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Fostering Collaborative Governance in Chronic Disease Management Programs: A Dynamic Performance Management Approach

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Enabling Collaborative Governance through Systems Modeling Methods

Part of the book series: System Dynamics for Performance Management & Governance ((SDPM,volume 4))

Abstract

Chronic diseases are the leading cause of disability and mortality in the world and represent a global health emergency due to the increase in frequency and complexity that has been occurring in recent years. The outcomes related to chronic care needs depend on the joint effort of a multi-provider, multi-disciplinary, and multi-professional service network, which operates along a clinical pathway. However, all the different players involved in the provision of services may have different interests and goals derived from their organizational structure and their role in the overall health system. This context of fragmented governance makes performance management of care services problematic. It requires the assessment of interorganizational relationships of the multiplicity of providers involved in the service delivery. This chapter aims to show how a dynamic performance-based perspective may effectively support chronic care management and help decision-makers focus on critical drivers impacting on desired results. For this purpose, the chronic disease management program implemented in the Lombardy Region (Italy) was used as a basis for developing a dynamic performance management framework. This approach is then used to address obstacles impeding the success of the chronic disease management program and to outline alternative policies the different decision-makers involved in the healthcare pathway delivery may implement to improve the whole program performance.

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Notes

  1. 1.

    Value in health has been defined as multifaceted and multidimensional outcomes achieved with the available resources (Porter, 2010).

  2. 2.

    The healthcare plans were set based on the national guidelines of care, Diagnostic and Therapeutic Care Pathways (Percorsi Diagnostici, Terapeutici e Assistenziali—PDTA) related to a certain pathology, and the data available on the treatments carried out in the past. Such data are collected by the patient’s database (BDA—Banca Dati Assistito) managed by the region. The healthcare plan determines all the care activities (e.g., general practitioner consultations, laboratory examinations, consultations with specialists, medication, assistance from nurses, etc.) deemed necessary for appropriate management of the patients’ chronic pathology. Since each patients’ case is different, healthcare pathways are adopted by also taking into account the individual needs and conditions of the patient; as a result, a one-year individual healthcare plan (Piano Assistenziale Individuale—PAI) is defined by the provider chosen by the patient.

  3. 3.

    For each CReG class, a fixed tariff is set. It is based on the previous resources consumed by patients with similar health needs as recorded in the patients’ database (BDA). CReG classes related to patients with the most sever chronicity level 1 are assigned the highest tariff. The lowest tariffs are set to patients in the level 3 of chronicity. The BDA is particularly important for the region to track the usage of healthcare services as well as medication consumption of patients enrolled in the CReG program and to monitor and update CReG classes tariffs.

  4. 4.

    The introduction of an incentive-penalty plan is stated in the regional act n° IX/1479 of the 2011 March 30.

  5. 5.

    The double-layer portrayed in a strategic resource shows a multi-dimension asset. For instance, “GPs & GPs coordination abilities” indicate both the number and the level of coordination abilities of GP involved in the program.

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Acknowledgments

The authors wish to thank Prof. Sabina Nuti, Dr. Francesca Ferrè, and Dr. Elisa Foresi from the Management and Health Laboratory of the Sant’Anna School of Advanced Studies, and Dr. Paolo Berta from Bicocca University for the fruitful discussions and suggestions provided on the topic explored in the chapter. We would like to thank also the two anonymous reviewers. The usual disclaimers apply.

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Authors and Affiliations

  1. Department of Political Sciences and International Relations (DEMS), University of Palermo, Palermo, Italy

    Enzo Bivona

  2. Department of Economics, University of Messina, Messina, Italy

    Guido Noto

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  1. Enzo Bivona
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  2. Guido Noto
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Correspondence to Enzo Bivona .

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Editors and Affiliations

  1. Department of Political Sciences CED4 – System Dynamics Group, University of Palermo, Palermo, Italy

    Carmine Bianchi

  2. Department of Public Administration & Policy, University at Albany, SUNY, Albany, NY, USA

    Luis F. Luna-Reyes

  3. Department of IS & Business Analytics, University at Albany, SUNY, Albany, NY, USA

    Eliot Rich

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Bivona, E., Noto, G. (2020). Fostering Collaborative Governance in Chronic Disease Management Programs: A Dynamic Performance Management Approach. In: Bianchi, C., Luna-Reyes, L.F., Rich, E. (eds) Enabling Collaborative Governance through Systems Modeling Methods. System Dynamics for Performance Management & Governance, vol 4. Springer, Cham. https://doi.org/10.1007/978-3-030-42970-6_14

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