Local health units in Portugal: key factors for successful implementation of an integrated care model

Background: Over the last few years, the health needs of the Portuguese population have suffered major changes, and this has generated strong pressure on healthcare services, with difficulties in access, quality of care and, consequently, user experience, despite the increase in healthcare budgets.

To respond to this problem, the Portuguese government decided to implement a new organizational model, local health units (LHUs). LHUs are a population-based management model in which healthcare is vertically integrated to achieve the triple aim, improve the health of the population, improve the user experience, and reduce healthcare costs.

A project was designed to monitor the implementation process of these LHUs. This project is divided into several steps and the first step has the following main objectives: to describe the state of the art of care integration to identify the main barriers and success factors that can influence the process of integrating care in Portugal.

Methodology: To achieve this objective of analyzing the state of the art of integration, a systematic literature review was carried out with the aim of understanding healthcare integration and its relationship with the instruments and mechanisms for organizing, financing, and evaluating the performance of integrated units, as well as defining the main aspects that should be worked on to ensure the success of this care integration initiative.

Along with this literature review, we applied benchmarking to a set of territories with consolidated experience in care integration. We reached five regions: the Basque Country, the United Kingdom, Australia, Canada and the USA.

Results: Based on this literature review and benchmarking, it was possible to divide the interventions into five main groups:

Strong leadership and team involvement, the alignment of all those involved in the process must be promoted, ensuring that they are well aware of what the project is and what its objectives are; awareness of the existence of long- and medium-term results, but with the need for short-term investments,  integration processes require immediate investment, both financial and human, to support the transformation and reorganization of structures and ways of working, but results only emerge in the medium to long term, which is why it is necessary to maintain consistency and commitment; creation of environments that encourage innovation; developing instruments for planning and managing the process itself, ensuring that things like funding and performance evaluation are in line with the strategic objectives set, and promoting adaptability and flexibility, no two places or populations are the same and so we can't expect an intervention to have the same results in all places, so there must be space for the teams on the field through a bottom-up approach adapt the interventions to the specific needs of each population.