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Background: In the World Health Report 2000, Spain ranked 7th out of 191 countries regarding health systems performance. According to WHO’s world health statistics, in 2015 life expectancy at birth in Spain was 82.8, the third highest in the world. The Spanish state is made up of the central state and 17 decentralized autonomous communities, responsible for payment with public funds as well as healthcare budgeting, and organization of the delivery of services. The right to health protection for all citizens, the right of universal access to health care, and a strong primary care are common elements in all the regions. Added to this, in the last years, the Strategy of Care for People with Chronic Diseases, has represented the strategic framework to drive the development of integrated initiatives in most of the regions in Spain. These three regions were selected as being within the most advanced in the implementation of new innovative integrated care initiatives. Objectives: To explore, identify, describe and analyze the main innovative integrated care initiatives implemented in the three regions that could be translated to the United States. To develop several case studies about integrated care initiatives with tangible results. Format: Moderator: Stephen Shortell (University of California, Berkeley). Keynote Speaker: Roberto Nuño (Deusto University Basque Country) Núria Mas (IESE -Navarra University Catalonia), Ana Miquel (Rey Juan Carlos University Madrid) Further Insights and US applications: Stephen Shortell and Richard Scheffler (University of California, Berkeley). Timings: 1. Background, Methodology objectives (S. Shortell) 2. Introduction to the Spanish Health System.Data of Cost and Population Health in Spain and in the three regions 3. Initiatives from Basque Country: Innovation relative to Chronic patients, Social and Healthcare Integration, Mental health integration, Budget integration, Local Area coordination across sectors. 4. Initiatives from Catalonia: Integration of Electronic Health Record, Stratification of population, personalized care plans, integration of the emergency medical services, social and healthcare integration, cross sectorial meetings 5. Initiatives from Madrid: Strategy of care for patients with Chronic Conditions, Stratification of the population, The integrated pathways, the Palliative Care plan, The evaluation of the implementation process and the impact in a territory 6. Conclusions and main lessons learned applicable to the US Target Audience: Professionals and leaders from the rest of Spanish Regions and other countries interested in the integrated care initiatives that are taken place in Spain. Learnings to take away: The key success elements that could be Applicable to the US: Overall framework and learning for area-based integration continuum in Spain; Local area care pathways; Personalized care plans for complex, chronic patients; Territorial meetings and agreements/plans for integrated actions among healthcare, social care, schools; Palliative care program; Public payment of private contractor such as Madrid from more than one source to create integration; the basic benefit package all Regional health systems must provide; certain roles such as negotiating drug prices for all of Spain; The definition in Spain of educational requirements of professionals. Leadership and aggressive Change Management are considered relevant factor for Integration Success

Introduction: This paper analyses the implementation of integrated care policies in the Basque Country through the deployment of an Integrated Health Organisation in Bidasoa area during the period 2011–2014. Structural, functional and clinical integration policies have been employed with the aim to deliver integrated and person-centred care for patients, especially for those living with chronic conditions. Methods: This organisational case study used multiple data sources and methods in a pragmatic and reflexive manner to build a picture of the organisational development over a 4-year period. In order to measure the progress of integration three concepts have been measured: (i) readiness for chronicity measured with Assessment of Readiness for Chronicity in Healthcare Organisations tool; (ii) collaboration between clinicians from different care levels measured with the D'Amour Questionnaire, and (iii) overall impact of integration through several indicators based on the Triple Aim Framework. Results: The measurement of organisational readiness for chronicity showed improvements in five of the six areas under evaluation. Similarly the collaboration between professionals of different care levels showed a steady improvement in each of the 10 items. Furthermore, the Triple Aim-based indicators showed a better experience of care in terms of patients’ perceptions of care coordination; a reduction in hospital utilisation, particularly for patients with complex chronic conditions; and cost-containment in terms of per capita expenditure. Conclusion: There is a significant amount of data that shows that Bidasoa Integrated Health Organisation has progressed in terms of delivering integrated care for chronic conditions with a positive impact on several Triple Aim outcomes.