Abstract

The Dutch long-term care and welfare system will be decentralized and transformed. From 2015 the municipalities will be responsible for a major part of the long-term care, youth care and work and income services. This national and local policy transition includes reform of current long-term care and welfare arrangements. To prepare this policy transition, the city of Amsterdam and ten providers of care, cure and community services developed and evaluated an action program, to realize an improvement in the quality of health care and welfare services, a healthier and a more self-sufficient population and cost reduction (Triple Aim).

The objective is to implement integrated care and services from the sectors cure, care and community. The program is developed for people with complex and/or multiple problems and limited self-sufficiency in the northern district of Amsterdam. The action program follows a multilevel approach to integration, focused on social innovation: – On the service level the processes to help the client are transformed, including assessing and action planning (based on the multidisciplinary consultation guidelines of Frieslab), outcome based patient stratification (based on an evidence-based self-sufficiency matrix) and progress monitoring – On the professional level, professionals receive training and coaching. Additionally, a program with required competences was developed with the professionals. On the organizational level, a joint venture was established by ten providers of health care, home care and welfare services, supported by research institute TNO and healthcare insurer Achmea. On the financial level, shared savings and population based funding is currently developed, starting with pooling budgets for case management. The presentation will describe the first, promising results of the action program on the Triple Aim dimensions. Self-sufficiency of the target population increased, especially on the field of mental health and income (debt restructuring).

This results in a better health for the population. The business case shows that the action program leads to lower costs. We are further discussing the criteria for efficient implementation, based on our process evaluation by continuous quality improvement loops. Lessons learned include various strategies for implementation (top down, bottom up). Although no blueprint seems to be available, working mechanisms can be identified. To conclude, this action program explores the opportunities for implementation of a regional, population-based approach as a reaction to policy changes in the field of integrated long-term care services in the Netherlands. The first results on population’s health and costs are promising, including valuable strategies to sustain changes, which will be elucidated in presentation.

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