For the past twenty years, France has been trying to break away from the hospital-centric approach to its healthcare system. It has embarked on the "virage ambulatoire" (ambulatory shift): the transition from a healthcare system in which the hospital is at the heart of all care, to an organization that makes local doctors and primary care teams the coordinators of healthcare pathways. The health crisis has reminded us of the importance of stepping up our efforts to accentuate this shift, while at the same time reinforcing the shift to the home.
At a time when the aging of the population is a reality, the development of new homecare and outpatient services is an imperative.
- Arnaud Morigault, Eurogroup Consulting partner, has joined the working group co-chaired by Florence Herry, co-founder and president, libheros, and Marion Menut, head of government and institutional affairs, Abbvie.
- Nathalie Loiseau, Director,
- Matthieu Sainton, Partner,
- and Caroline Schwartz, Manager, Eurogroup Consulting, were among those interviewed.
The report puts forward 6 concrete proposals to ensure that France fully embraces the shift to ambulatory and domiciliary care.
THE SHIFT TO AMBULATORY AND HOME CARE
The shift to ambulatory care began in France in the middle of the 20th century, with the possibility for patients to be cared for in hospital during the day, without having to stay overnight. This has led to the development of a range of care modalities, such as outpatient surgery, day hospitalization (HDJ) and home hospitalization (HAD). The development of ambulatory care also involves a less use of conventional hospitalization in favor of other ways of caring for patients, whether in the community or at home. At a time when 50 % of hospital carers may have been affected by burnout, the challenge here is indeed to restore the hospital to its rightful place and build healthcare pathways that mobilize the right player, for the right care, at the right time.
Ambulatory and domiciliary practices thus represent all of the devices that make it possible to limit the time spent in a healthcare facility. This has been made possible in particular by the emergence of numerous innovations which have contributed to significant changes in healthcare pathways:
- technical innovationsSurgical robots, for example, improve surgical precision and healing, enabling patients to return home more quickly;
- technological innovationsThese include remote monitoring devices, which allow more regular remote monitoring of chronic illnesses and, in some cases, avoid full hospitalization;
- therapeutic innovationsThese include treatments and drugs that are less burdensome for patients and can be delivered in the community.
Obstacles to the deployment of ambulatory and domiciliary practices
Despite the development of new care methods, France is still struggling to make the transition from ambulatory to residential care. In fact, the average length of hospital stay (LOS) in France is higher than the OECD average. Several obstacles to the deployment of ambulatory and domiciliary practices can be highlighted in our country.
Lack of coordination between players
The new healthcare pathways require greater coordination between hospital, city and homecare professionals. Geographical separation of these professionals and their multiplicity are making it more complex to set up teamwork around the patient. The development ofdigital toolsto help healthcare professionals get in touch with each other.emergence of coordinated exercises in the city, represent levers to be perpetuated to facilitate this coordination and build seamless care paths.
Training insufficiently geared towards outpatient care
The training of healthcare professionals (medical and paramedical) is poorly adapted to the issues raised by ambulatory and home care. As part of their initial and continuing training, these professionals remain insufficiently aware teamwork, coordination and the specificities of practice in the city and at home.
Patients on the sidelines of new pathway organization
Although patients are becoming increasingly expert in their disease, they are still rarely considered as a full player in their own healthcare journeyas well as their caregivers. Patients and their families are not always aware of the various possibilities treatment and care.
Financing and pricing models with few incentives
Our funding model, still largely based on fee-for-service pricing, offers little incentive for coordination between players and the integration of an integrated approach. preventive approach by healthcare professionals. Financing options to suit your needsinvolving players from hospitals, towns and the home, are being developed but must be perpetuated.
Other regulatory hurdles
Budget allocations and authorizations to deliver treatments in towns, for example, also represent additional constraints to "take" certain care and treatments out of the hospital.
A HEALTHCARE SYSTEM COMMITTED TO NEW CARE PATHWAYS
Proposal no. 1
Building coordinated practice areas between medical, paramedical and social professionals, adapted to local healthcare needs and supply. These spaces will enable us to pool resources and offer patients a one-stop shop.
Proposal no. 2
Facilitating coordination between healthcare professionals working in hospitals, towns and the home, in protocolizing hospital discharges according to pathologies and associated healthcare pathways.
Proposal no. 3
Include in the initial and continuing training of healthcare professionals coordination issues, teamwork and management skills, while at the same time training in digital tools capable of fostering this networking.
Proposal no. 4
Defining quality of care indicators adapted to outpatient pathologies, while at the same time equipping healthcare facilities (hospital, city, home, medico-social) in numerical applications able to collect and analyze these indicators.
Proposal no. 5
Developing new financing models capable of supporting both the coordination of healthcare professionals and organizational innovation.
Proposal no. 6
Create personalized therapeutic patient education (TPE) models, in the city and at home, taking into account the patient's level of knowledge and autonomy, his or her pathology and environment.
