integrated Care Commission Responsible for articulating the public
policy agenda define contents articulate coordination
Human resources strategy primary level integrated care centers
(physical or virtual) with healthcare and socialcare working together
Development of contentknowledge research and innovation
knowledge management integrated care pathways evidence based
models etccopy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
24
QampA
24copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
25copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
Dr Heacutector Upegui MD MSS PM OSHM
Mobile+49 172 407 01 31
E-Mail hectorupeguideibmcom
Hollerithstrasse 1
Munich 81829
Germany
26
httpswww-01ibmcomsoftwarecity-operationscuram-research-institute
Dr Hector Upegui MD MSS PM OSHM
13
httpwwwworkforcecomsection00article254691html
CONCLUSION Obesity in adolescence
may be associated with later depression in
young adulthood abdominal obesity
among male subjects may be closely
related to concomitant depression and
being overweightobese both in
adolescence and adulthood may be a risk
for depression among female subjects
13copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Examples (associated to exogenous
factors) -cont
Dr Hector Upegui MD MSS PM OSHM
Institution
Hospital
Other services
Diagnostics
Health
providers
Plans
Callcoordination center
NGOrsquos
Nutrition
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Why Integrated Care
Health care
sector
Dr Hector Upegui MD MSS PM OSHM
Buying
Provider
Counsellors
Work
Family
Social care
Aids
NGOrsquos
Case manager
Social
policies
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Social care
sector
Dr Hector Upegui MD MSS PM OSHM
Buying
Institution
Hospital
Provider
Counsellors
Work
Other services
Diagnostics
Health
providers
Family
Social care
Aids
Plans
Callcoordination center
NGOrsquos
Case manager
Social
policies
Nutrition
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Health care
sector
Social care
sector
Integrated care
market place
Prevention
Need of care
Need of
complex care
Social inclusion
Dr Hector Upegui MD MSS PM OSHM
17
Sharing some evidence
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Care for Older people
in Torbay UK (2004)
Diabetes care in
Bolton (1997)
Chronic Care
Management in Wales
Daily average number of
occupied beds from 750 in
19989 to 502 in 200910
emergency bed day use in
the population aged 65 and
over that is the lowest in
the region
Since 20078 144 fewer
people aged over 65 in
residential and nursing
homes with a
corresponding increase in
home care services
targeted at prevention and
low-level support
(Thistlethwaite 2011)
Patients and staff have
reported high levels of
satisfaction with the
service and in 20056
Bolton reported the
lowest number of
hospital bed days per
person with diabetes in
the Greater Manchester
area (Irani 2007)
reduction in the total number
of bed days for emergency
admissions for chronic illness
by 27 per cent 26 per cent
and 165 per cent respectively
between 2007 and 2009 This
represented an overall cost
reduction of pound2224201 (NHS
Wales 2010)
In Goodwin et Al Report to the Department of
Health and NHS Future Forum from The Kingrsquos
Fund and Nuffield Trust
Dr Hector Upegui MD MSS PM OSHM
18
bull Camden NJ research on
patients and emergency room
data reveals hotspots
bull Direct intervention with
individuals addressing their
medical and social needs
yielded significant results
‒Before one individual ndash 2
chronic conditions ndash 35 hospital
visits in 6 months
‒After holistic treatment same
individual - 2 hospital visits in 6
months
bull Outcomes 40-50 decrease in
visits and costs
18copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Catalan Healthcare system
bullUniversal system
bullGovernment is the
Payer
bullHealthcare Provider
for the region of
Catalonia
bull~7 million residents
served
bull$4 Billion annual
budget
httpswwwyoutubecomwatchv=J-9q5InjdrU
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
20
Sharing some evidence
Presented by Joan Carlos Contel 2015
Dr Hector Upegui MD MSS PM OSHM
21
A European healthcare provider collaborates across clinicians and social care teams to cut costs and improve outcomes
12 less re-admissions to emergency departments
10 less re-admissions to hospital acute care wards
8 less outpatient visits
Improvedpatient satisfaction and chronic disease treatment
Reducederrors from miscommunication or lack of coordination
results from the pilot 300 patients
several care coordinators and teams
Business Challenge Rising chronic diseases in an aging population where
25 of the individuals are over 65 years old were consuming 70 of resources
This provider aimed at improving adherence to care programs through better care
management and coordination amongst 20+ silos of data leading to enhanced
patient quality of life and satisfaction with the healthcare system and controlling
costs
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Dr Hector Upegui MD Martin Duggan bdquoIntegrated care The ongoing journey (to be published)
Isolated
Linked
The person is on its ownProviders donlsquot
communicate donlsquot share info
Neither the operator
The person might have an indication of how to use the
service but has to move the processes
Providers donlsquot share information The operator is
mainly responsible for guaranteeing a
basic network of providers
Articulated
Coordinated
The person has a better indication on how to use the
service however is still part of the process
not properly served by the model Providers and
operator share information amongst
them The operator interacts with the network but has
difficulties to coordinate services
Redundancies are still present
Integrated
The person starts to be in the center of the service
Coordination Is around health
services and social determinants for health start to be
considered Providers and
operator exchange more informationa and communicate
better amongst them
Operators Providers and users have
more information to take better decisions
and achieve better outcomes
The person is in the center of the service Coordination Is
about health and social care services
Social determinants are addressed Synergies amongst
health care and social care
organizations are in place Providers and operator(s)
exchange more information and
communicate better
Operators Providers
and users have more information to
take better decisions and achieve better and more
