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Learning from Accountable Health Models in Spain: The Converging Narratives of Integrated Care, Chronic Care Management and Promoting the Culture of Health


Ana Miquel Gómez ,

Rey Juan Carlos University and Servicio Madrileño de Salud, ES
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Roberto Nuño Solinis,

Deusto Bussiness School, Basque Country, ES
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Nuria Más,

IESE Bussiness School, Navarra University, ES
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Stephen Shortell,

Berkeley University, US
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Richard M. Scheffler,

Berkeley University, US
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Meg Kellogg

Berkeley University, US
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Background: In the World Health Report 2000, Spain ranked 7th out of 191 countries  regarding health systems performance. According to WHO’s world health statistics, in 2015 life expectancy at birth in Spain was 82.8, the third highest in the world. The Spanish state is made up of the central state and 17 decentralized autonomous communities, responsible for payment with public funds as well as healthcare budgeting, and organization of the delivery of services. The right to health protection for all citizens, the right of universal access to health care, and a strong primary care are common elements in all the regions. Added to this, in the last years, the  Strategy of Care for People with Chronic Diseases, has represented the strategic framework to drive the development of integrated initiatives in most of the regions in Spain. These three regions were selected as being within the most advanced in the implementation of new innovative integrated care initiatives.

Objectives: To explore, identify, describe and analyze the main innovative integrated care initiatives implemented in the three regions that could be translated to the United States.

To develop several case studies about integrated care initiatives with tangible results.

Format: Moderator: Stephen Shortell (University of California, Berkeley).

Keynote Speaker: Roberto Nuño (Deusto University Basque Country) Núria Mas (IESE -Navarra University Catalonia), Ana Miquel (Rey Juan Carlos University Madrid)

Further Insights and US applications: Stephen Shortell and Richard Scheffler (University of California, Berkeley).


1. Background, Methodology objectives (S. Shortell)

2. Introduction to the Spanish Health System.Data of Cost and Population Health in Spain and in the three regions

3. Initiatives from Basque Country: Innovation relative to Chronic patients, Social and Healthcare Integration, Mental health integration, Budget  integration, Local Area coordination across sectors.

4. Initiatives from Catalonia: Integration of Electronic Health Record, Stratification of population, personalized care plans, integration of the emergency medical services, social and healthcare integration, cross sectorial meetings

5. Initiatives from Madrid: Strategy of care for patients with Chronic Conditions, Stratification of the population, The integrated  pathways, the Palliative Care plan, The evaluation of the implementation process and the impact in a territory

6.  Conclusions and main lessons learned applicable to the US

Target Audience: Professionals and leaders from the rest of Spanish Regions and other countries interested in the integrated care initiatives that are taken place in Spain.

Learnings to take away: The key success elements that could be Applicable  to the US: Overall framework and learning for area-based integration continuum in Spain; Local area care pathways; Personalized care plans for complex, chronic patients; Territorial meetings and agreements/plans for integrated actions among healthcare, social care, schools; Palliative care program; Public payment of private contractor such as Madrid from more than one source to create integration; the basic benefit package all Regional health systems must provide; certain roles such as negotiating drug prices for all of Spain; The definition in Spain of  educational requirements of professionals.

Leadership and aggressive Change Management are considered relevant factor for Integration Success   

How to Cite: Miquel Gómez A, Nuño Solinis R, Más N, Shortell S, Scheffler RM, Kellogg M. Learning from Accountable Health Models in Spain: The Converging Narratives of Integrated Care, Chronic Care Management and Promoting the Culture of Health. International Journal of Integrated Care. 2019;19(4):37. DOI:
Published on 08 Aug 2019.


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