"Integrating" Patients and Citizens in Integrated Care: Insights from a large-scale PHM program in France

Introduction : Since 2022, FHF has deployed in five regions an integrated care/population health model that calls for local stakeholders to develop shared clinical programs along a Quadruple Aim framework. The model has generated impressive results, due in large part to patient involvement in key aspects. We illustrate this from three angles : patients in designing healthcare strategies, patients as operators, and citizen involvment in reaching vulnerable populations. Who is it for ? Managers and professionnals in PHM programs, patients and citizens seeking to engage healthcare organizations. Who did you engage with ? The model calls for local healthcare stakeholders to develop shared clinical programs built on FHF’s methodology and guidelines. Both call for active participation of patients at every step and every level. What did we do : Patients in each region participated in « clinical meetings », with healthcare stakeholders to design their local « shared clinical programs » : in the definition of local priorities, of pathways, in the design of actions aimed at target populations, and in setting up a broader alliance of all healthcare stakeholders. Following their local programs, patient associations are engaged in the operations. They participate in outreach and screeing, in patient education, in community mobilization, as well as in the improvement of integrated pathways. 76 Patients/Partners are actively involved in the five regions. One of the five regions developped a « citizen ambassador » program to improve to ability of the system to connect with vulnerable populations. This programs « trains » voluntary citizens to carry « health messages » in their communities and bridge the gap between them and healthcare services. Results ? Full scale deployment started in January 2022. 788 outreach activities have been performed, reaching 13 900 at risk individuals for counseling. 11 500 individuals have been screened for diabetes. 3 500 patients are enrolled in integrated pathways. Share of ER admissions for diabetic patients has dropped from 21% to 13%, and ambulatory stays increased from 36 to 57%. Patients and communities have been a major factor in mobilizing a network of 129 partners in the 5 regions. Although we only have empirical evidence at this stage, patients involvment has a positive impact on quality at work and pride in work. The « citizen ambassador » program is in the process of being replicated in the other four Territories. What is the learning: Patient at the planning, operationnal and pathways levels are key for the success of integrated care. Although robust data and clinical guidelines are a prerequisite, the life experience of patients and citizen is as important for success. Patients and citizens shouldn’t come « after » programs have been designed, they should be integral part of the process. Next steps : 3 new regions have joined the program. We expect to learn from them, since they can benefit from the methodology and experience generated by the five « Pionneers ». Also, FHF plans to build on the lessons learned to develop methodology targeting patients and citizens’ involvment.