Abstract Chapter 18

Chapter 18 analyzes the experiences of the Italian regions on the theme of Population Health Management (PHM), which has become the national reference model for the management of chronic diseases with the National Plan for Chronicity (PNC, 2016). It represents the evolution of the model of the Chronic Care Model, through an extension of the analysis of the population, with the use of administrative databases, and the policy and management perspective in which it is carried out, identifying the central role in regional governance and in cascade, on the health-care company joints up to the personalized treatment pathways for chronic diseases. In short, it is the model that is making possible a gradual transition from the supply to the demand, through the implementation of the "presa in carico del paziente". The adoption of PHM by the regions has seen different speeds and developments. In this context, the chapter presents, first of all, a survey of the state of evolution of the PHM in the Italian regions, through the results of a survey that has made it possible to analyze the state of progress in the regions that have recently started its adoption. Secondly, it examines in a comparative way the implementation modalities and the managerial and managerial implications of PHM in the two pioneer regions in the national panorama, Lombardy and Veneto. The analysis highlights how PHM represents a disruptive opportunity in the traditional models of policy and management for regional health systems: programming takes place for «the» target populations and this reinforces the need to balance standardized choices (top-down) with the specialisms of health conditions. Furthermore, there is a renewed role of public health, linked to the prevention and management of socio-health chronic diseases, in synergy with the centrality of territorial assistance. However, the development path remains open, as important requirements of mature PHM models are absent or embryonic even in more mature experiences such as the development of assessment systems on results and outcomes, the lack of socio-health and social information, the difficulties in integrating general medicine.