The Population health management as the road map of Italian Regional healthcare systems’ reforms for tackling chronic care

Abstract

The Italian Health Ministry recently approved a national plan for tackling chronic care, which sets out the prevailing organisational models and the clinical governance guide lines for major conditions. On the top of these addresses, the plan identified the Population Health Management (PHM) approach as a road map for Regional Healthcare Services (RHS) and organizations. The PHM identifies five pillars: 1) demand analysis, segmentation and targeting; 2) set up of clinical pathways from early prevention to treatment and follow up; 3) identify models of care for chronic care management; 4) personalized care pathways; 5) Results, outcome evaluation and quality improvement.The paper aims to provide a national overview of the PHM development in different RHSs, starting from the five pillars as the key variables for analyzing regional patterns further reinforced by the institutional context analysis of reforms driven by the PHM attainments. For instance, the call for population-based system has accelerated yet the processes of merges and establishment of bigger LHAs as healthcare services commissioners serving population of almost 1 billion inhabitants, on average; yet the processes for centralizing the support management processes and programme planning within the regional governance. The paper analyses in depth five regional cases that firstly underwent the PHM model, detangling the policy and management strategies developed compared to the five pillars as well as the resources, tools, infrastructure and ICT technologies put in place and the models of care. The analysis provides insights from the lessons learnt by these RHSs and the challenges they are facing today, in order to understand the implementation matters with the national endowment of the PHM.