sustainable outcomes
22copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Maturity models for Integrated Care (Health and social)
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
23
Integrated Care
Linked
Articulated
Coordinated
Isolated
Linked
Articulated
Coordinated
Isolated
Health Care Sector Social Services Sector
What possible model for Integrated Care in Singapore
23
1 2
3
Integrated Care Commission Responsible for articulating the public
policy agenda define contents articulate coordination
Human resources strategy primary level integrated care centers
(physical or virtual) with healthcare and socialcare working together
Development of contentknowledge research and innovation
knowledge management integrated care pathways evidence based
models etccopy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
24
QampA
24copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
25copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
Dr Heacutector Upegui MD MSS PM OSHM
Mobile+49 172 407 01 31
E-Mail hectorupeguideibmcom
Hollerithstrasse 1
Munich 81829
Germany
26
httpswww-01ibmcomsoftwarecity-operationscuram-research-institute
Dr Hector Upegui MD MSS PM OSHM
Institution
Hospital
Other services
Diagnostics
Health
providers
Plans
Callcoordination center
NGOrsquos
Nutrition
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Why Integrated Care
Health care
sector
Dr Hector Upegui MD MSS PM OSHM
Buying
Provider
Counsellors
Work
Family
Social care
Aids
NGOrsquos
Case manager
Social
policies
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Social care
sector
Dr Hector Upegui MD MSS PM OSHM
Buying
Institution
Hospital
Provider
Counsellors
Work
Other services
Diagnostics
Health
providers
Family
Social care
Aids
Plans
Callcoordination center
NGOrsquos
Case manager
Social
policies
Nutrition
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Health care
sector
Social care
sector
Integrated care
market place
Prevention
Need of care
Need of
complex care
Social inclusion
Dr Hector Upegui MD MSS PM OSHM
17
Sharing some evidence
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Care for Older people
in Torbay UK (2004)
Diabetes care in
Bolton (1997)
Chronic Care
Management in Wales
Daily average number of
occupied beds from 750 in
19989 to 502 in 200910
emergency bed day use in
the population aged 65 and
over that is the lowest in
the region
Since 20078 144 fewer
people aged over 65 in
residential and nursing
homes with a
corresponding increase in
home care services
targeted at prevention and
low-level support
(Thistlethwaite 2011)
Patients and staff have
reported high levels of
satisfaction with the
service and in 20056
Bolton reported the
lowest number of
hospital bed days per
person with diabetes in
the Greater Manchester
area (Irani 2007)
reduction in the total number
of bed days for emergency
admissions for chronic illness
by 27 per cent 26 per cent
and 165 per cent respectively
between 2007 and 2009 This
represented an overall cost
reduction of pound2224201 (NHS
Wales 2010)
In Goodwin et Al Report to the Department of
Health and NHS Future Forum from The Kingrsquos
Fund and Nuffield Trust
Dr Hector Upegui MD MSS PM OSHM
18
bull Camden NJ research on
patients and emergency room
data reveals hotspots
bull Direct intervention with
individuals addressing their
medical and social needs
yielded significant results
‒Before one individual ndash 2
chronic conditions ndash 35 hospital
visits in 6 months
‒After holistic treatment same
individual - 2 hospital visits in 6
months
bull Outcomes 40-50 decrease in
visits and costs
18copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Catalan Healthcare system
bullUniversal system
bullGovernment is the
Payer
bullHealthcare Provider
for the region of
Catalonia
bull~7 million residents
served
bull$4 Billion annual
budget
httpswwwyoutubecomwatchv=J-9q5InjdrU
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
20
Sharing some evidence
Presented by Joan Carlos Contel 2015
Dr Hector Upegui MD MSS PM OSHM
21
A European healthcare provider collaborates across clinicians and social care teams to cut costs and improve outcomes
12 less re-admissions to emergency departments
10 less re-admissions to hospital acute care wards
8 less outpatient visits
Improvedpatient satisfaction and chronic disease treatment
Reducederrors from miscommunication or lack of coordination
results from the pilot 300 patients
several care coordinators and teams
Business Challenge Rising chronic diseases in an aging population where
25 of the individuals are over 65 years old were consuming 70 of resources
This provider aimed at improving adherence to care programs through better care
management and coordination amongst 20+ silos of data leading to enhanced
patient quality of life and satisfaction with the healthcare system and controlling
costs
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Dr Hector Upegui MD Martin Duggan bdquoIntegrated care The ongoing journey (to be published)
Isolated
Linked
The person is on its ownProviders donlsquot
communicate donlsquot share info
Neither the operator
The person might have an indication of how to use the
service but has to move the processes
Providers donlsquot share information The operator is
mainly responsible for guaranteeing a
basic network of providers
Articulated
Coordinated
The person has a better indication on how to use the
service however is still part of the process
not properly served by the model Providers and
operator share information amongst
them The operator interacts with the network but has
difficulties to coordinate services
Redundancies are still present
Integrated
The person starts to be in the center of the service
Coordination Is around health
services and social determinants for health start to be
considered Providers and
operator exchange more informationa and communicate
better amongst them
Operators Providers and users have
more information to take better decisions
and achieve better outcomes
The person is in the center of the service Coordination Is
about health and social care services
Social determinants are addressed Synergies amongst
health care and social care
organizations are in place Providers and operator(s)
exchange more information and
communicate better
Operators Providers
and users have more information to
take better decisions and achieve better and more
sustainable outcomes
22copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Maturity models for Integrated Care (Health and social)
