Health for All Healthvision for for All a 1

HEALTH FOR ALL HEALTHVISION FOR FOR ALL A 1

SUSTAINABLE

HEALTHCARE

VISION FOR A SUSTAINABLE HEALTHCARE VISION FOR A SUSTAINABLE FOR ALL HEALTH HEALTH Health for all / Danish Regions 2017 Layout: UHI, Danish Regions / Publisher: PRinfoParitas ISBN publisher: 978-87-7723-920-5 / ISBN electronic: 978-87-7723-921-2 HEALTH FOR ALL 3 ------of health in the population in return for the money invites Regions Danish publication, this With invested. parties to participate in creating a sustain all relevant . able healthcare Enjoy! Jens Stenbæk Hansen and Bent part of a joined partnership between hospitals, gen part of a joined partnership between stakeholders, municipalities and private eral practice, the highest possible level of health for provide can the money invested. our to see need it means that we the Regions, For as We, of the hospitals. selves as more than owners to bring stakeholders must contribute the Regions, goal common together in partnerships that have the rehabilitation care, the best prevention, of providing with patients’ needs cost, and treatment at the lowest priority. as the overriding the health will work to ensure that, throughout We which incentives, from away we move system, care or solely serve to optimise each sector’s productivity to working of ways and incentives need We profits. gether that promotes health in the population and efficiency. represents a paradigm shift in health This publication which will require that staff throughout the care, the best level work together to provide health service treatment and care. At the same time, we need to fo time, we need the same At treatment and care. illness and the deterioration cus more on preventing much better at focus to become need We of illness. We illness. risk of developing at groups specific on ing assess patients’ needs and to gather knowledge need to target prevention we need and wishes. Moreover, and treatment. to hospital treatment from focus in shift requires a It pa to look at how need We the whole of healthcare. be more con of treatment can tients’ entire course we, as to look at how we need tinuous. Furthermore, - - - - - tion of creating a health service, which is sustainable tion of creating a health service, level. professional and organisational economic, an on in healtcare the challenges we face to see need We the to improve must continue We context. in a wider need to change the way we work. At the same time, we work. At to change the way need in heel biggest Achilles remains the of care continuity health care. proposal for a is Danish Regions’ FOR ALL” “HEALTH in Denmark. It is a ques new direction for healthcare mark faces demographic challenges. More and more mark faces and many suffer suffer from chronic illness, people from multiple chronic illnesses. This puts a tremen and in the future, dous strain on the health service in special- investment to put a significant we will need ised treatment. If we are to ease this pressure, we health care system more efficient, are things we must more system health care to pursue. continue it is the future challenges, to meet if we are However, Den along the same path. not sufficient to continue This is a huge achievement. Everyone involved should should This is a huge achievement. Everyone involved has improved be proud. It is an achievement, which and thereby benefited the Danish health service results we every single Danish citizen. The positive and the ongoing work of making the so far, have seen with national initiatives, we have achieved great im we have achieved with national initiatives, mor- in lower shows for patients, which provements have times Waiting rates and higher efficiency. tality of we are in the process Now, decreased significantly. efficiency improve new hospitals, which will building further. of care and patients’ experience all. have focused on Regions the Over the past decade, of hospital care. increasing the efficiency and quality specialisation, of This has resulted in a high degree Together and increased productivity. good quality We have a good public health service in Denmark. Not in Denmark. Not health service have a good public We – the Dan a high standard of care only do we provide for and equal access free provides ish health service Preface 2000 4.3 PERSONS BETWEEN THE AGE OF 18 AND 64 PER PERSON AGED 65 OR MORE

2016 3.2 PERSONS BETWEEN THE AGE OF 18 AND 64 PER PERSON AGED 65 OR MORE

2026 2.8 PERSONS BETWEEN THE AGE OF 18 AND 64 PER PERSON AGED 65 OR MORE

2036 2.3 PERSONS BETWEEN THE AGE OF 18 AND 64 PER PERSON AGED 65 OR MORE

Source: Based on numbers from “Fem megatrends der udfordrer fremtidens sundhedsvæsen”. Højgaard & Kjellberg. KORA (2017).

4 HEALTH FOR ALL 5 - - - - THE RATE FOR READMISSION THE RATE 5-12X BIGGER for patients with 2 and 3 or more chronic illnesses to patients who are not suffering from compared chronic illness PEOPLE SUFFERING FROM MULTIPLE MULTIPLE PEOPLE SUFFERING FROM EXPENSIVE: ILLNESSES ARE CHRONIC COSTS ARE CARE HEALTH 11X BIGGER for patients with 3 or more chronic illnesses to a patient who is not suffering from compared chronic illness S

154.000

2024 21% GROWTH 21% for the Danish health service. healthcare services. They expect solutions that fit into their everyday lives and conti and lives everyday their into fit that solutions expect They services. healthcare across sectors. of care nuity today. system of the biggest challenges in our healthcare is one of care Continuity have been different initiatives Through the last decades, The challenge is not new. remains a challenge this issue Nonetheless, of care. continuity established to enhance People live longer and therefore often require healthcare services over a longer pe over services therefore often require healthcare longer and live People number of patients with chronic ill riod. Diagnosis and treatment of an increasing patients suffering from multiple In particular, resources. nesses requires significant larger and larger section of the population. up a chronic illnesses will make of high demands on the accessibility place today are well informed and Patients mous pressure on the public sector. In the future, there will be less in the working In the future, there will be less public sector. mous pressure on the new of development The labour. of shortage great a be will There population. age from the patients will and technologies and higher expectations treatment therapies pressure put will it time, same the at but care, of quality higher ensure to contribute on our resources. The Regions will work to ensure that we will work to The Regions a sustainable healthcare to have continue changes will put enor of a period in which demographic are at the beginning We Sustainable healthcare Sustainable 128.000 2014 Source: Based on numbers from “Fem megatrends der udfordrer fremtidens sundhedsvæsen”. Højgaard & Kjellberg. KORA (2017). sundhedsvæsen”. Højgaard & Kjellberg. KORA megatrends der udfordrer fremtidens on numbers from “Fem Based Source: Projected growth Projected NUMBER OF PEOPLE SUFFERING FROM NUMBER OF PEOPLE SUFFERING ILLNES CHRONIC ONE THAN MORE Many well-informed patients are keen to help themselves – for example with the help of technology, which eliminates the need to see the doctor in person. The use of technology asks for a new organisation of healthcare and a greater focus on which services that can be provided closer to the everyday life of patients.

In the coming years, the possibilities to collect and use data will grow exponentially. The challenge will be to use data appropriately in order to make improvements in healthcare. At the same time, IT and data will transform healthcare, including the way we organise healthcare, the skills needed by healthcare professionals, and the way they work.

