Proposal for a comprehensive healthcare management model for people with multimorbidity and their caregivers – Colombia Key messages Multimorbidity is a growing and increasingly visible The proposal developed for Colombia of a global phenomenon due to population aging, to the comprehensive healthcare management model for physiological and emotional effects it causes, to the persons with multimorbidity and their caregivers high costs that its care generates for health incorporates elements derived from theoretical systems, but above all due to the impact on references, from successful national and the quality of life of those who live with international experiences, and from a pilot it, their families, and their caregivers. testing within the framework of the right to health and Primary Health Care (PHC). In Colombia, during 2012 - 2016, multimorbidity had a prevalence of The model is a flexible and holistic 19.5% for all ages, according to data proposal, focused on the person from the study carried out within the and their environment, with a path framework of this project, which also that begins with the identification showed an increase in the use and cost and stratification of the risk of those of health services associated with older age persons with multimorbidity in the space and the complexity of multimorbidity, in an aging of a strengthened primary care. It continues at population that shifts its epidemiological profile other levels with other elements that complement towards chronic diseases. healthcare, such as physical activity, emotional support or appropriate nutrition, among many Nowadays, multimorbidity is one of the greatest others. challenges for health systems in all countries. It requires innovations in the conception, The proposed model is adaptable to the different organization, and management of health systems, in health management and care realities of the the training and performance of human resources, country. However, it is imperative to establish the in the understanding of the person as a whole, in household and primary care centers (PCC) as the the prescription of medications, in interprofessional appropriate settings for the care and self-care of care, and in quality of care. complex chronic cases. This implies consolidating the patients’ links, and integrating the services into Attention to multimorbidity in Colombia has been comprehensive care circuits organized integrated a scattered response from different actors in health services networks, led by the PCCs within the system who have answered the problems of a PHC framework under the stewardship of the persons with multimorbidity. However, Colombia Territorial Health Entities and the participation of needs a national commitment to an innovative community actors. This will be conducive to the management and care model that addresses the fullfillment of needs, preferences and expectations needs, expectations, and preferences of those who of those living with multimorbidity and of their suffer from it and of their caregivers. caregivers. More information Improving the Management of Health Care Services for Patients With Multiple Chronic Conditions In Three Latin American Countries: Colombia Uruguay and Brasil Research for innovation in health systems A feasible undertaking Increase of well-being and quality of life by Decrease of costs for society by Impact improving health conditions and decreasing suffering lowering mortality, morbility, and avoidable disability The proposal for a management and health care model for persons with multimorbidity and their caregivers Results in Colombia is the result of more than two years of a collaborative work with the Ministry of Health and Social Person with multimorbility participating Person with multimorbility who knows their risk profile Person with multimorbility capable of understanding, Protection and representatives of public and private and exercising their right to healthcare and posseses habits and skills to remain healthy making decisions, coordinating, and acting for their own care insurers and providers, local health authorities, and groups of patients and their caregivers in different regions of the country. It aims to guide and organize comprehensive Products Risk Service Service Service Pharmaceutical Agency Hospital-household Care for the Social support Community Social and Healthcare health care for persons with multimorbidity, addressing networks assets map health care services prevention coordination continuity integration optimization capability care caregiver services their physiological and existential needs during the life course, with the support of their caregivers, family, and CAP ICP PCP Participation Collaboration Health Healthy Shared Rehabilitation and community. It takes into account the institutional and roundtable improvement promotion lifestyle habits decisión-making preservation measures community settings with which people engage. The proposed model is supported by: (i) a review of the national and international literature on multimorbidity, Processes especially in those aspects related to clinical, care, Public CHRM for Individual health Case Clinical Individual management and financing; (ii) the identification of collective collective management management management CHRM successful national experiences in multimorbidity population CHRM management; (iii) the formulation of a preliminary model for the management and comprehensive care of multimorbidity that was piloted in six locations: Barrancominas and Inírida in the department of Guainía; La Virginia in the department of Risaralda; Cajibío in the Resources department of Cauca; Barranquilla in the department Human Services and Infrastructure Information Human resources in Knowledge technologies and resources in of Atlántico; the Barú Peninsula in the department of healthcare in healthcare and provision communication healthcare Bolívar; and Bogotá; (iv) the exchange of national and