Transforming Chronic Disease Care in Uruguay: A New Approach

The World Bank's report, "Proposal to Optimize the Care Model for People with Chronic Diseases and Multimorbidity in Uruguay," presents a comprehensive approach to transforming chronic disease care. By focusing on patient-centered, efficient, and integrated healthcare services, Uruguay aims to improve outcomes for its most vulnerable patients.

Uruguay is taking a bold step towards transforming its healthcare system for people with chronic diseases and multimorbidity. Chronic diseases, which significantly impact mortality and healthcare costs, have long been a challenge for the country's health system. Despite existing health promotion and prevention strategies, the need to review and optimize care models, especially for multimorbidity, is more pressing than ever.

The World Bank, in collaboration with Uruguay's Ministry of Public Health (MPH), conducted a comprehensive study to address this issue. The study's primary goal was to formulate a stratification scheme for patients with chronic noncommunicable diseases (NCDs) based on health risk, identify multimorbid conditions, and propose a new care model. This involved three phases: stratifying the population, evaluating current care models, and proposing an optimized care model.

Disparities in Healthcare Expenditure

The stratification process revealed striking disparities in healthcare expenditure. Patients classified as Level 3, the most complex cases, make up only 8.21% of the population but account for a staggering 41% of institutional expenditure. In contrast, Level 0, comprising healthy individuals, makes up 48.13% of the population and only a small fraction of the costs. This highlights the urgent need for a more efficient care model to manage these high-cost, high-need patients better.

The economic impact of chronic disease care is significant. Care for patients with multimorbidity (five or more diseases) represents 42.07% of total expenditure and 50.48% of medication costs. Additionally, patients with more than two hospitalizations and taking five or more medications monthly constitute 5.4% of patients but require 83% of total expenditure. These figures underscore the inefficiencies and the critical need for a more effective approach.

New Care Model

The proposed care model aims to improve the quality of life for people with multimorbidity by developing an efficient, person-centered approach that focuses on prevention and early intervention. Key goals include replacing disease-specific care with a patient-centered model, balancing polypharmacy, and managing complex cases early to reduce hospitalizations.

The new model is built on several essential pillars: encouraging teamwork and the delegation of powers among healthcare providers, emphasizing early detection and management of chronic diseases, particularly focusing on cardiovascular risk, implementing strategies to prevent unnecessary hospital admissions, and promoting preventive self-care and healthy lifestyles among patients and their families.

Essential Elements for Success

The success of the proposed model hinges on five critical elements. Firstly, accurately identifying complex patients and predicting their care needs is crucial. Secondly, creating teams of healthcare professionals to provide comprehensive care ensures a holistic approach. Thirdly, empowering patients to actively manage their diseases fosters better health outcomes. Fourthly, developing individualized care plans tailored to each patient's unique needs enhances the effectiveness of care. Lastly, leveraging information and communication technologies (ICT) for remote monitoring and better coordination of care modernizes the approach and ensures continuous patient engagement.

Implementing the Optimized Model

The proposed model calls for significant transformations in the healthcare system, care models, and patient engagement. It envisions a health system that rigorously evaluates health outcomes and encourages best practices, collaborative teams focused on prevention, and active patients knowledgeable about their diseases. The new care model offers several value contributions, including improved medication reconciliation to reduce drug interactions, better treatment adherence, enhanced patient education and training, promotion of active lifestyles, and tailored social support.

To achieve these goals, the proposal outlines key innovations. Encouraging patients to take an active role in their health and regularly assessing patients' health status and needs through comprehensive periodic evaluations are fundamental. Identifying high-need patients for targeted interventions through population stratification, utilizing case managers to streamline care, and implementing technologies to facilitate integrated care networks are also essential steps.

In the short term, the focus will be on implementing the optimized care model and monitoring its impact. Long-term projections include evaluating the model's effectiveness and promoting regional collaboration to share successful experiences and lessons learned.

Looking Ahead

The World Bank's report, "Proposal to Optimize the Care Model for People with Chronic Diseases and Multimorbidity in Uruguay," presents a comprehensive approach to transforming chronic disease care. By focusing on patient-centered, efficient, and integrated healthcare services, Uruguay aims to improve outcomes for its most vulnerable patients.