Demands and expectations from patients, new technology and digital solutions and the massive challenges facing the healthcare system, confirm that we need to challenge the traditional thinking in healthcare. We need to explore new approaches and rethink organisation, coordination and leadership in the healthcare system in Den- mark. The goal is to create an integrated health service that meets patients’ needs and expectations.

6 HEALTH FOR ALL 7 - - - we evaluate and manage healthcare need to be made. need and manage healthcare we evaluate of health for all alone. Instead, it will re the objective achieve cannot The Regions out including patients and stakeholders across the health service, quire collaboration the health service. side planning of care, the individual’s situation and needs should always be taking in to always should situation and needs the individual’s planning of care, consideration. to on ensuring the best possible health among the population is one way Focusing we work Changes in the way faces. system the challenges the Danish healthcare meet and the way we provide we organise the care the way system, across the healthcare hospitalisation. This will require joined system. effort across the entire healthcare is to ensure the highest possible level system The goal of an integrated healthcare have an equal of health in the population. Health for all means that everyone should means to achieve good health will not be to achieve good health. The opportunity In the and situation. needs the same for everyone. It will depend on the individual’s rapid diagnosis, treatment and rehabilitation. rapid treatment afford to focus solely on illness and only provide In the future, we cannot as pos the population as healthy have to focus on keeping We arises. when the need prevent illness and on health interventions that can to focus more need We sible. The Regions will focus will on the The Regions population’s health We service. is a founding principle of the Danish health to care and equal access Easy and we all have the right to a high standard of care, all have an equal right to receive Health for all 1% Catastrophic illness

High-Cost Patients 4% 5+ chronic conditions

Rising-Risk Patients 20% 2-4 chronic conditions

25% One chronic condition

At-Risk Patients At risk for developing 15% a chronic condition

No ongoing Healthy Citizens 35% physical health needs

Clinical Risk Social Risk Behaviroral Risk

Population health management

“Population health management” is trending inter- degree of health literacy or who does not have the nationally. The aim is to achieve the best possible resources to contact the healthcare system is at an level of health in a given population and the most increased risk of becoming ill. Someone who suf- even distribution of health across the population fers from substance abuse has less opportunity to by personalising healthcare to the individual’s actively take care of his or her health and treat his needs and situation. Stratifying the population in or her illness, thereby increasing his or her risk of to different groups defined by their risk of devel- becoming more seriously ill. oping illness or suffering a deterioration of an existing illness is a key tool within population health The population-based approach shifts focus from management. Risk stratification requires data only treating disease to also focusing on health about the health of the population. and risks of becoming ill. At the same time, this approach will allow us to personalise care to the There may be various reasons why a patient is at individual patient based on the patient’s risk of ex- risk of developing illness or suffering a deteriora- periencing a deterioration of his or her health.

tion of an existing illness. A patient with diabetes The figure is from “Prioritizing Population Health Interventions”, and heart disease has a higher risk of suffering ad- The Advisory Board Company. ditional health problems. A person who has a low

8 HEALTH FOR ALL 9 - - - - care. ity. ity. In care. of organisation the decide not should boundaries common and Traditions We it brings to patients and society. stead organisation must be based on the value In system. must rethink and develop sustainable solutions throughout the healthcare and organise shared we finance way with the experiment dare to we must addition, The Regions will take responsibility for ensuring the best responsibility will take The Regions of care possible organisation that brings is organised in a way to ensure that care have a responsibility The Regions to this responsibil are committed We and for society. for the patient the most value This chapter addresses how we can ensure the best organisation of care and how we and how ensure the best organisation of care we can how This chapter addresses pos with the aim of ensuring the best system work as an integrated healthcare can sible health status in the population. to the patient, the population and the society. society. to the patient, the population and the across sectors. and collaboration of cooperation to try out new ways There is a need that and incentives to develop a structural framework the same time, we need At across settings. of care and continuity to support collaboration contribute a lack of continuity in care due to inadequate communication, which potentially has which communication, due to inadequate in care a lack of continuity resources. of use inefficient an creates and patient the of health the for consequences the to see need We are dependent on each other. system parts of the healthcare All best possible and work together to achieve the as one system system healthcare where it brings most value delivered Care must be health status for the population. higher value for patient and society higher value and each has a respon system, in the Danish healthcare There are many stakeholders healthcare challenge for our key citizens. A the Danish to healthcare to provide sibility lead to This can multiple stakeholders. from care need patients often is that system The regions will work to ensure that will work to ensure The regions leads to of healthcare the organisation Integrated healthcare Integrated This may lead to changes in the care organisation. There may be care carried out at the hospital that are more cost-efficient in general practice or in the municipalities. There may be care that hospital and municipality should carry out together with joint financing and management. There may be specific tasks that other professions, such as general practitioners or by private actors, should carry out. Furthermore, there may be care that patients themselves can carry out with the help of technology and digital solutions.

Re-organisation of cardiac rehabilitation

One region reorganised cardiac rehabilitation After the re-organisation of the cardiac rehabilita- and moved most of the rehabilitation from hos- tion, more patients follow the rehabilitation pro- pital to the municipalities. The hospital continues gram. This prevents relapses and admissions . At to have the medical responsibility, but for most the same time, the re-organisation is less costly patients, non-medical rehabilitation will take and frees up resources for care of others. place in the municipality. In this way, hospitals and municipalities work closely together to carry out This example illustrates how, with an open-mind- the rehabilitation of cardiac patients. The region ed approach to the organisation of healthcare, it monitors the quality of the rehabilitation, with is possible to provide more health for the scarce hospitals continually providing data to the Danish resources. Cardiac Rehabilitation Database, and municipalities providing data to a local database.

“Psykiatriens hus” – integrated psychiatric centres

In the recent years, multiple integrated psychi- same roof. Both region and the municipality atric centres have been established in Denmark. fund treatment and staff. This serves to promote The centres are a joint initiative between region greater continuity and cooperation. At the same and municipality, where professionals work to- time, a more holistic approach serves to reduce gether and treatment is carried out under the hospital admissions and readmissions.

The Regions want to collaborate with all stakeholders in the healthcare system to prevent illness and deterioration of illness. This relates to municipalities, general practitioners, private practitioners, private hospitals and clinics as well as voluntary organisations and patient associations. Collaboration may take form as formal partnerships or local alliances with inspiration from other countries.

