futureofprimarycare.com

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Key-elements for the national agenda how to
achieve integrated primary care?

• Prof.dr. Robbert Huijsman MBA,
• Professor of Integrated Care Management

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Neo-liberalist view prevails
Regulated health care markets
Civil Society
autonomy
responsibility
Free choice Shared decisions Quality of Life
Quality of care, Peers, income
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Contents of my contribution

• Wake up the market philosophy will continue!!
• Evidence-based or ideology-driven?
• Holistic/generalistic vs disease/specialistic
• New patients ? professional skills
• The service/business model
• Performance management
• The systems approach
• Strategy, politics and leadership

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Turn around in health care

• Input resources, availability, equal excess
• Throughput efficiency and cost minimisation
• Output products and performance
• Outcome public (health) accountability

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New care concepts

• De-institutionalization home and community,
  civil society
• Integrated care programmes for disabled, chronic
  diseases,
• Technology (ICT, domotica, robots, genomics,
  pharmacy)
• For supply on demand, quality of life, shared
  decision making
• Service as core product JIT, information,
  communication
• From evidence-based medicine to evidence-based
  (primary) care, -management and -policy

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Incorporating international evidence

• Example de-institutionalisation of care for the
  elderly
• multidisciplinary teams based in the community
• with medical expertise (here geriatrics)
• integral needs assessment and single-point entry
  system
• case management and monitoring (Individuals and
  Groups)
• integrated budgets (I and G again) and
  decentralized authorities
• a solid, durable organisation (ICT) pays itself
  back!

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Ideology for integrated primary care
policy with vision
housing, communities
social services
appropriate governance
cost containment
participation and education
care cure
demand focused
Example whos responsible for playing grounds
for obese kids?!
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The evidence base for primary care

• From health problems in the population to
  hospital care
• 1000 (pop) ? 100 (PC) ? 10 (hosp.) ? 1
  (acad.hosp.)
• Effectiveness 1GP gt GP-care gt joint cons gt
  dir.referals
• Evidence gap for many prevention and care
  programmes
• But international studies show strong
  relationship between good primary care and lower
  costs!

Primary care score
98 not EB
90 GP
Cost per caput
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Professional competencies in a multicultural and
multidisciplinary world
life-long learner
publichero
negotiator
educator
information broker
Expertise knowledge
shared decision making
disease manager
team- player
empathic supporter
facilitator
communicator
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The service/business model

• market segmentation what do you want to be to
  whom?
• optimise health, well-being and social
  functioning
• reduce health risks and prevent illnesses
• maximise clinical effectiveness and efficiency
• outcome measurement and continuous improvement
• adequate management, ICT and MIS
• incentive schemes difficult, but necessary!
• product/market combinations, including price
  setting
• service, operational excellence and/or
  innovation choose!

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The integration puzzles
Systems integration
Structure
Organisational system
chained careprocesses
Process
Performance
Outcome
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Driving the integration process
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Tracks of integration and coordination
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Elements for change management

• Clear urgency, with internal external pressure
• Vision, ambition, and leadership
• Communicate, communicate, communicate
• Dedicated teams, managers professionals
• Sufficient resources and competencies
• Open up the windows (best practices)
• Get short-term wins, to foster implementation
• Adapt structures, procedures, planningcontrol
• Challenge and adapt organisational culture
• Re-adjust incentives (not only financially)
• Performance management

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Too many objectives for Performance Indicators?
Choice for patients
Payment for professionals
PIs
Quality improvement
Governance and steering
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Performance management ideal
central database
benchmarking
guideline
team
results
patient
process
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Take away the barriers
Make oil and water mix
We love innovation, how about implementation
Challenge professional autonomy
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Key-elements for national agenda

• PC-sector leadership, evidence and integrated
  lobby
• Professionals out-reaching, skills training,
  teams
• Managers performance management
• Educators team work, organisation, innovation
  and implementation, ICT
• Local government put public health first,
  foster intersectoral linkages
• Insurers innovative incentive schemes, disease
  management, contracting for chains
• Researchers collect the proper evidence
• Minister paradigm shift towards PC, break-down
  barriers

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Do not hide from the challenges!
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Thanks for your attention
Prof.dr. Robbert Huijsman MBA Institute Health
Policy Management Erasmus University
Rotterdam/Erasmus MC PO Box 1738 3000 DR
Rotterdam email huijsman_at_bmg.eur.nl
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Principles of disease management
A process in which a continuous improvement of
measurable results of the treatment continuum
(prevention, diagnostics, management) is
stimulated
1. Shared vision 6. Evidence-based protocols 2.
Economic analysis 7. Casemanagement 3.
Prevention oriented 8. Integrated data
systems 4. Commitment patient 9. Involvement of
the 5. Continuity of care pharmaceutical
industry