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2016 Conference Presentation

(Inter)national systems Greece

7 September 2016

Social care governance structures and the business model at early stages of integrated care design and development in a LMIC region to create cashable savings and RoI

Stella I. Tsartsara, South East Europe Healthcare, Belgium


Introduction: Chronicity is the first cause of healthcare cost burden and will continue to increase due to the growing longevity worldwide. National and local care budgets are already experiencing severe cuts not only in EU countries under crisis (Greece, Karanikolos et al) but also in advanced economies such as the UK (NHS recent social care cuts, The Guardian Social Care 2016). A solution must be found imminently that it is not dependent neither on state funding that is in constant decline in social care which is the primary driver of Chronic Care nor on Private Equity managing LTC, a high risk option that has failed dramatically over the last years to assure community based care (Four Seasons closing residential care in UK, The Guardian Social Care, 2016). The burden in finding a solution is transferred to the local communities that either are offered slim resources such as the increase in local tax for social care of 2% in the UK or not at all as in Greece. The national and local authorities are defensive in moving forward with care reforms as those demand serious investment from state resources. None of the care reform proposals actually proposes how to generate income to build a sustainable community based system for long term care especially.

In this research we are proposing a community based integrated care model that is established on local resources that are lateral to the care services provided to the local population such as for instance senior tourism, health tourism and thermal rehabilitation in natural springs, or secondary housing of retirees relocated after pension or prevention services for the whole population. Although frailty is the Chronicity’s final stage of disease development, people with mild frailty whose rate to the Comprehensive Geriatric Assessment for Instrumental Living is quite high, are pursuing an active and healthy living and they are also travelling quite a lot.

The choice of those senior travellers is conditioned by settings that are matching their individual diseases or conditions and their care plans. The region that will prove that has the provisions for those travellers that are in similar conditions for the care that is provided to the local population as well, for them to travel safely, properly accompanied and facilitated throughout their whole journey by experienced carers and medically supervised staff, will of course attract more of those travellers over 60. The more the care is embedded in the existing care system for the local population, the larger the revenue margin will be for the care structure. If this is managed by PPP and provided by private companies that adhere to a New Care Model that encompasses also a type of Social Contract between all parties including the segments receiving care, then there might be a solution for local authorities that have potential for Local Resource Based Community Care Development to sustain self – financed structures providing long term care to the local population in a sustainable manner. And this can function as a strong motivation for the authorities to move on and reform care to integrate services and professionals in their localities in such a way that while integrated care structures are created those to serve the facilitation of the senior travellers/dwellers segment in the area. The 1st pilot was in Greece at the region of Aegean islands. The pilot now will be transferred to UK.


1. Extraction of epidemiological data and Risk Factors Assessment
2. VES -13 self-administered CGA questionnaire to measure i-ADL of the >65y.o. cohort. GIS mapping of population in a scale of primary and secondary prevention and care needs embedded in a care monitoring E-Health platform (existing and tested product)
3. Regression analysis of care means to the needs per CGA risk factor. Desk research analysis on the local health resources of the region
4. Alignment of the local Health and Care services and professionals of the area; drawing the lines for vision and strategy
5. Focus Groups and structured interviews to establish a Memorandum of Understanding between mayors of the area to create the Care Hub managed by Private Public Partnership with the local health ecosystem and with the Twinning and support of EU Regions with advanced experience
6. Setting the Investment Facility between the Municipal Authorities, a Bank in Greece and the public and private providers; elaborating the Business Plan of the entire Care Hub operations incl. Silver Economy service management and provision organization e.g. Senior tourism, retirement real estate, home care for senior dwellers, professionalized Living Labs, prevention services etc.
7. Proposing the Investment blending and assuring private equity, crowd funding, VC and impact investment at different stages of the Care Hub deployment until stabilization of the RoI and the cashable savings


1. Needs analysis for care service and HR for the local population delivered; primary and social care services aligned. Telemedicine for acute care and 2nd opinion deemed possible.
2. Care Hub structure and business plan delivered
3. Senior Tourism and Health Tourism model designed and delivered
4. Investment blending, investment familiarization tour to health resorts organized

Further results were compromised due to the banking crisis in Greece and the refugee crisis (as the pilot area was at the Aegean islands, entry gate of the refugee waves in 2015 and 2016) hence the relocation plans and transfer of the pilot to other touristic area of Europe, where the health and care costs are covered by the EU Social Security Regulation and the CBHD 24/2011/EC.

Key conclusions:

(1) In order to kick off integrated care reform in a locality it is necessary to provide the means that will cover the reform cost and assure sustainability of operations in the long run.
(2) For that it is necessary to apply a PPP structure to manage a Care Hub that will centralize organization, coordination and management of all Long Term Care services.
(3) This structure does not depend on neither health nor social policy central authorities and it is run locally by a new institution built to cover both health and care for at least the primary care, social and long term care of the population. If secondary healthcare can also be aligned with hospitals and clinics this is all the better but it concerns usually advanced countries with well-organized systems, abundance of resources and investments such as Israel, N. Ireland or Netherlands for instance.
(4) Investment and innovative financing and business innovation is necessary for any community care structure that wants to run sustainable care operations be it in low- middle or high income countries.
(5) the first priorities to implement integrated care by order of priority are:
a. leadership awareness and on the job training
b. Deliberation of the integrated care plan with all the local health ecosystem stakeholders, not only those concerned by health sector. The vision, strategy and action plan have to be endorsed by the entire ecosystem
c. build the right investment blend until the Care Hub is sustainably run with constant RoI
d. the Care Hub management has to be independent from central authorities and abide to local control for commissioning services
e. Workforce training and patient empowerment are the next steps to engage with.


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