10 HEALTH FOR ALL 11 ------place demands on quality and performance of and performance on quality demands place out require set The region has for instance care. times and immunisation rates. ments for waiting an incentive the organisation is given In this way the popu to ensure a high level of health among admis lation and to work to minimise hospital sions. tion. Hospitals and general practice are working general practice tion. Hospitals and they pro care ensuring that the together towards cost for the lowest is provided to patients vide policy a via healthcare, adequate ensures still that in hospital admissions through early of avoiding The hospitals have practice. tervention in general and general practice an obligation to support to guidance access have direct general practice the professionals at from hospitals. Healthcare are able to com practice hospitals and general about the mutual via a shared IT system municate care. patients for whom they provide amount The region pays the organisation a fixed this en of money per registered citizen without they Instead for activity. requirement a tailing - - - - one access to health care. to health care. one access that the model of the model shows evaluation An the municipalities The individuals, is a success. and the regions are satisfied with the model, saves the municipalities money. which in addition allel with employment and social initiatives. This allel with employment and social initiatives. with the person and the municipality provides - - - It is crucial that the organisation of healthcare constantly develops in order to meet to meet develops in order constantly It is crucial that the organisation of healthcare models It is a matter of designing innovative of the patients and society. the needs sec than the healthcare with other sectors including collaboration for collaboration, and employment. education the social sector, example as for tor, Population health management – International experiences experiences – International management health Population in partnership with local schools and local media schools and local in partnership with local pur in order to prevent illness. The organisation to ensure use of resources sues the most effective across the popula the best possible outcomes with a private In Spain, a region is contracting to citizens in healthcare organisation to provide selected parts of the region. The organisation hospitals and health in question has their own the organization is working addition In centres. ensure the best care for patients and good health for patients and good health ensure the best care and proactively working by communities their in IT shared data, of use by the care personalising and joint there financing. Furthermore, systems partnering up of healthcare examples good are system. of the healthcare with players outside with population health management. In the US, with population health are services health and Scotland Germany Spain, of organisation and co working with new forms on ensuring the highest operation, with a focus Hos population. the for health of level possible are working together to pitals and primary sector A number of places around the world is working world around the A number of places Collaboration between regions and municipalities on employment between Collaboration and health for early retirement or flexi-jobs, the region pro the support regions The guidance. medical vides and handling health municipalities by identifying par place takes initiatives issues. Healthcare care With the introduction of a new reform of early With retirement pension and flexi-jobs in 2013, a new established between model was collaboration part of the the municipalities and the regions. As citizens need of clarifying municipalities’ process The Regions will work to ensure that the planning of healthcare interventions is based on knowledge and data

Data and knowledge about the population is a prerequisite for providing the best and most appropriate care for the individual and for achieving the goal of health for all.

Knowledge about the health status of the population is useful for stratifying and identifying groups of people who, for various reasons, are at risk of developing a given illness or experience a deterioration of health. Population groups identified can be middle-aged working people, unhealthy middle-aged people, active elderly, frail elderly, young people who engage in risky behaviour, socially vulnerable people and young people who are unhappy, etc.

Healthcare should, to a higher degree, be planned and organised based on each group’s risk of disease and the cause of the risks, rather than on diagnosis.

“The Health Profile” – a source of knowledge about the population

Every fourth year, the regions perform health profile indicates that Danish citizens’ assessment profiles, which are an important source of knowl- of their own health varies depending on their edge about the Danish population’s health and social circumstances. With other words, being health behaviour. A large, representative sample uneducated and without work puts you at an in- of the population completes a questionnaire. The creased risk of disease. In this way, the health pro- health profile helps to highlight health issues and file provides knowledge that makes it possible to groups at particular risk of developing illness. The carry out targeted interventions with respect to regions use the information in the planning of various groups of the population. healthcare interventions. For instance, the health

Knowledge of the population’s risk of experiencing a deterioration in health is of relevance in the meeting between healthcare professionals and the patient. Informa- tion concerning patients’ health can help healthcare professionals to individualise the care to the patient’s needs and situation. Individualised treatment can prevent further illness and hospital admissions.

The possibilities to access and share data across different health care settings are limited. The limited access can lead to adverse events, lack of information and an experience of uncoordinated care for the patient. It is important we work to ensure secure data sharing across the healthcare system for the benefit of patients and a better use of resources.

12 HEALTH FOR ALL 13 ------how they are doing. Patients who are ill but at a they are doing. Patients how of their risk of experiencing a deterioration low able to treat their symptoms health, and who are to a health portal with them-selves, have access to a and guidance symptoms information about to the organisation This allows lifestyle. healthy the best pos while ensuring focus their resources most even distribution of sible health and the health in their population. - - - tive should always be the same: to ensure the highest level of health among the pop always should tive this rea For initiatives. patient-centred must promote and enable local We ulation. to test and develop new forms of management and financing models. son, we want rection of cross-sectoral collaboration. However, we should increase the use of local increase the use of local we should However, rection of cross-sectoral collaboration. Collaboration the development and implementation of interventions. in agreements hospi and private professionals healthcare practitioners, other private with private tals and clinics is also important. but the objec conditions; on local will depend health care to organise The best way to carry them out are missing and the gap between clinical ideals and the real world and the real world ideals clinical them out are missing and the gap between to carry conditions. depending on local varies between strengthen collaboration we can how to consider this reason, we need For support a more binding collaboration. the formal framework can sectors and how di the sets that agreement political a be to continue should agreements health The guidelines and disease management programmes to ensure quality of care and co of care programmes to ensure quality and disease management guidelines ordinated care. agreements, health these implement and develop to resources extensive spend We the obligation and disease management programmes. However, guidelines clinical The Regions will work to improve cross-sectoral will work to improve The Regions collaboration have formalised the regions, the municipalities and general practice 2007, Since develops clinical Health Authority The Danish in health agreements. collaboration Furthermore, the potential to collect and use patient and population reported data potential to collect the Furthermore, is not used and planning of healthcare via apps and questionnaires in the treatment which intends to prevent improper use of data, standards of data security, High fully. to ensure better data sharing. are necessary Data can be utilised to personalise care to patients’ needs to care personalise be utilised to Data can of experiencing a deterioration has a specific has deterioration a experiencing of checks up with them to see nurse who regularly tion data to personalise care to the individual to the individual care tion data to personalise includes The patient record of patients. needs patient’s risk of experienc information about the infor use the doctor can ing deterioration. The patient’s the to care the personalise to mation are ill and at high risk who situation. Patients A Spanish healthcare organisation uses popula A Spanish healthcare Value for patients and society

The Regions will prioritise healthcare interventions that brings the most value for the patient, the population and society

A sustainable healthcare requires prioritisation of healthcare resources. We need to optimise the use of resources in order to avoid waste. The resources invested in healthcare is an investment that will ensure a healthy population and an evolving society.

We have to prioritise resources to areas that provide the best overall value for the patient, the population and the society. In order for this to happen, it is necessary that incentives are contributing to promote a proactive and coherent provision of care.

At the same time, the way we assess quality of care must serve to promote the highest level of health in the population relative to the money invested. The national goals for quality introduced with the new national quality programme in 2016 are the framework for this work.

This chapter addresses how we can ensure a better use of resources by the way we manage and assess the health service.