While the challenges faced by hospitals are not new, they will become more acute in the years ahead. An ageing population and an explosion in the number of pathologies chronicles are increasing the need for care, while the amount of medical time available is not. This complex equation argues in favor of reorganizing the healthcare system and imagining new ways of working. new care pathsMore efficient and balanced between the city, hospital and home.
WORKING GROUP COMPOSITION
Chairmen
- Florence Herryco-founder and president, libheros
- Marion MenutHead of Government and Institutional Affairs, Abbvie
Working group members
- Christophe BouteloupHAD General Manager, ELSAN
- Thierry HouselsteinMedical Director, MACSF
- Alain Laforêtmember of the executive committee and board of directors, France Assos Santé
- Martin Le Roux-CaucheDirector of Public Affairs, Air Liquide
- Claire Lhériteau-CalméPublic Affairs Manager, Doctolib
- Catherine LiabeufDirector of Government Affairs, Intuitive Surgical
- Pierre-Michel LlorcaHead of Psychiatry Department, CHU Clermont Ferrand
- Stéphane LocretDirector, Research and Teaching Department, Ramsay Santé
- Arnaud MorigaultPartner - Healthcare Consulting, Eurogroup Consulting
- Françoise RimareixMedical Director, Gustave Roussy
Project team
- Margaux Buguethealthcare consultant, EY (rapporteur)
- Sophie Leroseyconsultant, Pergamon (rapporteur)
- Laure MilletHead of Health Program, Institut Montaigne
- Emma RosResearch Manager, Health Program, Institut Montaigne
People interviewed
- Guillaume AlsacDirector, Soignons Humain
- Eugénie BarjonEva Santé Development Director, Galileo Global Education
- Fabrice BarlesiGeneral Manager, Gustave Roussy and Professor of Medicine, Université Paris Saclay
- Sophie BeaupèreGeneral Delegate, Unicancer
- Alain BeaupinPresident, Coopérative de santé Richerand
- Alexandre Berkesse, Director Europe, Center of Excellence on Partnerships with Patients and the Public (CEPPP) and Associate Professor, EHESP Management Institute
- Jeanne Bertrand, institutional project manager, Unicancer
- Julien BlancDirector of Major Projects and Public Affairs, Galileo Global Education
- Antoine BlochVice-President, France, Biomérieux
- Sandrine Boucher, Director of Medical Strategy and Performance, Unicancer
- Stéphanie du BoucherSenior Manager Public Affairs, Roche and General Secretary, Roche Foundation
- Alice Bouleaueconomic researcher, Asterès
- Marc BourquinStrategy Advisor, Fédération Hospitalière de France
- Mathieu BouthemyHead of Institutional Relations & Public Affairs, France Biotech
- Rémi BouvierGeneral Manager, Aésio Santé
- Maxime BubrovszkyDirector, Fédération Régionale de Recherche en Psychiatrie et Santé Mentale, Hauts-de-France
- Yvanie Cailléfounder and member of the Comité Consultatif National d'Éthique pour les sciences de la vie et de la santé (CCNE), Renaloo
- Michael CanovasDirector of Cabinet and Communications, Unicancer
- Axel Cardecoordinating pharmacist, OCTAVE
- Emmanuelle CauchardSubnational Market Access Director (Hospital/Retail),Roche
- David CaumartinVice-President, France Biotech
- Thierry ChichePresident, ELSAN
- Gabriel DaubechDirector of Public Affairs, AstraZeneca
- Adrien DebeverDeputy Director, Ambulatory Care Department, ARS Hauts-de-France
- Sophie Delmottecross-functional project manager, Direction de l'Offre de Soins, ARS Hauts-de-France
- Marie-Alexandra DivandaryHead of the Authorization, Planning and Contractualization Department, Direction de l'Offre de Soins, ARS Hauts-de-France
- Jean-François DumasGeneral Secretary, Conseil national de l'Ordre des masseurs-kinésithérapeutes
- Jean-Philippe EstradePresident, Society of Gynecological and Pelvic Surgery
- Gérard FriedlanderGeneral Delegate, Fondation Université Paris Cité
- Christelle GalvezDirector of Care and Pathways, Clcc de Lyon and Co-President, Association Française de Chirurgie Ambulatoire (French Ambulatory Surgery Association)
- Guillaume GaudPresident and Founder, Continuum+
- Agathe Gobelco-founder, Gudule
- Nicolas GombaultChief Operating Officer, MACSF
- Inès GraveyDeputy Director of Innovation, AP-HP HAH
- Anne-Ségolène GruartHead of Risk Management/ ONDAM Plan, Healthcare Services Department, ARS Hauts-de-France
- Elodie GuilbaultHead of the Amélioration Efficience department, Direction de l'Offre de Soins, ARS Hauts-de-France
- Thierry GuillaumePresident, Experf
- Daniel GuillermPresident, Fédération Nationale des Infirmiers
- Larbi HamidiPresident, Santé Cie
- Eric HaushalterHead of the Department of Care Coordination and Efficiency (DCES), CNAM