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
23
Integrated Care
Linked
Articulated
Coordinated
Isolated
Linked
Articulated
Coordinated
Isolated
Health Care Sector Social Services Sector
What possible model for Integrated Care in Singapore
23
1 2
3
Integrated Care Commission Responsible for articulating the public
policy agenda define contents articulate coordination
Human resources strategy primary level integrated care centers
(physical or virtual) with healthcare and socialcare working together
Development of contentknowledge research and innovation
knowledge management integrated care pathways evidence based
models etccopy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
24
QampA
24copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
25copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
Dr Heacutector Upegui MD MSS PM OSHM
Mobile+49 172 407 01 31
E-Mail hectorupeguideibmcom
Hollerithstrasse 1
Munich 81829
Germany
26
httpswww-01ibmcomsoftwarecity-operationscuram-research-institute
Dr Hector Upegui MD MSS PM OSHM
Buying
Provider
Counsellors
Work
Family
Social care
Aids
NGOrsquos
Case manager
Social
policies
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Social care
sector
Dr Hector Upegui MD MSS PM OSHM
Buying
Institution
Hospital
Provider
Counsellors
Work
Other services
Diagnostics
Health
providers
Family
Social care
Aids
Plans
Callcoordination center
NGOrsquos
Case manager
Social
policies
Nutrition
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Health care
sector
Social care
sector
Integrated care
market place
Prevention
Need of care
Need of
complex care
Social inclusion
Dr Hector Upegui MD MSS PM OSHM
17
Sharing some evidence
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Care for Older people
in Torbay UK (2004)
Diabetes care in
Bolton (1997)
Chronic Care
Management in Wales
Daily average number of
occupied beds from 750 in
19989 to 502 in 200910
emergency bed day use in
the population aged 65 and
over that is the lowest in
the region
Since 20078 144 fewer
people aged over 65 in
residential and nursing
homes with a
corresponding increase in
home care services
targeted at prevention and
low-level support
(Thistlethwaite 2011)
Patients and staff have
reported high levels of
satisfaction with the
service and in 20056
Bolton reported the
lowest number of
hospital bed days per
person with diabetes in
the Greater Manchester
area (Irani 2007)
reduction in the total number
of bed days for emergency
admissions for chronic illness
by 27 per cent 26 per cent
and 165 per cent respectively
between 2007 and 2009 This
represented an overall cost
reduction of pound2224201 (NHS
Wales 2010)
In Goodwin et Al Report to the Department of
Health and NHS Future Forum from The Kingrsquos
Fund and Nuffield Trust
Dr Hector Upegui MD MSS PM OSHM
18
bull Camden NJ research on
patients and emergency room
data reveals hotspots
bull Direct intervention with
individuals addressing their
medical and social needs
yielded significant results
‒Before one individual ndash 2
chronic conditions ndash 35 hospital
visits in 6 months
‒After holistic treatment same
individual - 2 hospital visits in 6
months
bull Outcomes 40-50 decrease in
visits and costs
18copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Catalan Healthcare system
bullUniversal system
bullGovernment is the
Payer
bullHealthcare Provider
for the region of
Catalonia
bull~7 million residents
served
bull$4 Billion annual
budget
httpswwwyoutubecomwatchv=J-9q5InjdrU
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
20
Sharing some evidence
Presented by Joan Carlos Contel 2015
Dr Hector Upegui MD MSS PM OSHM
21
A European healthcare provider collaborates across clinicians and social care teams to cut costs and improve outcomes
12 less re-admissions to emergency departments
10 less re-admissions to hospital acute care wards
8 less outpatient visits
Improvedpatient satisfaction and chronic disease treatment
Reducederrors from miscommunication or lack of coordination
results from the pilot 300 patients
several care coordinators and teams
Business Challenge Rising chronic diseases in an aging population where
25 of the individuals are over 65 years old were consuming 70 of resources
This provider aimed at improving adherence to care programs through better care
management and coordination amongst 20+ silos of data leading to enhanced
patient quality of life and satisfaction with the healthcare system and controlling
costs
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Dr Hector Upegui MD Martin Duggan bdquoIntegrated care The ongoing journey (to be published)
Isolated
Linked
The person is on its ownProviders donlsquot
communicate donlsquot share info
Neither the operator
The person might have an indication of how to use the
service but has to move the processes
Providers donlsquot share information The operator is
mainly responsible for guaranteeing a
basic network of providers
Articulated
Coordinated
The person has a better indication on how to use the
service however is still part of the process
not properly served by the model Providers and
operator share information amongst
them The operator interacts with the network but has
difficulties to coordinate services
Redundancies are still present
Integrated
The person starts to be in the center of the service
Coordination Is around health
services and social determinants for health start to be
considered Providers and
operator exchange more informationa and communicate
better amongst them
Operators Providers and users have
more information to take better decisions
and achieve better outcomes
The person is in the center of the service Coordination Is
about health and social care services
Social determinants are addressed Synergies amongst
health care and social care
organizations are in place Providers and operator(s)
exchange more information and
communicate better
Operators Providers
and users have more information to
take better decisions and achieve better and more
sustainable outcomes
22copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Maturity models for Integrated Care (Health and social)
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
23
Integrated Care
Linked
Articulated
Coordinated
Isolated
Linked
Articulated
Coordinated
Isolated
Health Care Sector Social Services Sector
What possible model for Integrated Care in Singapore
23
1 2
3
Integrated Care Commission Responsible for articulating the public