The Regions believe that a change from activity-based management to value-based management is necessary in order to achieve better value for money in healthcare provision

At present, hospitals are assessed based on their activity level – as for the services they produce. This focus on activity has helped to increase productivity in hospitals. This has resulted in short waiting times and reduced length of stay. However, a focus on activity does not necessarily ensure quality of care or a focus on the outcomes that matter for the patient.

At the same time, the focus on activity does not create incentives to collaborate and ensure coordination of care, since it generates an incentive to focus on the department’s activity budget. Nor does the focus on activity support the transfer of care out of hospitals into the patient’s home, the municipality or general practice, since to do so would result in the hospital carrying out less activity and thereby becoming less productive. 14 SUNDHED FOR ALLE

These years a paradigm shift towards value-based management is growing. There is an international trend towards focusing more on the value of care for the individual, the population and society.

Instead of measuring activity, one measures the effect of all the interventions com- bined. For instance, the number of operations is not important. Instead, it is important to assess the value for the patient and society of all the interventions, including the operation and rehabilitation. This creates incentives for collaboration across healthcare.

A new management paradigm is necessary in order for health service to deliver the best care for the patient and the economy and achieve the highest possible level of health in the population.

THE NORTH DENMARK REGION Hip/knee Diabetes

CENTRAL DENMARK THE CAPITAL REGION REGION OF DENMARK Stroke Anxiety/depression Cardiac disease

THE REGION OF REGION ZEALAND SOUTHERN DENMARK Epilepsy Prostate cancer

The Regions are working towards value-based healthcare

All regions carry out projects with the aim of test- project, the departments receive a fixed amount of ing value-based models. The regions have selected money to fund the treatment of their patients. The seven groups of diseases to test the models. With- budget is not determined by activity. This type of in each group, the regions are developing specific management can improve treatment for patients outcome measures important to the patients. The who suffer from multiple diseases, because it sup- projects provide the regions with experience in ports the hospital to carry out multiple interven- managing healthcare initiatives based on the value tions at the same time. Furthermore, it provides they create. These projects are an important step greater incentives for the hospital to work togeth- towards the regions’ vision of value-based health- er with the municipality and general practice. The care. project helps to promote a coherent provision of care, improve the hospitals’ cooperation with mu- Bornholm Hospital is selected as a project hospital nicipalities and general practice, and minimise hos- to try out new management models with the goal pitalisations. of achieving better continuity of care. During the

15 Information from patients contributes to achieve greater value for the patient and for society

In order to achieve the best value for patients for hospitals to cooperate with municipalities, and society, hospitals need to gather information since the achievement of the goals will depend on patients’ own experiences of treatment and on their contribution as well. outcomes of treatment continuously. This may include the patient’s experience of their functional At the same time, the information supplied by capacity or an assessment of postoperative pain. patients can personalise care and ensure that By using these types of data, the hospital not only conversations with healthcare professionals focus places a focus on whether the surgery was suc- on matters that are of particular importance for cessful, but also on whether the patient suffers the individual. As a result, the patient can avoid from pain, is better to cope with their everyday unnecessary check-ups. This will allow for a pri- life, or in some cases is able to return to work. oritisation of resources to those who need it the Given that rehabilitation in most cases takes place most. within the municipalities, this creates incentives

The Regions want to be assessed on the healthcare system’s ability to keep the population healthy

The Regions will take responsibility for ensuring that the healthcare system works towards ensuring the best possible level of health among the population.

In order to promote a focus on health, it is important that the methods we use to assess the quality of healthcare reflect this focus. We have to assess wheather we succeed with preventing illness and patients recovery.

The Regions focus on implementing the eight new national goals for quality in the health service. The goals set the framework for how we manage and assess the performance of the health service. One part of the healthcare sector cannot succeed in achieving the goals by themselves. It requires collaboration and contribution from multiple parts of the healthcare system. This creates an incentive for different stakeholders to collaborate across sectoral boundaries. In this way, the goals contribute to ensure continuity of care, and focus care to meet the needs and interests of patients and society. However, in the opinion of the Regions, there is a need to develop the indicators of the goals, since they do not in all aspects, reflect whether we succeed in ensuring the highest level of health among the population.

16 HEALTH FOR ALL 17 - - -

- Years of good health Years Lost years of good health there is a need to develop the indicators so that so that indicators to develop the there is a need ensuring towards initiatives they direct healthcare the best possible health among the population. of a better indication give should The indicators a sustainable and towards whether we are moving system. healthcare coherent life present, we assess the goal of “Healthy At “average lifespan” indicators years” based on the However, in the population”. and “daily smokers of any indication do not provide these indicators been so far have whether the years one has lived be con in good or poor health. It should lived of “healthy an indicator whether to add sidered is part of the Danish Health years”. The indicator Profile. a number of indicators have been set out to con have been a number of indicators Regions, cretize each goal. In the opinion of the in good health (healthy years) health (healthy in good living years of Expected or bad health in less good years of living and expected man. a 16 year old years lost) for (healthy sundhedsprofil”, Sundhed – Den nationale “Danskernes Source: (2014). Authority The Danish Health - - - 2013 2010 lead to radical changes to our society. In the years to come, the new technologies new the come, to years the In changes to our society. radical to lead perform operations via re including robots that can healthcare, will revolutionise of help diagnose thousands artificial intelligent machines, which can control, mote profile, patient’s genetic tailored to the be patients, personalised medicine that can optimise production and logistics, and 3-D printers that can technologies that can print out organs. The Regions will work to ensure that technological to ensure that technological will work The Regions use of resources to a better solutions contribute They will range of new technologies are being developed and introduced. A wide More effective health care system health care More effective ly patients rates and patient safety survival Improved of care High-quality diagnosis and treatment Fast Increased patient involvement life years More healthy More coherent patient pathways More coherent ill and elder Increased efforts for chronically system – state, regions, municipalities and gen system the same goal towards – will work eral practice goal, each For healthcare. excellent of providing • pri The national goals reflect the top political They serve as a system. orities in the healthcare all levels of the tool to ensure that governance • • • • • In spring 2016, eight national goals for quality in quality In spring 2016, eight national goals for introduced: were healthcare • • National goals for quality in healthcare for goals quality National In healthcare, there is an inherent force to innovate new medicines, treatment methods, and technologies are developed continually. We must strengthen innovation in the development of technological solutions and provide time and resources for the healthcare staff to assist in developing and testing new ideas. In addition, we must become better at cooperating with stakeholders outside of the health service such as tech communities and companies.