international knowledge with Brazil, Uruguay y Chile that occurred throughout the study. Need Segmented view Scattered attention The model proposed has three main components: CAP: Collective Action Plan - ICP: Individual Care Plan - PCP: Personalized Care Plan - CHRM: Comprehensive Health Risk Management strategic, tactical, and operational (Figure 2) Strategic Figure 1. Value chain of the management model and attention to people with multmorbidity. Proposal for a Strategic Figure 2. Components of the multimorbidity Refers to the frameworks that support the model, comprehensive healthcare management model for people References care and management model. Proposal for including model’s references, definition, objectives, with multimorbidity and their caregivers. Colombia 2022 Component Definition a comprehensive healthcare management subject population, and risk groups. Source: The authors Objectives model for people with multimorbidity and Subject population their caregivers. Colombia 2022 The model has three main frameworks of reference: Conceptual Source: The authors Public policy and Rights-based and differential approach Tactical Strategies Salutogenesis approach Regulatory Component Social determinants of health approach, and Approaches Attributes Links approach. Tactical The model contains five attributes: Refers to the organization of the model through approaches, attributes, and strategies. Governance Management Care Agency Operational The model contains five different approaches: Component Legitimacy of the other Resources Processes Results Person-centered approach (person, caregivers, Holism and family, and community) Integrality/integration. The model proposes ten strategies: those living with multimorbidity. It seeks to improve health outcomes and quality of A focus on primary health care life through management and care at Health authority leadership different levels. The model focuses on the Promoting coherent financing necessary resources and their efficient Articulation of social, economic, and sustainable use, the fulfillment of environmental, and community the processes to achieve the objectives, resources the consolidation of the results, and other elements of care integration, such as the links Continuous improvement of care between people and the articulation between Strengthening interprofessional care institutions. The value chain of the model is illustrated Promoting self-care / self-management in Figure 1. More information Use of interoperable technological and information systems Authors Delivery of care; and MMery Concepción Bolívar Vargas, Sandra Milena Hernández Support for decision making. Zambrano, Alexandra Porras Ramírez, Guiovanni Esteban Hurtado Cárdenas, Axel Darío Arcila Carabali, Janet Bonilla Torres Co-researchers Operational Eduardo Andrés Alfonso Sierra, María Heidi Amaya Valdivies Focused on bridging the potential the gap between Collaborators aspirations and reality through the implementation of María Luisa Latorre Castro, Juan Pablo Toro Roa, Ana María Lara Salinas various actions related to health management and care. Research Director Mery Concepción Bolívar Vargas The management dimension covers set of coordinated General Project Management institutional and inter-institutional actions required Roberto Iunes to achieve the objectives of the model. Health, Nutrition and Population Global Practice - World Bank The care dimension articulates different actors, Acknowledgements strategies, and interventions within the framework The team thanks the officials of the Ministry of Health and Social Protection of Colombia from the following areas, who accompanied of the health system, aimed at promoting the the project over more than two years and acted as counterparts: Office attributes of the model. of the Minister, Vice Ministry of Public Health and Service Provision, Vice Ministry of Social Protection, Advisory Office of Planning The operational component covers activities at the and Sectoral Studies, Group of Sectoral Studies, and Public Policy macro, meso, and micro levels of management and Evaluation. Promotion and Prevention Directorate, Non-Communicable Diseases Subdirectorate, Integrated Management Group for care. At the macro level, at the national level, with the cardiovascular, oral, cancer and other chronic conditions. Directorate Ministry of Health and Social Protection, and at the of Regulation of Benefits, Costs and Rates of Health Insurance and territorial level, with the Territorial Health Entity. In Cooperation and International Relations Group. Special thanks to the the meso with the benefit plan administration insurers, providers, patients, caregivers, doctors, nursing assistants, companies. At the micro level, with health service health secretaries, and liaison professionals of the municipalities of Bogotá, Barranquilla, Cajibío, La Virginia, Barrancominas, Inírida, providers, following a systemic approach related to: and Barú who were linked to the test pilot, and to the insurers and providers who participated in the interviews and focus groups of the Resources: human, knowledge, health services and study of successful experiences of multimorbidity care in Colombia. technologies, physical, information technologies, Also, to the professors from the universities Fundación Universitaria and economic and financial. de Ciencias de la Salud - FUCS, Hospital San Juan de Dios Sevilla – Spain and Universidad Nacional de Colombia who trained the team that Processes: strategic, care, support, monitoring, implemented the pilot test of the Model. and evaluation. Summary document preparation: Results: process, product, effect and impact on Mery Bolívar Vargas and Paula Zamorano health and quality of life. Edited by: Janet Bonilla Torres Graphic creation: María Cristina Rueda The proposed care model is grounded in value- Photography: World Bank Flickr based care so that the model creates more value for More information Apoyo financiero Colombia 2023