policy agenda define contents articulate coordination
Human resources strategy primary level integrated care centers
(physical or virtual) with healthcare and socialcare working together
Development of contentknowledge research and innovation
knowledge management integrated care pathways evidence based
models etccopy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
24
QampA
24copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
25copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
Dr Heacutector Upegui MD MSS PM OSHM
Mobile+49 172 407 01 31
E-Mail hectorupeguideibmcom
Hollerithstrasse 1
Munich 81829
Germany
26
httpswww-01ibmcomsoftwarecity-operationscuram-research-institute
Dr Hector Upegui MD MSS PM OSHM
Buying
Institution
Hospital
Provider
Counsellors
Work
Other services
Diagnostics
Health
providers
Family
Social care
Aids
Plans
Callcoordination center
NGOrsquos
Case manager
Social
policies
Nutrition
Person
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Communitiy
Care
providers
Why Integrated Care
Health care
sector
Social care
sector
Integrated care
market place
Prevention
Need of care
Need of
complex care
Social inclusion
Dr Hector Upegui MD MSS PM OSHM
17
Sharing some evidence
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Care for Older people
in Torbay UK (2004)
Diabetes care in
Bolton (1997)
Chronic Care
Management in Wales
Daily average number of
occupied beds from 750 in
19989 to 502 in 200910
emergency bed day use in
the population aged 65 and
over that is the lowest in
the region
Since 20078 144 fewer
people aged over 65 in
residential and nursing
homes with a
corresponding increase in
home care services
targeted at prevention and
low-level support
(Thistlethwaite 2011)
Patients and staff have
reported high levels of
satisfaction with the
service and in 20056
Bolton reported the
lowest number of
hospital bed days per
person with diabetes in
the Greater Manchester
area (Irani 2007)
reduction in the total number
of bed days for emergency
admissions for chronic illness
by 27 per cent 26 per cent
and 165 per cent respectively
between 2007 and 2009 This
represented an overall cost
reduction of pound2224201 (NHS
Wales 2010)
In Goodwin et Al Report to the Department of
Health and NHS Future Forum from The Kingrsquos
Fund and Nuffield Trust
Dr Hector Upegui MD MSS PM OSHM
18
bull Camden NJ research on
patients and emergency room
data reveals hotspots
bull Direct intervention with
individuals addressing their
medical and social needs
yielded significant results
‒Before one individual ndash 2
chronic conditions ndash 35 hospital
visits in 6 months
‒After holistic treatment same
individual - 2 hospital visits in 6
months
bull Outcomes 40-50 decrease in
visits and costs
18copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Catalan Healthcare system
bullUniversal system
bullGovernment is the
Payer
bullHealthcare Provider
for the region of
Catalonia
bull~7 million residents
served
bull$4 Billion annual
budget
httpswwwyoutubecomwatchv=J-9q5InjdrU
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
20
Sharing some evidence
Presented by Joan Carlos Contel 2015
Dr Hector Upegui MD MSS PM OSHM
21
A European healthcare provider collaborates across clinicians and social care teams to cut costs and improve outcomes
12 less re-admissions to emergency departments
10 less re-admissions to hospital acute care wards
8 less outpatient visits
Improvedpatient satisfaction and chronic disease treatment
Reducederrors from miscommunication or lack of coordination
results from the pilot 300 patients
several care coordinators and teams
Business Challenge Rising chronic diseases in an aging population where
25 of the individuals are over 65 years old were consuming 70 of resources
This provider aimed at improving adherence to care programs through better care
management and coordination amongst 20+ silos of data leading to enhanced
patient quality of life and satisfaction with the healthcare system and controlling
costs
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Dr Hector Upegui MD Martin Duggan bdquoIntegrated care The ongoing journey (to be published)
Isolated
Linked
The person is on its ownProviders donlsquot
communicate donlsquot share info
Neither the operator
The person might have an indication of how to use the
service but has to move the processes
Providers donlsquot share information The operator is
mainly responsible for guaranteeing a
basic network of providers
Articulated
Coordinated
The person has a better indication on how to use the
service however is still part of the process
not properly served by the model Providers and
operator share information amongst
them The operator interacts with the network but has
difficulties to coordinate services
Redundancies are still present
Integrated
The person starts to be in the center of the service
Coordination Is around health
services and social determinants for health start to be
considered Providers and
operator exchange more informationa and communicate
better amongst them
Operators Providers and users have
more information to take better decisions
and achieve better outcomes
The person is in the center of the service Coordination Is
about health and social care services
Social determinants are addressed Synergies amongst
health care and social care
organizations are in place Providers and operator(s)
exchange more information and
communicate better
Operators Providers
and users have more information to
take better decisions and achieve better and more
sustainable outcomes
22copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Maturity models for Integrated Care (Health and social)
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
23
Integrated Care
Linked
Articulated
Coordinated
Isolated
Linked
Articulated
Coordinated
Isolated
Health Care Sector Social Services Sector
What possible model for Integrated Care in Singapore
23
1 2
3
Integrated Care Commission Responsible for articulating the public
policy agenda define contents articulate coordination
Human resources strategy primary level integrated care centers
(physical or virtual) with healthcare and socialcare working together
Development of contentknowledge research and innovation
knowledge management integrated care pathways evidence based
models etccopy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
24
QampA
24copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
25copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
Dr Heacutector Upegui MD MSS PM OSHM
Mobile+49 172 407 01 31
E-Mail hectorupeguideibmcom
Hollerithstrasse 1
Munich 81829
Germany
26
httpswww-01ibmcomsoftwarecity-operationscuram-research-institute
Dr Hector Upegui MD MSS PM OSHM
17
Sharing some evidence
copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Care for Older people
in Torbay UK (2004)
Diabetes care in
Bolton (1997)
Chronic Care
Management in Wales
Daily average number of
occupied beds from 750 in
19989 to 502 in 200910
emergency bed day use in
the population aged 65 and
over that is the lowest in
the region
Since 20078 144 fewer
people aged over 65 in
residential and nursing
homes with a
corresponding increase in
home care services
targeted at prevention and
low-level support
(Thistlethwaite 2011)
Patients and staff have
reported high levels of
satisfaction with the
service and in 20056
Bolton reported the
lowest number of
hospital bed days per
person with diabetes in
the Greater Manchester
area (Irani 2007)
reduction in the total number
of bed days for emergency
admissions for chronic illness
by 27 per cent 26 per cent
and 165 per cent respectively
between 2007 and 2009 This
represented an overall cost
reduction of pound2224201 (NHS
Wales 2010)
In Goodwin et Al Report to the Department of
Health and NHS Future Forum from The Kingrsquos
Fund and Nuffield Trust
Dr Hector Upegui MD MSS PM OSHM
18
bull Camden NJ research on
patients and emergency room
data reveals hotspots
bull Direct intervention with
individuals addressing their
medical and social needs
yielded significant results
‒Before one individual ndash 2
chronic conditions ndash 35 hospital
visits in 6 months
‒After holistic treatment same
individual - 2 hospital visits in 6
months
bull Outcomes 40-50 decrease in
visits and costs
18copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Catalan Healthcare system
bullUniversal system
bullGovernment is the
Payer
bullHealthcare Provider
for the region of
Catalonia
bull~7 million residents
served
bull$4 Billion annual
budget
httpswwwyoutubecomwatchv=J-9q5InjdrU
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
20
Sharing some evidence
Presented by Joan Carlos Contel 2015
Dr Hector Upegui MD MSS PM OSHM
21
A European healthcare provider collaborates across clinicians and social care teams to cut costs and improve outcomes
12 less re-admissions to emergency departments
10 less re-admissions to hospital acute care wards
8 less outpatient visits
Improvedpatient satisfaction and chronic disease treatment
Reducederrors from miscommunication or lack of coordination
results from the pilot 300 patients
several care coordinators and teams
Business Challenge Rising chronic diseases in an aging population where
25 of the individuals are over 65 years old were consuming 70 of resources
This provider aimed at improving adherence to care programs through better care
management and coordination amongst 20+ silos of data leading to enhanced
patient quality of life and satisfaction with the healthcare system and controlling
costs
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Dr Hector Upegui MD Martin Duggan bdquoIntegrated care The ongoing journey (to be published)
Isolated
Linked
The person is on its ownProviders donlsquot
communicate donlsquot share info
Neither the operator
The person might have an indication of how to use the
service but has to move the processes
Providers donlsquot share information The operator is
mainly responsible for guaranteeing a
basic network of providers
Articulated
Coordinated
The person has a better indication on how to use the
service however is still part of the process
not properly served by the model Providers and
operator share information amongst
them The operator interacts with the network but has
difficulties to coordinate services
Redundancies are still present
Integrated
The person starts to be in the center of the service
Coordination Is around health
services and social determinants for health start to be
considered Providers and
operator exchange more informationa and communicate
better amongst them
Operators Providers and users have
more information to take better decisions
and achieve better outcomes
The person is in the center of the service Coordination Is
about health and social care services
Social determinants are addressed Synergies amongst
health care and social care
organizations are in place Providers and operator(s)
exchange more information and
communicate better
Operators Providers
and users have more information to
take better decisions and achieve better and more
sustainable outcomes
22copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Maturity models for Integrated Care (Health and social)
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
23
Integrated Care
Linked
Articulated
Coordinated
Isolated
Linked
Articulated
Coordinated
Isolated
Health Care Sector Social Services Sector
What possible model for Integrated Care in Singapore
23
1 2
3
Integrated Care Commission Responsible for articulating the public
policy agenda define contents articulate coordination
Human resources strategy primary level integrated care centers
(physical or virtual) with healthcare and socialcare working together
Development of contentknowledge research and innovation
knowledge management integrated care pathways evidence based
models etccopy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
24
QampA
24copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
25copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
Dr Heacutector Upegui MD MSS PM OSHM
Mobile+49 172 407 01 31
E-Mail hectorupeguideibmcom
Hollerithstrasse 1
Munich 81829
Germany
26
httpswww-01ibmcomsoftwarecity-operationscuram-research-institute
Dr Hector Upegui MD MSS PM OSHM
18
bull Camden NJ research on
patients and emergency room
data reveals hotspots
bull Direct intervention with
individuals addressing their
medical and social needs
yielded significant results
‒Before one individual ndash 2
chronic conditions ndash 35 hospital
visits in 6 months
‒After holistic treatment same
individual - 2 hospital visits in 6
months
bull Outcomes 40-50 decrease in
visits and costs
18copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Catalan Healthcare system
bullUniversal system
bullGovernment is the
Payer
bullHealthcare Provider
for the region of
Catalonia
bull~7 million residents
served
bull$4 Billion annual
budget