In order to ensure sustainable stakeholders it is essential that we invest in technological solutions. Technological solutions have great potential to optimise processes and logistics in healthcare. Robots can help free up time for medical staff, who instead can concentrate on tasks in which there is a need for human contact. Advanced surgi- cal techniques and personalised medicine can serve to shorten treatment and help patients to get back to work and their everyday lives sooner. Other solutions will require a much more intensive investment of resources. It is important that we do not allow ourselves to be dazzled by technology, but always have an eye for prioritising resources in a way that provide the best value to patients and society.

Artificial intelligence in medical care

IBM has developed a supercomputer, named cer treatment. At present, Watson is designed Watson, for developing artificial intelligence. to support treatment at hospitals in the United So far, Watson is able to understand nine differ- States. Therefore, Watson has yet to incorporate ent languages and with relative ease digest a the European research and guidelines, which large amount of medical literature – as much as is necessary before we can use Watson in clini- twenty million pages of research in ten minutes. cal practice in Denmark. There is great potential Watson can be utilised by doctors as a tool to for a machine like Watson to play a major role in support decisions relating to the patient’s treat- supporting doctors in the future. Particularly in ment. This means that, in case of doubt, a general relation to diagnosis and monitoring, artificial in- practitioner or a junior doctor can ask the com- telligence has a promising future. For instance, ar- puter questions and the computer can assist the tificial intelligence can contribute to optimise the doctor in reaching a more precise diagnosis and use of specialist resources in diagnostic imaging recommend the appropriate treatment based on by automatically analysing x-rays of fractures or the symptoms that the patient presents. The com- by filtering out mammograms that show no signs puter is constantly learning, with the result that of breast cancer. the recommendations will only get better with time. Therefore, it is widely predicted that within In addition, artificial intelligence will be able to few years, artificial intelligence will contribute to process large amounts of data in order to estab- free up specialist resources, while diagnosis will lish patterns, thereby contributing to greater, fast- become faster and treatment will improve. er and more cost-effective advances in research and development. Here in Denmark, a cancer ward has trialled a smaller version of Watson in three areas of can-

18 HEALTH FOR ALL 19 - - - - in their treatment. This will contribute to improve care results, increase quality of life results, increase quality care to improve in their treatment. This will contribute of care. quality and improve well both physically, mentally and socially. The health service is able to diagnose and able to diagnose and is service The health socially. mentally and well both physically, we alone that determines how treat disease, but it is by no means the health service thereby our health and well-being. and live simply focus a more holistic approach to patients – and not Therefore, we must take role and play an active and their families must be involved on their illness. Patients of patients and engage other stakeholders in the provision in the provision other stakeholders of patients and engage of healthcare means being fit and healthy of disease. Being Health is much more than the absence care closer to home. It will also address how new digital solutions and technology will how closer to home. It will also address care and sustainable health service to create a more accessible contribute the care in will promote a holistic perspective The Regions Moving care closer to home will affect the way we work together and how we man we work together and how closer to home will affect the way care Moving age and organise healthcare. contrib can and general practice hospitals, municipalities how This chapter addresses of health among the population and support ute to ensure the highest possible level ment and rehabilitation phases, and no less in decisions concerning the organisation less in decisions concerning ment and rehabilitation phases, and no of patient care. care people must have the option to receive and more be accessible, must Healthcare also We their everyday life. to live continue at home or close to home, so they can solution. be part of the can new digital solutions and technology to look at how need Everyone, irrespective of their social background, is entitled to the same opportuni their social background, is entitled to of Everyone, irrespective and circumstances needs based on the care must personalise We life. ties to a healthy and the involvement in healthcare, part must play an active People of the individual. – both in the diagnosis, treat the health service be a natural part of of people should The Regions will provide personalised personalised will provide The Regions as possible as close to home care Care close to home to close Care Together with the municipalities, we must examine the needs of the population in a broad perspective and become better at engaging other areas of the social welfare sector. This entails a need for knowledge about the effect of initiatives carried out in both the health sector as well as the social sectors.

For many patients, medication and other traditional treatments are not sufficient to help them recover or to ensure that they stay healthy. Social problems can affect a patient’s willpower to stop smoking, despite a desire to do so. Lack of a social network can lead to loneliness, which in turn increases a patient’s risk of developing illness.

Many general practitioners experience that some patients consult them repeatedly without being able to help the patient medically. These patients are often individuals who have social or mental problems or who are lonely or socially vulnerable. As it is now, general practitioners do not have the possibility to offer these patients alterna- tives to medical treatment. There is a need to integrate and develop social interventions in the treatment of this group of patients. This will help to increase patient’s quality of life, promote healthier lifestyle and avoid costly hospitalisations.

Municipalities, regions, patients themselves or voluntary organisations and patients associations can manage the social initiatives and a large number of social initiatives already exist. However, it can be challenging for the healthcare professionals to keep track of the wide range of initiatives. Together with the municipalities, we need to explore how we can gain a better overview of existing social initiatives. Likewise, we need to expand the scope of alliances and partnerships between authorities and organisations.

Structural prevention and nudging

If we are to achieve the best possible health Another way to promote healthy choices is by among the population, we need to become bet- nudging. Nudging means to influence people’s ter at preventing risk factors that lead to illness choices in a particular direction without limiting and deterioration of illness. In order to obtain their options. In this way, nudging supports struc- a profound effect of preventative initiatives, we tural prevention. Examples of nudging include need to promote a local environment that makes making it more attractive to take the stairs than it easier to make healthy choices and supports a the lift or encouraging use of seat belts, etc. There healthy lifestyle. are many opportunities to use nudging more systematically. Structural prevention includes initiatives, which, via legislation, management and regulation, aim to create a framework for health promotion and prevention. Examples include legislation on mandato-ry use of helmets, the addition of iodine to salt and easy access to recreational fa- cilities. Structural prevention is an essential mean to achieve equality of health. We must make the healthy choice the easy choice.

20 HEALTH FOR ALL 21 - - Some private hospitals and clinics in Denmark hospitals Some private have also begun to offer similar services. to visit the doctor in person and can consult the consult and can doctor in person to visit the in bed or doctor wherever they are – e.g. at home signed up at work. 50.000 Swedes have already for this service. - - solutions. Having said this, there is a need to create a better overview of which digital a better overview to create this, there is a need solutions. Having said and the potential uses of digital solutions. solutions are available and apps can for instance assist diabetics in monitoring their disease. In this way, digi in monitoring their disease. In this way, assist diabetics for instance and apps can dete and illness prevent healthcare, to access greater ensure to help can solutions tal helping to ensure a better use of resources. rioration of illness while at the same time and use of digital has a potential to further the implementation The health service to support patients in managing their Digital solutions open up new opportunities medication, help patients remember to take reminders can health and illnesses. Text to home in the future and for engaging patients in their care. Solutions such as online Solutions such as online and for engaging patients in their care. to home in the future interact to service for the health telemedicine open up new ways booking, apps and to like when they would for patients to determine where and with patients – and the health service. contact The Regions will work to make digital solutions a natural solutions a digital make will work to The Regions treatment part of and integrated closer care bringing for opportunities new create solutions technological and Digital about eczema, fever or another minor problem, eczema, fever or about The consultation. it is possible to book a video but via a normal consultation is like con-sultation patient the provide can doctor the and webcam, refer issue prescriptions and make with advice, not need rals. This means, that the patient does Visit the doctor via your smartphone your the doctor via Visit gener In Sweden, a group of doctors has a digital e.g. to talk to a doctor, When you need al practice. “Click-first” – Prioritisation of the doctor and the patient’s time

