The Basque Country, a northern region of Spain, developed a cutting-edge and inclusive approach to control health expenditures driven by chronic disease. It provided citizens with easy access to nurse hotlines and their personal health records through their phone and television.

Our connection to that far-off and seemingly exotic health care initiative? Dr. Rafael Bengoa, the region’s former minister of health, is currently serving as an adviser to President Obama on Affordable Care Act implementation.

“So some of the learnings from [his] project may find their way into the U.S. health care system,” explained Michael Taylor, North America managing director of Accenture’s Health Management Consulting, when he presented their findings during the Care Continuum Alliance forum this fall.

In the Basque Country, 80% of patient interactions with the public health system are related to chronic conditions and diseases. Further, chronic patients drive 77% of the total health expenditure in the region, and their health expenditure on current trends is expected to double. Facing the inevitable challenges that come with an aging population, government leaders put a comprehensive pilot program into motion. As a result, the average health expenditure per citizen has begun decreasing and the region will be able to better support its aging population for the future.

The program provides mobile and online support services through diverse channels, including telemetric monitoring for patients at home and online consultations, which minimize disruptions to patients’ and physicians’ lives and work.

Unified initiative

Before implementing the structure of this unified initiative, the Basque Region had more than 170 health pilot programs for long-term conditions. Doctors and providers alike needed to make sure they were all on the same platform and following best practices.

“We made an aggregate program and integrated in a meaningful way. The system also allows us to customize from patient to patient,” explained Josep Carbo, Accenture’s lead for health management in Europe, Africa and Latin America.

Through an Internet services portal and mobile solutions, citizens can get access to medical advice over phone or online. By pressing a button on their smartphone, patients are connected immediately with a nurse to ask their health question. These nurses can solve nonemergency issues, sometimes saving users a trip to their doctor or hospital. In 2009, 70% of health meetings did not require an in-person meeting.

The mobile outreach tool gives patients support when they’re not at their doctor, or the nurse can contact ambulance or emergency services if needed. Patients can also make appointments with their care provider through the app. In the last 12 months, 500,000 appointments were scheduled through the mobile program. Also through their phone, individuals can access their personal health data at any time, along with chronic disease management programs. They can also upload their data through the app, which offers consistency for their health providers.

Patients can also access disease management programs and schedule doctor appointments through their TVs, without having to master a complicated remote control. Using Microsoft Kinect technology — not unlike the once-popular Wii console — patients can even access the interface by simply using their body to point and select. Among older patients, many of whom would be uncomfortable trying to do the same with a smartphone, the system was a roaring success, with 95% of patients using it every day after six months.

The final component of the Basque program is a customer relationship management tool that tracks patient calls, health conditions, when patients access the service portal and any alarm signaled during disease monitoring. All of this data lives together and is integrated into a clinical solution so the physician has access to the patient’s full information. The program offers all patients — chronic patients in particular — easy access to their health information. Not surprisingly, the overall population has experienced a 2% decline in prescriptions related to chronic disease, as many patients had been prescribed drugs by various specialists, and now are being managed by one central system.

Other positive results from the program include:

  • More than 600,000 calls are made to per month coming to the call center, in a region with a 2.1 million population. And 18% of appointments are scheduled take place over the phone.
  • 83% of health advice is offered by nurses over the phone so patients don’t need to go to the ER or their doctor when it’s not called for.
  • Over 2,600,000 visits were made in 2012 to the health services portal.
  • An increase of 48.9% in hospital-at-home stays due to increased utilization of technology.

By hosting all of these programs on one system, the state system also united different providers and ensured that care delivery professionals were not working in silos.
“You need holistic transformation, as partial solutions do not work … If you only have telemedicine solution or health coaching or electronic health records, it will not work — it needs to be a combination of programs,” added Carbo.

Decreased health expenditures

In 2009, the first year all these services were available, the government efforts decreased the total health expenditure by 2.5%. In 2013, there was already a 4.2% reduction, and that is expected to be reduced by 6.8% in 2014. Carbo warns that savings don’t necessarily mean the state can keep more money in its pockets, though it can more effectively begin to cope with an aging population.

“It’s not about saving money, but about dealing with [increases in chronic diseases as the population gets older] and keeping budget under control,” said Carbo. “The health budget is now under control. It’s about transforming the health system in a way that is sustainable in the future,” he added.

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