Building integrated care systems: a case study of Bidasoa Integrated Health Organisation

Abstract

IntroductionThis paper analyses the implementation of integrated care policies in the Basque Country through the deployment of an Integrated Health Organisation in Bidasoa area during the period 2011–2014. Structural, functional and clinical integration policies have been employed with the aim to deliver integrated and person-centred care for patients, especially for those living with chronic conditions.MethodsThis organisational case study used multiple data sources and methods in a pragmatic and reflexive manner to build a picture of the organisational development over a 4-year period. In order to measure the progress of integration three concepts have been measured: (i) readiness for chronicity measured with Assessment of Readiness for Chronicity in Healthcare Organisations tool; (ii) collaboration between clinicians from different care levels measured with the D'Amour Questionnaire, and (iii) overall impact of integration through several indicators based on the Triple Aim Framework.ResultsThe measurement of organisational readiness for chronicity showed improvements in five of the six areas under evaluation. Similarly the collaboration between professionals of different care levels showed a steady improvement in each of the 10 items. Furthermore, the Triple Aim-based indicators showed a better experience of care in terms of patients’ perceptions of care coordination; a reduction in hospital utilisation, particularly for patients with complex chronic conditions; and cost-containment in terms of per capita expenditure.ConclusionThere is a significant amount of data that shows that Bidasoa Integrated Health Organisation has progressed in terms of delivering integrated care for chronic conditions with a positive impact on several Triple Aim outcomes.

Preserving Care Delivery in Hard-to-Serve Regions: A Case Study of a Population Health System in the Swiss Lower Engadin

“…The formation of the system in the Lower Engadin has been driven by a highly committed management team collaborating based on trust and relationships among equals. This finding echoes previous research similarly emphasising the central role of leadership for building population health systems [519]. …”

“…Similar to other countries, Switzerland’s fee-for-service system lacks incentives for coordinating patients across providers [515171819]. Actors in the Lower Engadin developed a creative solution, financing case management with regional funds.…”

“…Considering the broader determinants of health, they require collaboration across multiple providers from several sectors, local authorities, patients, and the public [5]. Examples are Jönköping County Council in Sweden [17], Gesundes Kinzigtal in Germany [18], Bidasoa Integrated Health Organisation in Spain [19], or accountable care organisations in the US [e.g. 20].…”

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“…Individual integrated care models cover personal care planning, case management, and patient-centered medical home (American Case Management Association, 2002;Curry & Ham, 2010). Population-based models are currently implemented by Kaiser Permanente and Basque country (Pines et al, 2015;Polanco et al, 2015).…”

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