A group of general practitioners in the UK use a An evaluation of the service has shown that over a “click-first” approach in the treatment of their pa- third of patients chose to treat the specific prob- tients. Before patients contact general practice, lem themselves. Altogether 60 per cent of all con- they are encouraged to fill out an electronic ques- sultations carried out via “click-first” were without tionnaire on the doctors’ website. Patients can any need for the patient to attend the medical choose whether they would like to treat himself or practice physically. The patients experience a high herself with the assistance of information concern- degree of satisfaction and 95 per cent of patients ing their condition (e.g. back pain), whether they consider the solution “good” or “excellent”. The want advice on over-the-counter medicines to treat click-first approach is now spreading to more than their condition, whether they need to contact the one million patients in the UK, and there are plans emergency department or whether they require to extend it even further. an e-consultation with their general practitioner.

Internet-based psychological support

In one Danish region, an internet-based treatment It is the person themselves who choose whether service has been set up for people who suffer to sign up for the programme. After signing up, a from anxiety and mild to moderate depression. team of psychologists evaluates whether the pa- The treatment happens via a computer program tient is a suitable candidate for the programme. that guides the person through a series of treat- The assessment is based on a video interview with ment steps including daily exercises. A psycholo- the patient. The programme ends with another gist supports and monitors the patient through- video conversation, and information regarding out the treatment and it is possible to contact the the treatment is sent to the patient’s GP. psychologist via mail or telephone.

In recent years, new technological solutions have made it possible to move treatment closer to home. Treatment at home gives the patient more freedom to live their everyday lives close to their families. At the same time, it frees up resources for those patients who are unable to treat themselves. In this way, care at home and self-treatment are useful tools to ensure the best possible level of health and a more even distribution of health throughout the population.

22 HEALTH FOR ALL 23 - - - - - Chemotherapy at home is a result of an idea from of an idea at home is a result Chemotherapy the staff to supported Management the staff. and ideas new develop and explore time to take and development the for prerequisite a was this the project. The implementa implementation of in resulted has home at chemotherapy of tion of patient and a high degree outcomes positive in department satisfaction. Every haematological at chemotherapy implementing now is Denmark home. - - - tematic access to specialists. With the specialists on the side, it is possible for general the specialists on the side, With to specialists. tematic access the for treatment of chronic illness and reduce more responsibility to take practice contribute talking to specialists can to refer patients to the hospital. In addition, need among general practitioners. the expertise of chronic care to enhance port general practice to work more proactively to prevent illness and people becom people and illness prevent to proactively more work to practice general port to empower an opportunity time, the regions recognise the same ing more ill. At for the treatment of a range of chronic ill more responsibility to take general practice hospitalisations. costly personalised treatment and avoid nesses and thereby provide and sys easy by providing This will require that hospitals support general practice process of becoming ill, and throughout the course of their illness. This puts general ill, and throughout the course becoming of process the unique position of being able to prevent and detect illness at an early in practice with the patient. contact stage and maintain continuous that the regions sup in the future, it is necessary In ensuring sustainable healthcare most common chronic illnesses most common the population with to provide opportunity an excellent provides practice General helps the population throughout their lives; practice General personalised treatment. ill, while they are in the both before they become patients they interact with their The Regions will support general practice to work practice will support general The Regions of patients suffering from the care and manage proactively with the hospital. After three days, the patient re days, the patient three with the hospital. After check- a and chemotherapy of dose new a ceives the hos telephone can hospital. Patients the at up questions. pital department 24/7 if they have any ceive chemotherapy in their own homes via a pro via homes own their in chemotherapy ceive chemotherapy gives that pump digital grammed be would patients Previously, day. a times several a month at a time. hospitalised for approximately be at home patients can Under the new scheme, without requiring any contact days for up to three Chemotherapy at home Chemotherapy now can leukemia from acute suffering Patients re- and instead hospitalisations lengthy avoid The Regions will improve treatment of patients with complex and intensive needs and strengthen out-of- hospital care

Hospitals provide specialised care to patients with complex and intensive needs. Over the past ten years, the regions have focused on making hospitals more efficient and specialising care. This has resulted in excellent outcomes for patients including high quality, short waiting times and better treatment outcomes.

In the future, an even greater number of pa-tients will suffer from complex, intensive or acute medical needs that require highly spe-ialised treatment. With respect to this group of patients, it would not be safe or financially feasible to provide treatment outside of hospital. It is crucial that we continue to work to provide this group of patients with effective treatment of a high standard.

In the future, there will be more patients having complex needs and suffering multiple diseases. This requires that healthcare professionals with knowledge and expertise from different treatment areas work together in order to give the patient the best and most efficient treatment.

Reorganising the care of patients suffering from multimorbidity

In 2016, a region opened the first outpatient clin- multiple illnesses can receive treatment for multi- ic, at which staff of different expertise work to- ple conditions on the same day. This arrangement gether to diagnose and treat patients with mul- also makes it possible to draw on multiple medi- tiple symptoms or illnesses. The outpatient clinic cal specialists in the investigation of complex and brings together nurses and doctors from multiple ambiguous symptoms. This saves the patient time departments in one place, so that patients with and the health service resources.

A smaller group of hospital patients suffer from particularly complex needs and need extensive treatment. This group of patients needs extra support from healthcare professionals if we are to prevent the deterioration of their conditions and prevent unnecessary hospitalisations. This may take the form of assistance, such as a nurse who follows the patient closely and, together with the patient, puts together a plan of action, which the nurse will follow up on via telephone. It can include assistance to navigate the healthcare system and remembering and organising appointments. The Regions will develop and systematise various types of patient support interventions for this patient group.

