The prevalence of chronic diseases in the EU Member States seriously endangers the sustainability of social security systems and is a threat to the prosperity of national economies as such. Today, already more than 70% of national budgets are allocated to chronic conditions. Acknowledging that healthcare systems were originally designed to provide care for acute patients, their structural adequacy is now a matter of major concern. Therefore, EU policies and national activities need an even stronger shift towards implementation of cost-effective, patient-centred chronic disease management schemes.

Founded in 2014, ERCPA represents corporate providers that offer integrated care to patients with Chronic Kidney Disease (CKD) across a large majority of EU Member States. Among those who benefit from our care services are about 56,000 late-stage CKD patients in the EU who receive life-saving dialysis at home, in centres and also in nephrology units located in public hospitals that have been contracted out.

CKD is often secondary to two other major chronic conditions: cardiovascular disease with persistent hypertension and chronic diabetes. Only if these highly inter-related comorbidities are adequately managed can CKD progression be controlled. Therefore, it has always been a crucial part of our care challenge to define integrated pathways that ensure collaboration between different medical professions across care sector borders.

Chronic care management and coordination is also crucially required for late-stage CKD patients to ensure a high-quality renal replacement therapy. ERCPA’s members have gained decades of chronic disease experience with several hundred million treatments in many different healthcare settings world-wide. We want to contribute with our observations and experience to the policy work at EU level and interact with all stakeholders to define solutions for the chronic disease epidemic. We also support transplantation with active enrolment in transplantation lists and offer home dialysis whenever this is required and made possible by the different local healthcare systems.

 

The largest challenge is surely the diversity of healthcare settings across EU Member States. Therefore, health actors that try to design a universal healthcare model often face a dilemma. On the one hand they have to follow a certain “one-size-fits-all” approach, and on the other hand they need to ensure that the concept matches the reality of each different national environment and that its implementation is possible. ERCPA’s members are very much familiar with this difficult trade-off. Finding the right balance is the pre-requisite for successfully managing the complexity of chronic care providers that operate EU- and world-wide.

Based on our expertise with integrated care of CKD, we have detailed certain priorities in the ERCPA Manifesto that can be implemented across EU Member States and are also transferable to other chronic conditions. We regard as essential transparency of treatment outcomes and defining real outcome parameters that allow patients and all other stakeholders to compare treatment quality.

ERCPA’s members are able to constitute real-life evidence that could be merged with the data of other private and public providers, trial results and claims data of institutional payers. This will allow entering a new dimension of healthcare service research towards defining high-quality and cost-effective chronic care schemes. For example, applying advanced analytics on such data would allow modelling disease progression and better define schemes of primary and secondary prevention. Clustering patients in risk categories would allow a sort of personalised and patient-centric cluster therapy.

Furthermore, effective and efficient patient-centric chronic disease management requires integration in a top-down direction from primary to secondary care but also horizontally within the different specialties of secondary care. Such integration often requires adjusting the legal framework defining sectorial care provision and public-private partnership. Generally, healthcare budgets should be allocated to the entire care pathways of particular chronic conditions (including prevention) and not for single elements, which currently fosters care fragmentation. Reimbursement schemes need adjustment towards incentivising provider competition for outcomes.

There is still a lot to be done. The Reflection Process on chronic diseases finalised in October 2013, together with the Reflection Process on modern, responsive and sustainable health systems concluded in April 2014, were milestones in addressing the issue at the EU level. Projects resulting from these processes, such as the European Innovation Partnership on Active and Healthy Ageing, or the Health Systems’ Performance Assessment, are surely a step in the right direction. Nevertheless, the chronic disease community is waiting for even more progress from the Member States in reforming their healthcare systems towards chronic diseases. ERCPA regards the European Commission as an important supporter and catalyst of such changes.