Overview:

• In its first year, the project is expected to save around $9 million on integrated care for the client. 

Challenge:

The leaders of a health service organisation in a European city believed that patients could be better served at better costs, if care could be tightly integrated among primary, secondary, social, and mental health providers.

The client asked for Challenge Advisory’s help in designing and implementing an integrated care program for patients in two priority groups: diabetics and the elderly. This program had four main objectives – reducing emergency admissions for the elderly, and nursing home admissions for the diabetics; as well as improving quality and reducing overall costs.

The Revelation:

Challenge Advisory’s health team came together to understand the challenges facing the client. They devised a four-step process in order to implement an integrated care plan that would ensure better care at better costs.

The first phase, the setup phase, was devoted to defining specific pilot goals, establishing a governance model with health system leaders. An incentive structure was also put in place, designed to reward performance and align the interests of the participants involved.

Secondly, the design phase saw the health team construct a new operation model for the program. To create this, Challenge Advisory collaborated with clinicians to map new treatment pathways for the target patient groups, which required an overhaul of the financial models in place to ensure appropriate funding and incentives, and the development a business case to justify the program to various providers and practices.

The third phase was the pre-launch phase, and Challenge Advisory focused on created multidisciplinary groups (MDGs) of doctors, specialists, and social and community care workers who would be providing holistic treatment to patients. These groups were given important supporting tools to identify available services, help share digital patient records, and facilitate coordination between providers. Finally, the multidisciplinary groups were trained in improving the consistency of programs by way of new pathways, tools and processes. Performance metrics were established, which defined the risk categories for all patients.

Such risk-assessment data helps to proactively map out the level of care and frequency of intervention that patients should receive, which allows for fewer emergency admissions overall.

Outcomes:

In its first year, the project is expected to save around $9 million on integrated care for the client. On top of this, for each of the following four years set apart from the program, the cost reduction is set to improve by two percent.

The total spending on acute care over a five-year period is expected to go down by 24%. The integrated care is being prepared for extension to other groups, including patients suffering from asthma, CHD and multimorbid conditions (two or more conditions at the same time).