24 HEALTH FOR ALL 25 - - - factors together with the patient prior to dis- with the patient factors together is at high risk of readmis charge. If the patient will further include procedure sion, the discharge including rel consultation, a cross-disciplinary of the hospital. outside stakeholders evant the hospital department gives Risk stratification their limited resources to prioritise an opportunity of more for those patients most in need to caring helps risk stratification In this way, care. intensive for health of level possible highest the ensure to the money invested. - - in a safe and secure manner. in a safe and secure manner. The future hospital must proactively encourage innovation and intelligent solutions innovation encourage The future hospital must proactively out treatment at home. It is important patients in a better position to carry that place to develop better skills and flexibility that management and staff have the necessary helps alleviate the increasing burden on hospitals solutions for patients. Home care support from hospitals in the With people to have a more flexible life. while allowing home at care manage to empowered are, patients monitoring, and guidance of form the hospital. The hospitals will largely, need to support the other parts of the health need the hospital. The hospitals will largely, and the municipalities. to patients, general practice consultancy by providing service the same treatment out of hospital. At more it will be possible to move In that way, of care. for ensuring continuity responsibility time, hospitals must take proach in their interaction with patients. health for the population entails that we The goal of ensuring the best possible in hospitals as something separate from the no longer view specialised treatment hospital. Therefore, it is of outside that is provided treatment and care follow-up to expertise at access and municipalities to have easy general practice for necessary If we are to achieve the goal of securing the best possible level of health for the If we are to achieve the goal of securing This for healthcare. a broader responsibility entire population, the regions must take and engaging ap holistic a proactive, take entails that hospitals to a higher degree The staff organise the discharge procedure based discharge procedure The staff organise the every discharge, profile. At on the patient’s risk a plan of discharge. If a patient is the staff makes health at moderate risk of readmission, relevant and risk professionals review potential obstacles patient’s risk of readmission. The healthcare pro The healthcare patient’s risk of readmission. on data about patients based fessionals stratify hospitalisation, comorbid of cause length of stay, the acute admissions over and the number of ity past six months. Discharge adjusted to the patient’s risk of readmission patient’s risk to the adjusted Discharge of examples a number of international There are on the based procedures personalised discharge Paediatrics

Each year multiple children are hospitalised with and staff in the design of specific children’s hos- serious illness. Some of these children need to be pitals and departments to ensure the best envi- hospitalised for long periods of time. In such cir- ronment for the treatment of children and young cumstances, it may be a challenge to make family people. The involvement of patients in a major life work. At the same time, it is very important construction project has given staff new insights for the sick child and its healthy siblings to keep into children and families’ needs, and these in- the family together through the period of illness. sights have been incorporated into the architect’s In several parts of Denmark, family centres have plans for the new hospital. The staff looked at cur- been established in which families with a child rent patient treatment programmes to identify hospitalized long-term is able to live in close prox- waste. This has revealed a need for the creation imity. The family itself sees to the running of the of flexible outpatient clinics where relevant spe- house. These centres contribute to providing the cialties and professional groups can provide care family with safe surroundings and allow the family together. At the new children’s hospital, there will to carry on a day-to-day life together. be a greater focus on integrating care, research and education - and this will all take place in the Children are a unique patient group with different context of interaction between patients, health- needs than adults. There has been success with care staff and occupational health and safety ex- the systematic involvement of patients, relatives perts.

26 HEALTH FOR ALL 27 ------wards a sustainable healthcare. a sustainable healthcare. wards ensuring of work the continue to forward look We FOR ALL HEALTH oration of existing illness is key to achieving the high oration of existing illness is key must We est level of health among the population. and systematically use data on the population’s needs initiatives as a foundation for the planning of health to use analyses of the need We for the population. sectors. Further across healthcare patient’s pathway use of digital solu far greater more, we must make brings. tions and the opportunities technology achieve to solution for how a fixed not deliver do We we have proposed a range Yet, sustainable healthcare. in order to take necessary of steps, which we consider Some to achieve the goal of a sustainable healthcare. implement ourselves, but most of the steps, we can across the of the steps will require the collaboration be realised in Some steps can continuum. healthcare a longer period. the near future, others will take is a long one. It The road to a sustainable healthcare com will require that all parts of the health service bine their efforts to achieve the highest possible level to like would Regions of health in Denmark. Danish to parties to participate in the drive all relevant invite cal conditions. We want to test new forms of collabo to test new forms want We conditions. cal with new jointration and experiment organisations of joint and care financing. strong partner to promote like would Danish Regions municipali practice, general hospitals, between ships that support sus Partnerships players. ties and private to provide us collectively tainable solutions, allowing for the money invested, the best possible healthcare grounded in the population’ needs. deteri to prevent illness and initiatives of Prevention ------We must develop the way we collaborate across the we collaborate must develop the way We patients with the in order to provide health service be must We possible. service efficient most and best lo adjusted to organisation and performance to open Throughout the health service, we need to have com we need Throughout the health service, of the service mon goals and focus on the total value to the population. If we do this, we will provided and optimise health service achieve a more coherent the use of resources. with continuity of care grounded in the needs of each grounded in the needs of care with continuity illness or developing of risk including the individual, deterioration of illness. within the health service, with our partners Together we manage healthcare. to develop the way we want ongoing development, which must be supported by ongoing development, which must be action. that we look Implementing these changes will require the population we – across sectors –provide at how tire healthcare system: the way we work, collaborate we work, collaborate the way system: tire healthcare It requires a change of care. and manage our provision on management, hospital in regions, the in culture of among health the part of our municipal partners and not changes, which we are These professionals. care an is part of next. It to the day from one achieve can together to provide the best care. The goal should be The goal should care. the best together to provide for the en to ensure the best possible level of health tire population. health for the The goal of achieving the best possible entire population requires major re-forms of the en We need a new perspective on healthcare. Instead Instead on healthcare. a new perspective need We to focus on health. we need of focusing on disease, as more than be seen should The role of the Regions see to we need owners; hospital as role the simply that works ourselves as part of a bigger partnership “HEALTH FOR ALL” is Danish Regions’ idea of how we of how idea is Danish Regions’ FOR ALL” “HEALTH in Den have a sustainable healthcare to continue can mark. Postscript The way forward

In this section, Danish Regions proposes a range of actions that can support our way forward. The actions described in the following will not be enough to meet the future challenges. The transformation health service has to undergo will be achieved via a process of continuous development. The actions set out below are steps on the way to a sustainable healthcare.

The Regions will take responsibility for ensuring the best possible organisation of care

New initiatives will be developed and evaluated • The Regions will initiate a project focusing based on whether they contribute to a more pos- on patients suffering from severe psychiatric itive outcome for the individual, the population ill-ness who receive treatment from both re- and the economy as a whole. gion and municipality. The project will aim at promoting cooperation between regions and • The Regions will initiate a project in which municipalities via joint financing and shared hospitals, general practice, the private prac- staff. Patients will experience continuity of tice sector and private clinics and hospitals care irrespective of whether it is the region work together in an integrated healthcare or the municipality who provides the care. model with a shared goal and budget. The The project should serve to reduce the risk project could look at a specific population of deterioration of patients’ conditions and group or a particular type of organisation – thereby prevent readmission. e.g. health centres.