httpswwwyoutubecomwatchv=J-9q5InjdrU
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
20
Sharing some evidence
Presented by Joan Carlos Contel 2015
Dr Hector Upegui MD MSS PM OSHM
21
A European healthcare provider collaborates across clinicians and social care teams to cut costs and improve outcomes
12 less re-admissions to emergency departments
10 less re-admissions to hospital acute care wards
8 less outpatient visits
Improvedpatient satisfaction and chronic disease treatment
Reducederrors from miscommunication or lack of coordination
results from the pilot 300 patients
several care coordinators and teams
Business Challenge Rising chronic diseases in an aging population where
25 of the individuals are over 65 years old were consuming 70 of resources
This provider aimed at improving adherence to care programs through better care
management and coordination amongst 20+ silos of data leading to enhanced
patient quality of life and satisfaction with the healthcare system and controlling
costs
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Dr Hector Upegui MD Martin Duggan bdquoIntegrated care The ongoing journey (to be published)
Isolated
Linked
The person is on its ownProviders donlsquot
communicate donlsquot share info
Neither the operator
The person might have an indication of how to use the
service but has to move the processes
Providers donlsquot share information The operator is
mainly responsible for guaranteeing a
basic network of providers
Articulated
Coordinated
The person has a better indication on how to use the
service however is still part of the process
not properly served by the model Providers and
operator share information amongst
them The operator interacts with the network but has
difficulties to coordinate services
Redundancies are still present
Integrated
The person starts to be in the center of the service
Coordination Is around health
services and social determinants for health start to be
considered Providers and
operator exchange more informationa and communicate
better amongst them
Operators Providers and users have
more information to take better decisions
and achieve better outcomes
The person is in the center of the service Coordination Is
about health and social care services
Social determinants are addressed Synergies amongst
health care and social care
organizations are in place Providers and operator(s)
exchange more information and
communicate better
Operators Providers
and users have more information to
take better decisions and achieve better and more
sustainable outcomes
22copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Maturity models for Integrated Care (Health and social)
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
23
Integrated Care
Linked
Articulated
Coordinated
Isolated
Linked
Articulated
Coordinated
Isolated
Health Care Sector Social Services Sector
What possible model for Integrated Care in Singapore
23
1 2
3
Integrated Care Commission Responsible for articulating the public
policy agenda define contents articulate coordination
Human resources strategy primary level integrated care centers
(physical or virtual) with healthcare and socialcare working together
Development of contentknowledge research and innovation
knowledge management integrated care pathways evidence based
models etccopy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
24
QampA
24copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
25copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
Dr Heacutector Upegui MD MSS PM OSHM
Mobile+49 172 407 01 31
E-Mail hectorupeguideibmcom
Hollerithstrasse 1
Munich 81829
Germany
26
httpswww-01ibmcomsoftwarecity-operationscuram-research-institute
Dr Hector Upegui MD MSS PM OSHM
Catalan Healthcare system
bullUniversal system
bullGovernment is the
Payer
bullHealthcare Provider
for the region of
Catalonia
bull~7 million residents
served
bull$4 Billion annual
budget
httpswwwyoutubecomwatchv=J-9q5InjdrU
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
20
Sharing some evidence
Presented by Joan Carlos Contel 2015
Dr Hector Upegui MD MSS PM OSHM
21
A European healthcare provider collaborates across clinicians and social care teams to cut costs and improve outcomes
12 less re-admissions to emergency departments
10 less re-admissions to hospital acute care wards
8 less outpatient visits
Improvedpatient satisfaction and chronic disease treatment
Reducederrors from miscommunication or lack of coordination
results from the pilot 300 patients
several care coordinators and teams
Business Challenge Rising chronic diseases in an aging population where
25 of the individuals are over 65 years old were consuming 70 of resources
This provider aimed at improving adherence to care programs through better care
management and coordination amongst 20+ silos of data leading to enhanced
patient quality of life and satisfaction with the healthcare system and controlling
costs
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Dr Hector Upegui MD Martin Duggan bdquoIntegrated care The ongoing journey (to be published)
Isolated
Linked
The person is on its ownProviders donlsquot
communicate donlsquot share info
Neither the operator
The person might have an indication of how to use the
service but has to move the processes
Providers donlsquot share information The operator is
mainly responsible for guaranteeing a
basic network of providers
Articulated
Coordinated
The person has a better indication on how to use the
service however is still part of the process
not properly served by the model Providers and
operator share information amongst
them The operator interacts with the network but has
difficulties to coordinate services
Redundancies are still present
Integrated
The person starts to be in the center of the service
Coordination Is around health
services and social determinants for health start to be
considered Providers and
operator exchange more informationa and communicate
better amongst them
Operators Providers and users have
more information to take better decisions
and achieve better outcomes
The person is in the center of the service Coordination Is
about health and social care services
Social determinants are addressed Synergies amongst
health care and social care
organizations are in place Providers and operator(s)
exchange more information and
communicate better
Operators Providers
and users have more information to
take better decisions and achieve better and more
sustainable outcomes
22copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Maturity models for Integrated Care (Health and social)
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
23
Integrated Care
Linked
Articulated
Coordinated
Isolated
Linked
Articulated
Coordinated
Isolated
Health Care Sector Social Services Sector
What possible model for Integrated Care in Singapore
23
1 2
3
Integrated Care Commission Responsible for articulating the public
policy agenda define contents articulate coordination
Human resources strategy primary level integrated care centers
(physical or virtual) with healthcare and socialcare working together
Development of contentknowledge research and innovation
knowledge management integrated care pathways evidence based
models etccopy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
24
QampA
24copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
25copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
Dr Heacutector Upegui MD MSS PM OSHM
Mobile+49 172 407 01 31
E-Mail hectorupeguideibmcom
Hollerithstrasse 1
Munich 81829
Germany
26
httpswww-01ibmcomsoftwarecity-operationscuram-research-institute
Dr Hector Upegui MD MSS PM OSHM
20
Sharing some evidence
Presented by Joan Carlos Contel 2015
Dr Hector Upegui MD MSS PM OSHM
21
A European healthcare provider collaborates across clinicians and social care teams to cut costs and improve outcomes
12 less re-admissions to emergency departments
10 less re-admissions to hospital acute care wards
8 less outpatient visits
Improvedpatient satisfaction and chronic disease treatment
Reducederrors from miscommunication or lack of coordination
results from the pilot 300 patients
several care coordinators and teams
Business Challenge Rising chronic diseases in an aging population where
25 of the individuals are over 65 years old were consuming 70 of resources
This provider aimed at improving adherence to care programs through better care
management and coordination amongst 20+ silos of data leading to enhanced
patient quality of life and satisfaction with the healthcare system and controlling
costs
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Dr Hector Upegui MD Martin Duggan bdquoIntegrated care The ongoing journey (to be published)
Isolated
Linked
The person is on its ownProviders donlsquot
communicate donlsquot share info
Neither the operator
The person might have an indication of how to use the
service but has to move the processes
Providers donlsquot share information The operator is
mainly responsible for guaranteeing a
basic network of providers
Articulated
Coordinated
The person has a better indication on how to use the
service however is still part of the process
not properly served by the model Providers and
operator share information amongst
them The operator interacts with the network but has
difficulties to coordinate services
Redundancies are still present
Integrated
The person starts to be in the center of the service
Coordination Is around health
services and social determinants for health start to be
considered Providers and
operator exchange more informationa and communicate
better amongst them
Operators Providers and users have
more information to take better decisions
and achieve better outcomes
The person is in the center of the service Coordination Is
about health and social care services
Social determinants are addressed Synergies amongst
health care and social care
organizations are in place Providers and operator(s)
exchange more information and
communicate better
Operators Providers
and users have more information to
take better decisions and achieve better and more
sustainable outcomes
22copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Maturity models for Integrated Care (Health and social)
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
23
Integrated Care
Linked
Articulated
Coordinated
Isolated
Linked
Articulated
Coordinated
Isolated
Health Care Sector Social Services Sector
What possible model for Integrated Care in Singapore
23
1 2
3
Integrated Care Commission Responsible for articulating the public
policy agenda define contents articulate coordination
Human resources strategy primary level integrated care centers
(physical or virtual) with healthcare and socialcare working together
Development of contentknowledge research and innovation
knowledge management integrated care pathways evidence based
models etccopy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
24
QampA
24copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
25copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
Dr Heacutector Upegui MD MSS PM OSHM
Mobile+49 172 407 01 31
E-Mail hectorupeguideibmcom
Hollerithstrasse 1
Munich 81829
Germany
26
httpswww-01ibmcomsoftwarecity-operationscuram-research-institute
Dr Hector Upegui MD MSS PM OSHM
21
A European healthcare provider collaborates across clinicians and social care teams to cut costs and improve outcomes
12 less re-admissions to emergency departments
10 less re-admissions to hospital acute care wards
8 less outpatient visits
Improvedpatient satisfaction and chronic disease treatment
Reducederrors from miscommunication or lack of coordination
results from the pilot 300 patients
several care coordinators and teams
Business Challenge Rising chronic diseases in an aging population where
25 of the individuals are over 65 years old were consuming 70 of resources
This provider aimed at improving adherence to care programs through better care
management and coordination amongst 20+ silos of data leading to enhanced
patient quality of life and satisfaction with the healthcare system and controlling
costs
Sharing some evidence
Dr Hector Upegui MD MSS PM OSHM
Dr Hector Upegui MD Martin Duggan bdquoIntegrated care The ongoing journey (to be published)
Isolated
Linked
The person is on its ownProviders donlsquot
communicate donlsquot share info
Neither the operator
The person might have an indication of how to use the
service but has to move the processes
Providers donlsquot share information The operator is
mainly responsible for guaranteeing a
basic network of providers
Articulated
Coordinated
The person has a better indication on how to use the
service however is still part of the process
not properly served by the model Providers and
operator share information amongst
them The operator interacts with the network but has
difficulties to coordinate services
Redundancies are still present
Integrated
The person starts to be in the center of the service
