Including patient perspectives in locoregional governance to value care in Belgium

Haakma, Teunisje Adriana [UCL] Germeni, Evi [University of Glasgow] Macq, Jean [UCL]

In a fragmented health care system, without a garanteed reference provider to guide patients in their journey to better health, it can become difficult to search for appropriate care. This is especially the case when confronted with chronic illness, comorbidities, or frailty and receiving care from different health care settings. Therefore, Belgium started in 2015 a nationwide program aimed at improving integration of care for people with chronic diseases, called Integreo. This includes 12 integrated care projects (ICPs), who have all engaged in co-creation and progressive loco-regional governance development to restructure care organization. Each locoregional governance consortium came up with an action plan. This plan requires constant adaptation in order to improve care integration and possibly have an effect on the triple aim. Decisions on locoregional level are made with a population based perspective on value of care. Value driven health care is defined on the base of mean effects of care and its mean cost for specific groups of the population. However, so far, it hardly takes into account the individual specificities of experiencing care. Question: How can we include individual patient experience in value driven care as part of the governance process in order to improve care integration? Why is it important to include individual patient perspectives in valuing care? There are several reasons: • The health care system is a public good, therefore it is politically mandated that the people get a say in what is done and how it is delivered. • Including patient perspectives has the potential to improve the quality of care and subsequently the efficiency of care. • Health professionals (HPs) are experiencing tensions • To deliver the best possible care, customized to each individual patient • To taking into account population effects of care. • This tension should not stay a problem of the HPs, but it should be taken into account in each decision on loco-regional governance. • This need to balance statistical and narrative approach in evidence generation.