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tion for local initiatives. It should be possible It should initiatives. tion for local through the to enter and adapt agreements arises in the population. period as the need This requires a revision of the legislation con health agreements. cerning The Regions will contribute to ensure that the to will contribute The Regions more a much takes system healthcare entire use risk stratification approach and proactive to prevent ill and population segmentation of existing illness. ness and the deterioration the to enhance will contribute The Regions Health profile systemat- use of data from the hos between within the collaboration ically pitals, municipalities and general practice. of care be used in the planning Data should level of health to achieve the best possible among the population. • • - - - - - We want to develop the concept of health to develop the concept want We element of the The political agreements. direc set out a common should agreement patient data to be realised. ing sharing of patient data throughout the ing sharing of patient data throughout devel quality Treatment, system. healthcare For linked. closely are and research opment believe that legisla this reason, the Regions best tion must be modernised to create the for the full potential of the use of conditions provided for the patient, the population and provided be utilised These analyses must the society. across to promote innovation systematically system. the entire healthcare improv will work towards The Regions The Regions will place a strong emphasis on a strong will place The Regions with system the entire healthcare providing of the care and value analyses of the impact sectoral collaboration. • We need to reconsider the framework for cross- to reconsider need We • Healthcare should be grounded in the popula be grounded should Healthcare deteriorating health. tion’s risk of experiencing • The Regions will work to improve the cross-sectoral collaboration will work to improve The Regions The Regions will work to ensure that the planning of healthcare healthcare planning of ensure that the will work to The Regions and data on knowledge is based interventions The Regions believe that a change from activity-based management to value-based management is necessary in order to achieve better value for money in healthcare provision

Management and incentives must ensure that the • The Regions will develop and test differen- healthcare service provides the best value for the tiated financing models, which support effi- population and society. ciency and continuity of care.

• The Regions will assess the value and impact • The Regions will strive to eliminate the re- of the patient’s entire course of treatment in quirement of productivity the Regions expe- order to promote efficiency and continuity of rience. care

The Regions want to be assessed on the healthcare system’s ability to keep the population healthy

The Regions will work to promote incentives for • The Regions will promote development of the whole of the health service to focus on achiev- the indicators for the eight national goals for ing the best possible level of health among the quality in healthcare such that they support population. the goal of achieving the best possible level of health among the population.

30 HEALTH FOR ALL 31 ------purchases, which can contribute to efficiency contribute purchases, which can and sup perspective, economic in an overall port innovation. further we can will look at how The Regions in or- social services of various the knowledge der to promote a more holistic approach to patients. documentation encourage will Regions The of social interventions. of the outcomes The Regions will promote ourselves as an will promote The Regions in the de partner for companies attractive solutions technological velopment of new setting up will do this by We for healthcare. with consolidated long-term partnerships development, with working companies tech of new techno testing and implementation for healthcare. solutions and services logical scal will work to support faster The Regions so ing and implementation of the innovative in have developed lutions, which the Regions industry. partnership with the private will work to promote valuable The Regions strategy for prevention. • • in In “Health for Life – prevention is a necessary read more about the regional vestment”, you can • • • ------The Regions will examine possibilities for al will examine The Regions and partnerships with a broad range liances organisa including voluntary of stakeholders, in order to pre tions and the social sector, vent illness and the deterioration of illness. malpractice. malpractice. The Regions will gather knowledge about will gather knowledge The Regions intel new technologies, such as artificial test out these solutions in the and ligence, This system. of the Danish healthcare context and prevent up resources will help to free cines Council so in time, the Council will as will as Council time, the so in Council cines treat clinical for technologies new assess well must of new technologies ment. Assessment in terms of they add be based on the value level of health the highest possible providing in return for the money invested. The Regions will develop the Danish Medi will develop The Regions • health among the population, it will be necessary health among the population, it will be necessary to focus on health promotion and prevention. the welfare across Health must be incorporated sectors in order to achieve a more holistic ap proach to health. In order to achieve the best possible level of In order to achieve the best possible • There is need for systematic assessment of the assessment for systematic There is need to possibilities with respect new technological the most pos to creating whether they contribute money invested. sible health for the • The Regions will promote a holistic perspective in the care of patients the care in will promote a holistic perspective The Regions of healthcare in the provision other stakeholders and engage The Regions will work to ensure that technological solutions contribute solutions contribute ensure that technological will work to The Regions use of resources to a better The Regions will work to make digital solutions a natural and integrated part of treatment

Digital solutions can provide new ways for the • The Regions will initiate a project in which population to access healthcare while helping to international experiences of digital access to focus resources in order to achieve the best pos- general practice are examined with the pur- sible level of health for the money invested. pose of testing and implementation of similar portals in Denmark. • The Regions will develop a strategy for the digital transformation of the health sector. • The Regions will expand the use of internet- The strategy will support a better use of based psychiatric treatment in Denmark, in potential new technologies and a quicker order to provide free psychological counsel- translation and implementation of approved ling without referral to people suffering from solutions benefiting patients and health pro- mild to moderate anxiety and depression. fessionals. Evaluations of the scheme will be collected and used in order to examine whether the • The Regions will certify health apps with the scheme should be expanded to other patient purpose of providing a qualified overview for groups within psychiatric care. the population and the clinicians. This will serve to support a more systematic integra- tion and utilisation of apps in the treatment and monitoring of illness. Apps will help to provide better opportunities for self-monitoring and self-treatment.

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The Regions will support general practice to work proactively and manage care of patients suffering from the most common chronic illnesses

General practice must share the goal of achieving • The Regions will initiate a project to support the best possible level of health among the pop- general practice in working more proactive- ulation and contribute to the goal by providing ly with the help of data concerning specific more services for patients suffering from the most patient groups. The target group may for in- common chronic diseases and by working more stance be diabetes or COPD patients. proactively. • The Regions will secure close links between • The Regions will secure general practice easy general practice and hospitals via hospital and systematic access to specialists in the management so that hospitals to a higher form of telemedicine solutions, hotlines, e- degree have a perspective of the needs of mail correspondence and visits by specialists general practice. in general practice. In “Vision for general practice”, you can read • The Regions will support general practice to more about regional objectives for the future of work proactively by surveying international general practice. experiences of databased solutions, with a view to implementation of the solution in Denmark.

The Regions will improve treatment of patients with complex and intensive needs and strengthen out-of-hospital care

In the future, the work of hospitals will largely be • The Regions will focus on developing hospi- focused on treating citizens with complex, acute tals in a way so that they to a higher degree and intensive needs. Furthermore, hospitals will can support the rest of the healthcare system. in the future take more responsibility to support other players in the health system in the provision • The Regions will develop and implement pro- of care. active support targeted at the most vulnerable patients and patients who are at high • The Regions will develop a strategy for the risk of repeated acute admissions. future hospitals. The strategy will focus on how hospitals can contribute to achieve the best possible level of health among the population.

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