- Gérard HermantManaging Director, ISRP
- Clotilde JolivetDirector of Government and Public Affairs France, Sanofi
- Julien JourdanGeneral Manager, Fédésap
- Sophie Labrosselife sciences officer, Embassy of Denmark in France
- Carole Lamotteliberal nurse, administrator, Fédération Nationale des Infirmiers and president URPS Occitanie
- Sandy LavieProject Manager, OCTAVE
- Orianne Le HenaffChief of Staff, Ramsay Santé
- Hélène LeblancDirector of Public, European and International Affairs, Ordre National des Pharmaciens
- Olivier LebouchéChairman, Petits-fils and Managing Director, Korian France, in charge of New Activities
- Martine LefebvrePresident of the Board of Directors, Fédération de Recherche en Psychiatrie et Santé Mentale, Hauts-de-France
- Aurélie de LehvenfehltSubnational Market Access Project Manager, Roche
- Pascale LejeuneGeneral Secretary, Fédération Nationale des Infirmiers
- Chrystèle Lemannurse, health executive, project manager for the Art.51 Équilibres experiment, co-founder, Association Soignons Humain
- François LemareDirector of Territorial Strategy, AstraZeneca
- Magali LeoAdvocacy Officer, Renaloo
- Nathalie LoiseauDirector of Healthcare Consulting, Eurogroup Consulting
- Pierre MaitrotExecutive Vice President, Operations, ELSAN
- Delphine MalletDirector of the Health & Autonomy Business Unit, La Poste Group
- Pauline Martinotco-founder of Les Ateliers Mercure and public health physician
- Dr Jean-Christophe MasseronPresident, SOS Médecins France
- Pascale MathieuPresident, Conseil national de l'Ordre des masseurs kinésithérapeutes
- Constance Maudouxpublic and government affairs specialist, Doctolib
- Samuel Ménagerpublic affairs officer, Ordre National des
Pharmacists - Prof. Etienne MinvielleDirector of the Centre de Recherche en Gestion,
École polytechnique (I3-CRG, CNRS, IP Polytechnique) and health physician
public, Gustave Roussy - Benjamin Mousnier-Lomprépartner, ipso santé
- Mathieu Nochelskinurse, health executive, project manager for the Art.51 Équilibres experiment, co-founder, Association Soignons Humain
- Ruth O'MalleyDirector of the Oncology-Hematology Business Unit, AbbVie France
- Jean-Paul Ortizformer President, CSMF (Confédération des Syndicats Médicaux Français) and private nephrologist
- Hervé Picardpartner, general practitioner and public health physician, ipso
health - Aude QuesnotPresident of the Public Health and Demography Commission and National Councillor, Conseil national de l'Ordre des masseurs-kinésithérapeutes
- Thomas RappAssociate Professor (HDR) and holder of the AgingUP! chair, Université Paris Cité (LIRAES), co-director of the health policy axis, Sciences Po Paris (LIEPP)
- Gérard RaymondPresident, France Assos Santé
- Nicolas Raynal, General Secretary, French Federation of Psychomotricians
- Adrienne Reixmedical manager of the HAH innovation mission and of the projects and transformation department of GH Paris Sorbonne, AP-HP
- Marie-Jeanne Richard, President, Unafam
- Guillaume RoussonGeneral Secretary, Les Ateliers Mercure and D.E. Physiotherapist
- Thibault de Saint Blancardco-founder, Alenvi
- Matthieu SaintonPartner, Eurogroup Consulting
- Caroline SchwartzManager, Healthcare Consulting, Eurogroup Consulting
- Florian ScottéHead of the Interdisciplinary Department for Patient Pathway Organization (DIOPP), Gustave Roussy
- Emmanuel SinnaeveDeputy Director, Performance, Efficiency, Quality of Healthcare Provision and Products/Biology, Healthcare Provision Division, ARS Hauts-de-France
- Anne SmetanaHealth Attaché, Embassy of Denmark in France
- Daniel Szeftelco-founder, SÊMEIA
- Jean-François ThébautVice-President, Fédération Française des Diabétiques
- Isabelle TongioDirector of Public and Government Affairs, Biomérieux
- Mohamed TouatiHematologist and Head of HAH Department, Limoges University Hospital
- Adeline Townsendmember, Les Ateliers Mercure and head of the care and permanence of care division, URPS médecins libéraux Hauts-de-France
- Dan VahdatCEO and Founder, HUMA
- Robert VassoyanFormer head of healthcare and life sciences, Atos and Digital entrepreneur
- Raphaël Veilco-founder of Les Ateliers Mercure and public health physician
- Charles-Henri des Villettesformer President of the French Federation of Home Healthcare Providers (PSAD)
- Pascale WitzPresident, PWH Advisors
- Carine Wolf-Thal, President, Conseil national de l'Ordre des Pharmaciens
- Manuela Wollgrammadministrative and financial assistant, Renaloo
- Célia ZamiaraGDR-ONDAM-PAPRAPS, Direction de l'Offre de Soins, ARS Hauts-de-France
