Coordinated care for the elderly

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A personalised and integrated model to cope with the ageing curve

Two assumptions underpin the traditional approach to healthcare: that it's about the treatment of disease; and that it's the domain of a particular professional group. In this report, PwC calls for a different approach to cope with the ageing curve - an approach that expands the focus from care and cure to vitality and wellbeing, and from episodic intervention to personalised integrated services.

The report offers case examples of how some countries have approached reform to create more innovative and effective ways to deliver services in ageing societies.

The report also identifies eight key factors for health systems to support the quality of life of older people:

1. Political vision and courage for change

Political vision—and the courage to enact change—is crucial. Governments alone have the mandate to formulate a national care strategy. And the move to personalised care for the elderly may require such intervention, especially in countries with market-oriented or hybrid healthcare systems. Where subsystems of competing payers exist, there is more fragmentation than in systems with single payers.

Many countries may also need new laws to establish an overarching, coordinating body or harmonise incompatible regimes. Read more in the report, including a case study: SPICE from Singapore.

2. Embrace change and cooperate with new entrants

New entrants from the retail, consumer products, telecommunications and technology industries are expanding and reshaping the health sector. Some of these companies aim to help older people live more comfortably and safely in their own homes.

For example, Deutsche Post has launched a new service called ‘Personal Post’ for elderly citizens who live alone. Subscribers pay a small monthly fee to have a postman ring the doorbell and speak to them every Tuesday till Saturday. If something is wrong, the postman notifies the local help service, which immediately contacts a relative. Read more in the report.

3. Reallocation of resources from the secondary sector

It will also be necessary to reallocate resources from the secondary sector to the primary, community and social care sectors. The most integrated care networks operate with about 1.57 hospital beds per 1,000 people without compromising the quality of the service they provide. However, most countries are far from this ideal.

4. New payment models

Several innovative payment models have emerged in those countries that are in the vanguard of integrated care.

Some of these new models employ outcomes-based and performance-based incentives. Other countries are testing alternative approaches. The Dutch Ministry of Health has, for example, launched a bundled payment scheme for treating people with diabetes, chronic obstructive pulmonary disease and vascular disease. The United States is experimenting with accountable care organisations (ACOs). The English National Health Service (NHS) is piloting an even bolder version of population-based care delivery.

Read our report for examples and a case study: The Manises Model.

5. New contractual structures

New contractual structures will needed to align the interest of payers, providers, new entrants from outside industries and citizens more effectively. The simplest solution is to merge all the providers in one single integrated organisation, but that is not always feasible or likely to happen. Another option is to borrow from the various contract types used in the private sector. These include

  • the prime contracting model,
  • the joint venture, and
  • the alliance.

Read our report for more on the strengths and weaknesses of these models.

6. Integrated information systems and digitalisation

Care services improve when doctors and social workers have immediate access to information on the elderly they serve to coordinate delivery. Four general guidelines apply in building an IT system that supports personalised service delivery:

  • The needs of each of the stakeholders must be identified. Clinical safety should obviously be a top priory, as should the security of the system itself.
  • The system must work horizontally as well as vertically. Most health IT systems are designed to perform a specific set of functions in a specific department or organisation. But patients move from one department to another and from one organisation to another.
  • The information contained within the system must also be accurate and instantaneously available. Users must thus be able to update it wherever they are, which means that mobile access is essential.
  • Lastly, the terminology and formats different care providers and administrators use must be standardised to encourage more effective utilisation of existing IT assets and minimise the amount of additional investment that is required.

7. Effective governance and performance management

Robust multidimensional performance management and measurement is critical – and numerous measures of clinical performance have already been developed. But there are many other areas in which the indicators required to evaluate personalised integrated care are still missing: like the professional involvement and capabilities to act as a coach for elderly.

Read our report for more on a conceptual design and building blocks for an effective, multi-dimensional performance measurement system.

8. Strong leadership and cultural transformation

The transition to a new care model likewise entails a major cultural shift – and “the soft stuff is the hard stuff.” This new vision of care entails knocking down the walls between different care providers, collaborating closely and sharing accountability.

Adopting a more personalised integrated model of service delivery for older people requires new knowledge, skills and abilities, so it’s imperative to provide proper training. E-learning modules and practical exercises delivered online can be useful here in helping individual employees identify what they need to know and learn at their own pace. In an employee survey amongst Dutch professionals working in elderly care, 56% expressed their willingness to learn new capabilities.

Read more in our report, including a case study: Back to basics.

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