Introduction
Ageing and chronicity, along with technological and pharmacological innovation upswing, require transformation of healthcare organizations and systems to focus on value-based integrated care (VBIC) management models.

Health Value Lighthouse is an initiative that pursues the commitment of healthcare organizations to advance on VBIC as a means to allow health system sustainability, innovation and person-centered care. Its core tool is a questionnaire for maturity analysis, that is fulfilled by a management team and allows self-assessment as well as the definition of a roadmap for advancing in VBIC management.

We describe the design process and preliminary piloting results of the questionnaire.

Methods
For the initial development of the questionnaire, a multidisciplinary group of experts in the field of health policy, management, health economics, pharma industry and consultancy was formed. A literature review to identify main topics and key elements in the value-based framework preceded the group discussion.

The preliminary version of the questionnaire was contrasted with a sample of potential users in healthcare organizations.

The final online version was tested for its usability, acceptability and user´s satisfaction before launching the pilot projects at two healthcare organizations in Spain in 2024.

Results
The questionnaire is an open access tool with 39 items structured in 7 domains, which have been considered essential in a value-based healthcare management model.

Discussion
Although value-based healthcare delivery is a fashionable topic, there are not many actionable tools that allow organizations to self-assess their organizational maturity on this topic. Health Value Lighthouse is intended to fill this gap as well as to expand current value-based healthcare approaches towards value-based integrated care by merging key concepts from both knowledge areas.

Conclusions
The Health Value Lighthouse questionnaire presents an opportunity to analyze the situation of an organization with respect to VBIC and align teams towards it.

Lessons learned
The validation done with final users suggest that the Health Value Lighthouse questionnaire is both applicable and easy to use tool.

Limitations
Transformation processes must go beyond the implementation of a tool and they require a favorable environment at all levels of the organization which would allow changes to happen. Therefore, thisinitiative has been conceived as a transformational project, being the application of the questionnaire the starting point.

Introduction
Aging, increased life expectancy, the presence of chronic diseases, and structural changes in families and society are factors that have an impact on the deterioration of health and the need for a constant increase in health and social resources. In Spain, according to data from the National Institute of Statistics, in 2023, the percentage of the population over 64 years of age was 20.34%, life expectancy was 83 years (80,36 in men and 85,74 in women) and the dependency rate in people over 64 years of age was 31.35%. Chronic diseases are the main cause of dependency and most of these diseases require ongoing monitoring and treatment to prevent dependency from progressing. Decompensations, multiple pathologies and polypharmacy are frequent, which makes care management difficult and requires the activation of more social resources.

Methodology
Following the recommendations of the Strategy for Addressing Chronicity in the National Health System, in the Balearic Islands, in 2017, a new proactive and coordinated care model was implemented for addressing complex and advanced chronic patients, which involves structural changes at the different levels of care, and focuses on person-centred care and support for their caregivers and where the case management nurse (CMN) has a key role in ensuring continuity of care and coordination between the different care areas. The main objective of the CMN is to ensure comprehensive and quality care through the coordination of all the agents involved, ensuring continuity of care, with a collaborative, comprehensive and multi-professional advanced practice model that promotes that the person can be at home most of the time, with the best quality of life.

Results
There are currently a total of 71 CMNs in the Balearic Islands, 53 of them in primary care, 14 in acute care hospitals and 4 in intermediate care hospitals. Among other interventions, the CMNs promote the proactive identification of patients with complex and advanced chronicity (with palliative care needs) and high dependency and record it in the information systems, proactive home care, manage admissions to the most appropriate resource, plan discharge together with the healthcare team, manage appointments for continued care with their primary care nurse, make indications for medical products and technical aids, promote effective coordination between different professionals from different healthcare areas and other institutions (such as social services and education), joint work with social workers, and carry out training actions for patients, families and other professionals. The number of people identified with complex chronicity in October 2024 is 29.499 (79.34% over those expected) and with advanced chronicity 1.971 (15.90% over those expected).

Conclusions
Patients with chronic diseases require comprehensive and integrated care that responds to the multiple complexes needs they present. Proactive identification of the population, activation and adaptation of health and social resources, shared information systems together with professionals who ensure continuity of care such as CMN are interventions that improve the quality of care for these people.

BACKGROUND: Chronic pain is defined as pain that persists or recurs for three months or longer. In Alberta, Canada, one in five individuals lives with chronic pain. For years, many patients living with chronic pain in Alberta have faced significant barriers to accessing care(1,2), having to “fight to get what [they] need”(3), and called for change.

The Alberta Virtual Pain Program (AVPP) was developed to address gaps in chronic pain care in the province. Recognizing that chronic pain is physiologically distinct from acute pain, AVPP offers easy and timely access to patient-centered interdisciplinary care and evidence-based non-pharmacological resources.

APPROACH: Patient engagement has been a cornerstone of the AVPP's development and implementation. The program was developed as a direct response to patient advocacy and shaped through robust collaboration with people with lived experience.

