Content of policy
In 2014, the Minister of Health launched regional pilot projects aimed at improving care coordination for fragile elderly people and finding alternatives to the existing fragmented care organisation (Personnes Agées en Risque de Perte d’Autonomie; PAERPA) (ANAP, 2014). Pilots are being launched in nine regions, with each receiving approximately €4 million per year over three years. The objective is to improve care pathways for the elderly, ensuring that they receive the right care by the right professionals within the right institutional structures while reducing costs due to avoidable care.
Political and economic background
People aged 75 years and older now account for over 9% of the population in France, and this proportion is projected to reach 11% by 2025 and 16% in 2050 (Insee, 2010). Currently, frail elderly people frequently encounter fragmented services due to uncoordinated delivery of medical care, long-term care and home- and community-based services. Improving care coordination for frail elderly people was a major component of the National Health Strategy (see Health Policy Update 11/10/2013). In 2011, a report by the High Council for the Future of Health Insurance estimated that avoidable hospitalisations of the elderly cost approximately €2 billion per year (HCAAM, 2011). The report drew attention to the growing total health care expenditure for frail elderly people and the potential for savings by better coordinating medical and social services. The HCAAM advocated the launch of pilot projects to be implemented locally by regional health agencies (agences régionales de santé; ARSs). The 2013 Social Security Financing Act provided funding for the pilots with the aim of experimenting with new care organisations for the elderly over the next five years.
Implementation
ARSs wishing to participate in a pilot project applied on a voluntary basis and were selected by the Minister of Health. Each participating ARS must sign a memorandum of understanding with all partners and stakeholders involved in the project.
The projects target all people aged 75 years and over residing in a defined locality. The objectives include improving communication and coordination between the acute and social care sectors, reducing hospital readmissions and emergency hospitalisations and addressing overuse/misuse of drugs. Each participating ARS is free to set the priorities for their local areas and must propose major actions to achieve them. To date, only one-third of the regions have finalised their action plans, and the others should finish by next fall.
Although there is no nationally-defined organisational model, a number of common tools will be used in all pilots. The common measures include the introduction of a shared diagnostic tool called a Personalised Health Plan (Plan personalisé de santé; PPS), an information/support platform for health professionals and patients, and a secure messaging system. The PPS, which will be undertaken by a GP, will be used to assess the frailty as well as the health and social conditions of the patient and to identify the main contact person(s) involved in care delivery. The charge for the PPS (€100) will be paid by Statutory Health Insurance (SHI) as a special consultation fee to be shared among GPs and nurses or other health professionals involved in the care process. Moreover, an information-sharing platform at the local level will support health professionals and families by providing guidance and promoting professional exchanges. Finally, the projects will invest in a secure messaging tool, which will allow patients’ medical and social information to be shared among the different health professionals.
Stakeholder Positions
In the current context of economic constraints, finding new configurations for better organising care for the elderly is seen as an important source of cost savings.
The participating ARSs, which must establish a local diagnosis of the health care situation for the elderly, have only recently obtained the right to access the SHI health consumption database (SHI inter-scheme system, SNIIR-AM). Access to these data was one of the key motivations for ARSs to participate.