Alberto de Rosa, Chief Executive of Ribera Salud, shares lessons on improving integration of health care services.
This presentation was filmed at our conference on Sustainability and transformation plans: moving towards implementation on 24 May 2017.
We are leading a time of changes and challenges, changes in demography, in technology and medication, and we have to face new challenges by providing new answers. We have to change our strategy and vision because we cannot manage health as 50 years ago. For the National Health it has been a long journey full of barriers. When we began the first project in 1999 and Hospitale de la Ribera, our contract was only to manage the hospital level, everything was new and there was no previous experience. In 2003 the contract was extended to primary care which in Spain includes mental health and home care. So the challenge was to launch the first care integration project at the health department, in which we had to transform the views of all involved, politicians, managers, professionals, and also citizens. In other words, we had to change the culture. Our challenge today is that we are involving for projects, managed for hospital over 100 primary care centres, and the responsibility to manage the health of more than 800,000 citizens.
Our obligation is to apply the best practices, reduce clinical variation, move towards benchmarking between different organisations and introduce new technology tools such as the health portal for example, the segmentation of citizens and predictive models. It is the challenge of moving on to a networking model in which we can apply all the technology, know-how and benchmarking to compare every project and set off in another direction. Transformation must begin with these three pillars, and all three at the same time, clinical management, human resources and IT tools. Everything we do must be around the citizen’s needs, we are a patient-centred organisation. And when we talk about sustainability and transformation of the NHS, I think we need to refer to a very important question. What is best for the citizens? Talking about accountable care implies to talk about the triple aim: best healthcare outcomes, improved patient experience and affordable costs. To get to this point I think there is a critical factor, alignment. This is about building the new more integrated system in the simplest and conflict free manner. Of course doing so implies the personal commitment of the professional because this is about people. Therefore we are talking about cultural change and transformation.
There are a number of tools that we can use to move forward in the right direction. First healthcare integration, with processes and pathways based on population health management, all of each reported by the intensive use of modern integrated and cross functional IT solutions. Second, single budget and capitation. The best for the citizen is the best for the system and what is the best for the citizen? To keep them as healthy as possible for as long as possible. So it’s necessary to put in place a new payment frame, focus on financial healthcare not activity. Last but not least, goals and incentives. It’s critical to agree on a shared vision, shared goals, and incentives to promote the whole system integration. On top of that, networking and consolidation putting synergies and economies of scale in place. Some outcomes and some figures of our history: integrated care began in 2003, after that the number of hospital emergency room visits dropped, especially compared to them increasing in the Valencia region and in Spain. Waiting lists, the concession results are much better than the Valencian community and the National Health’s system results.
In 2016 a patient in Torrevieja waited 38 days on average to be operated while the average in the Valencian community was 115 days. Remember at the end of the day the pressure on the cost will be increased, so we need reforms. And in our experience, healthcare integration, capitated payment, productivity, networking, can be the perfect tools to achieve this transformation. Thank you very much.