Coordination Is around health
services and social determinants for health start to be
considered Providers and
operator exchange more informationa and communicate
better amongst them
Operators Providers and users have
more information to take better decisions
and achieve better outcomes
The person is in the center of the service Coordination Is
about health and social care services
Social determinants are addressed Synergies amongst
health care and social care
organizations are in place Providers and operator(s)
exchange more information and
communicate better
Operators Providers
and users have more information to
take better decisions and achieve better and more
sustainable outcomes
22copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Maturity models for Integrated Care (Health and social)
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
23
Integrated Care
Linked
Articulated
Coordinated
Isolated
Linked
Articulated
Coordinated
Isolated
Health Care Sector Social Services Sector
What possible model for Integrated Care in Singapore
23
1 2
3
Integrated Care Commission Responsible for articulating the public
policy agenda define contents articulate coordination
Human resources strategy primary level integrated care centers
(physical or virtual) with healthcare and socialcare working together
Development of contentknowledge research and innovation
knowledge management integrated care pathways evidence based
models etccopy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
24
QampA
24copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
25copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
Dr Heacutector Upegui MD MSS PM OSHM
Mobile+49 172 407 01 31
E-Mail hectorupeguideibmcom
Hollerithstrasse 1
Munich 81829
Germany
26
httpswww-01ibmcomsoftwarecity-operationscuram-research-institute
Dr Hector Upegui MD MSS PM OSHM
Dr Hector Upegui MD Martin Duggan bdquoIntegrated care The ongoing journey (to be published)
Isolated
Linked
The person is on its ownProviders donlsquot
communicate donlsquot share info
Neither the operator
The person might have an indication of how to use the
service but has to move the processes
Providers donlsquot share information The operator is
mainly responsible for guaranteeing a
basic network of providers
Articulated
Coordinated
The person has a better indication on how to use the
service however is still part of the process
not properly served by the model Providers and
operator share information amongst
them The operator interacts with the network but has
difficulties to coordinate services
Redundancies are still present
Integrated
The person starts to be in the center of the service
Coordination Is around health
services and social determinants for health start to be
considered Providers and
operator exchange more informationa and communicate
better amongst them
Operators Providers and users have
more information to take better decisions
and achieve better outcomes
The person is in the center of the service Coordination Is
about health and social care services
Social determinants are addressed Synergies amongst
health care and social care
organizations are in place Providers and operator(s)
exchange more information and
communicate better
Operators Providers
and users have more information to
take better decisions and achieve better and more
sustainable outcomes
22copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Maturity models for Integrated Care (Health and social)
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
23
Integrated Care
Linked
Articulated
Coordinated
Isolated
Linked
Articulated
Coordinated
Isolated
Health Care Sector Social Services Sector
What possible model for Integrated Care in Singapore
23
1 2
3
Integrated Care Commission Responsible for articulating the public
policy agenda define contents articulate coordination
Human resources strategy primary level integrated care centers
(physical or virtual) with healthcare and socialcare working together
Development of contentknowledge research and innovation
knowledge management integrated care pathways evidence based
models etccopy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
24
QampA
24copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
25copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
Dr Heacutector Upegui MD MSS PM OSHM
Mobile+49 172 407 01 31
E-Mail hectorupeguideibmcom
Hollerithstrasse 1
Munich 81829
Germany
26
httpswww-01ibmcomsoftwarecity-operationscuram-research-institute
Dr Hector Upegui MD MSS PM OSHM
23
Integrated Care
Linked
Articulated
Coordinated
Isolated
Linked
Articulated
Coordinated
Isolated
Health Care Sector Social Services Sector
What possible model for Integrated Care in Singapore
23
1 2
3
Integrated Care Commission Responsible for articulating the public
policy agenda define contents articulate coordination
Human resources strategy primary level integrated care centers
(physical or virtual) with healthcare and socialcare working together
Development of contentknowledge research and innovation
knowledge management integrated care pathways evidence based
models etccopy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Implementing Integrated Care
Dr Hector Upegui MD MSS PM OSHM
24
QampA
24copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
25copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
Dr Heacutector Upegui MD MSS PM OSHM
Mobile+49 172 407 01 31
E-Mail hectorupeguideibmcom
Hollerithstrasse 1
Munich 81829
Germany
26
httpswww-01ibmcomsoftwarecity-operationscuram-research-institute
Dr Hector Upegui MD MSS PM OSHM
24
QampA
24copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
25copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
Dr Heacutector Upegui MD MSS PM OSHM
Mobile+49 172 407 01 31
E-Mail hectorupeguideibmcom
Hollerithstrasse 1
Munich 81829
Germany
26
httpswww-01ibmcomsoftwarecity-operationscuram-research-institute
Dr Hector Upegui MD MSS PM OSHM
25copy 2016 IBM Cuacuteram Research Institute All Rights Reserved
Dr Hector Upegui MD MSS PM OSHM
Dr Heacutector Upegui MD MSS PM OSHM
Mobile+49 172 407 01 31
E-Mail hectorupeguideibmcom
Hollerithstrasse 1
Munich 81829
Germany
26
httpswww-01ibmcomsoftwarecity-operationscuram-research-institute
Dr Hector Upegui MD MSS PM OSHM
Dr Heacutector Upegui MD MSS PM OSHM
Mobile+49 172 407 01 31
E-Mail hectorupeguideibmcom
Hollerithstrasse 1
Munich 81829
Germany
26
httpswww-01ibmcomsoftwarecity-operationscuram-research-institute