Evaluation of value-based integrated care in Spain: results from six Regions

Abstract

Ageing and chronicity, and technological and pharmacological innovation, require transformation of healthcare organizations and systems to focus on value-based integrated care (VBIC). MORE (Spanish acronym for Madurez de las Organizaciones Sanitarias Orientadas a Resultados en Salud) is an initiative that seeks the commitment of healthcare organizations to make progress on the delivery of VBIC to ensure sustainability of the health system. It provides a validated evaluation tool to first assess the organizational level in relation to value-based integrated care, before organizations and regional health systems work on the design of their own development path towards a VBIC model.\xa0 We present the main findings of the implementation of the evaluation tool in six Spanish Regional Health Systems. Methods An on-line survey was completed by top managerial teams from six Spanish Regions. These teams were appointed by the regional health system CEO, and included top managers from all relevant areas: clinical, human resources, finance, informatics, health planning and so on. The questionnaire contains 57 items, grouped into 5 areas of analysis (politics, care coordination, information systems, management, evaluation), and each participant completed the questionnaire individually. Results In total, 59 top managers of 6 regional health systems in Spain participated in these evaluation processes, completing the questionnaire from January to June 2019. Overall, Information Systems and Care Coordination areas showed the highest average scores; 56 and 55, respectively (ranging from 42 to 71, and from 38 to 64, respectively, on a 100-point scale for the two areas); while Management and Evaluation areas were rated lowest, 45 and 47, respectively (ranging from 24 to 49, and from 20 to 54, respectively, on a 100-point scale for the two areas). Discussions Six out of seventeen Spanish Regions participated in this evaluation; thus, although it is not a complete picture of the overall situation, it allows us to identify some common patterns. Few initiatives in this area of research have been developed with such extensive implementation across the Spanish Regions. Regions show “balance” in the five analysed areas, with the exception of one that scored very low in evaluation and management (20 and 24, respectively). MORE provides an opportunity for participating teams to draw conclusions on the level of value-based organizational maturity of the regional health service, before designing their own path towards a VBIC model. Conclusions MORE has been shown to be an effective initiative to assess organizational status in relation to value-based integrated care at the top managerial level in Spain. The results of the assessment allow regions to design their own development path.\xa0 Lessons learned The experience has been shown to be potentially replicable in other regions and countries, with the opportunity to generate a benchmarking framework based on MORE dimensions. Limitations 1)\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0 the respondents’ self-perception with respect to the organizational situation, and 2)\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0 2) the scope of the evaluation group. Suggestions for future research\xa0\xa0 This practice allows an iterative process of improvement of the tool and working methodology with users’ feedback. Further experiences will contribute to the refinement of the tool.