Integrated Clinical Pathways (ICPs) and managed care networks for complex chronic conditions: the case of Multiple Sclerosis (MS) management at Parma Local Health Authority (LHA)

The paper presents the case of Parma LHA, located in northern Italy. Following a broad regional programme aimed to reorganise primary health care through the development of Health Homes model, the LHA in mid-2014 started a... [ view full abstract ]

The paper presents the case of Parma LHA, located in northern Italy. Following a broad regional programme aimed to reorganise primary health care through the development of Health Homes model, the LHA in mid-2014 started a project for setting up a MS managed care network. Moving from a systematic analysis yet of the demand of MS patients yet of the local supply chain, the project has sought for establishing a managed care network based on the newly primary health care system and for identifying special commissioning strategies for this patients' target-group through ICPs.
The objectives thus were: 1) to set up a method for assessing the appropriate needs of patients with MS, according to both disease stage development and social needs; 2) to analyse the current delivery chain and patients management by tracing patients' pathways and their current health services’ utilisation patterns; 3) to develop tools for supporting process management across different care settings and according to different patients’ needs; 4) to set up a managed care network for MS patients, across all the stages, at the local level, integrating different providers.
The project holds a paradigmatic and innovative value from a double perspectives. Firstly, the method used for patients identification and segmentation is salient for further exploitation and transferrable to different contexts, providing a reliable tools for strategic commissioning related to complex care needs. In fact, the method applied to Parma LHA, was previously tested in other contexts. Secondly, this methodology hinges on the set-up of ICPs, allowing to directly establish a routinely system relating both to the patient-centred perspective and the commissioners objectives. Therefore, the efforts to standardise a set of ICPs paved the way for relevant practice achievements in the management of complex chronic conditions through the population health management approach.
Furthermore, the project delivers an innovative experience towards understanding how to implement a managed care network through the integrative functions by primary care and ICPs. Service use data revealed activation of delivery network in relation to the four most relevant health service used for MS: neurological visits, MRI, physiatrist and rehabilitation examinations. The last part of the projects refers to the question whether the hub of the care network, could be placed in a patient-centred health home, out of hospital, and whether it might be able to coordinate spoke centres at the community level through the implementation of ICPs.