Key examples of collaboration and co-design in the AVPP’s case include:
1. Model of Care Informed by the Patient-to-Patient Research: The proposed model of care for the AVPP was directly informed by patient and community engagement research, led by patient-researchers. This research produced key recommendations for the health delivery system, outlining actionable steps to improve care and support for individuals living with chronic pain(3), which served as the foundation for the AVPP’s design.
2. Advocacy for Change: People with lived experience provided letters of support, which accompanied the AVPP proposal submitted to the government, and participated in meetings with government leaders to advocate for enhanced chronic pain resources in Alberta.
3. Co-Design: People with lived experience actively contributed to the co-design of the AVPP as members of the advisory committee and working groups. They played a key role in determining the structure and content of services, reviewing materials, and shaping program delivery.
4. Continuous Feedback and Improvement: Following the AVPP’s launch, a robust feedback process was established to capture and act on participant experiences. Feedback is collected through anonymous surveys. Participants can also voice their opinions during Peer Support Worker–led group sessions, fostering open dialogue and deeper insights. This feedback is reviewed by the AVPP team to enable timely improvements to the program and prioritize the development of topic-specific programming.

RESULTS: In October 2022, the provincial government announced a plan to start a Provincial Pain Program, the AVPP, and committed funding for its first phase. The AVPP officially launched in April 2024, and within less than six months, over 200 patients have already engaged with its services. Participant feedback has been overwhelmingly positive. For instance, one participant called it an "eye-opener" that has renewed their hope: “The program has helped me validate my mission to start finding ways of healing.”

IMPLICATIONS: The success of the AVPP underscores the critical role of people with lived experience in every phase of health system innovation. By integrating patient voices throughout health system planning, program design, and ongoing refinement, the AVPP is driving meaningful change to addresses gaps in care and ensure the program is responsive to the real and pressing needs of those living with chronic pain.

References:
1.https://doi.org/10.1371/journal.pone.0272638
2.https://www.albertahealthservices.ca/assets/about/scn/ahs-scn-alberta-pain-strategy-executive-summary-2019-24.pdf
3.https://doi.org/10.1136/bmjopen-2023-072048

BACKGROUND:
Remote patient monitoring (RPM) is a promising tool to support chronic pain (CP) management and improve outcomes through routine timely data transmission, enabling early symptom detection and intervention by healthcare providers. However, existing digital solutions have important limitations such as minimal end-user involvement in co-design, raising concerns about adoption and relevance. To address these gaps, a collaborative user-centred approach was used to (1) explore the needs of patients and their providers regarding healthcare delivery and self-management; (2) identify perceived benefits of using TM beyond clinical encounters; (3) codevelop an interactive patient-provider RPM prototype tailored to previously identified needs and (4) evaluate the implementation and preliminary efficacy of the platform. This presentation describes the perspective of a health system administrator, a patient and technology expert on the development approach, technology and preliminary evaluation.
APPROACH:
Guided by user-centred design principles, we employed a multi-phased research approach to facilitate the identification of user needs and support the development of the RPM prototype. In Phase 1, semi-structured focus groups were conducted with a convenience sample of 6 patients and a purposive sample of 16 providers recruited from CP clinics to identify the perceived needs of users, RPM features supporting those needs, and perceived benefits of RPM. In Phase 2, purposive sampling was used to select 20 providers, 5 patients, and 7 content experts in the fields of eHealth and/or research or service delivery in CP. All participants were asked to use findings from Phase 1 to develop and iteratively modify an initial prototype through a series of virtual co-design sessions with the technology partner. Prior to full-scale evaluation and provincial deployment, we will be conducting a 4-month multi-method exploratory evaluation (early 2025) to uncover micro, meso and macro level factors that need to be considered in the planning, implementation and health system impacts phases of the project prior to full-scale evaluation.
RESULTS:
The iterative multi-phased user-centred design approach combined with ecological momentary assessment methodology, resulted in changes of the prototype to meet important user needs: 1) Pain impact; 2) Challenges in care delivery and CP management; 3) RPM priority features; and 5) RPM value proposition. Design principles (real-time information sharing, technological literacy, partnership, behavioural activation, capacity-building, actionable monitoring, and human connection) informed modifications to the prototype to ensure acceptability, usability, feasibility and meaningfulness. The prototype integrates symptom questionnaires to assess biopsychosocial domains, treatment adherence and self-efficacy; actionable clinical alerts; and tailored advice and education guided by rule-based algorithms. The results of the exploratory evaluation will highlight barriers/facilitators to adoption and preliminary impacts of RPM.
Implications:
Developing, implementing and evaluating innovative technologies with end-users ensures a greater willingness to adopt new processes, behaviours and technologies. Tools developed using user-centred design resonate with patients, providers and health system administrators/policy-makers and enhance willingness to change processes and behaviours at the micro-, meso-, and macro-level to adopt innovative technologies. The exploratory evaluation will demonstrate impact at the patient, provider and system level while documenting optimal integration into workflows to support large-scale deployment across various levels of care.