Business Experience in Implementing an Advanced Telemonitoring Service

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Business Experience in Implementing an Advanced Telemonitoring Service. Valdivieso Martinez B. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

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Business Experience in Implementing an Advanced Telemonitoring Service

  1. 1. The Challenge: “Improving Care Condition” Dr. Bernardo Valdivieso Martinez, Quality Manager & Planning Director Department of Health La Fe, Valencia, Spain
  2. 2. Implementing an Advanced Chronic Disease Management Service - Business Experience -
  3. 3. Sumary The introduction The problem The solution Lessons & learnt
  4. 4. An introduction Spain Valencia land Population: 4.396.318 > 65 years old: 17,3% Health System: Hospitals: 28 Primary Care Centres: 500 Budget: (million €) 3.074 (36,9%)
  5. 5. An introduction Valencia land Health Department LA FE • Atraction 52% • Population: 260.000 • > 65 years old: 17,3% • Health System • Hospital: 1 • Primary Care Team: 13 • Budget (million €) • 540 total • 260 “capitation”
  6. 6. An introduction Capitation Concepts Expenses % Personal costs 371.962.870,10 68,3% Operating costs 110.761.052,67 20,4% Arrendamientos 2.618.677,60 0,5% Reparaciones 6.625.557,57 1,2% Material oficina e informática 1.619.786,59 0,3% Consumos energéticos, telefonía y ostales 9.416.549,05 1,7% Vestuario y lencería 370.835,45 0,1% Ptos. Farmacéuticos y de laboratorio 41.376.621,87 7,6% Mat sanitario fungible 18.373.486,69 3,4% Otros suministros de material 3.270.195,82 0,6% Otros gastos 1.427.326,23 0,3% Trabajos otras empresas 25.359.426,80 4,7% Dietas personal 302.589,01 0,1% Investments 6.189.361,29 1,1% Concerts costs 30.399.165,41 5,6% Prosthesis and stents costs 14.962.901,26 2,7% Others costs 10.000.000,00 1,8% Total 544.275.350,73 100,0%
  7. 7. Sumary The introduction The problem The solution Lessons & learnt
  8. 8. The problem
  9. 9. The problem
  10. 10. The problem Current Health Systems
  11. 11. The problem Current Health Systems
  12. 12. Sumary The introduction The problem The solution Lessons & learnt
  13. 13. Policies Models Best practices Scientific evidence
  14. 14. Key elements 1. Identify and stratify population 2. Planning and coordinate care within all health care levels, using case management methodology 3. Specific guidelines and protocols for each disease 4. Specific educational disease programmes 5. Integrated Information Systems 6. Evaluate and improve quality, cost and service 7. Align resources and incentives
  15. 15. Key elements 1. Identify and stratify population 2. Planning and coordinate care within all health care levels, using case management methodology 3. Specific guidelines and protocols for each disease 4. Specific educational disease programmes 5. Integrated Information Systems 6. Evaluate and improve quality, cost and service 7. Align resources and incentives
  16. 16. Population stratification 5% 60% CASE MANAGEMENT 15% DISEASE MANAGEMENT 80% SELF CARE 40% HEALTH PROMOTION AND DISEASE PREVENTION
  17. 17. Population stratification Department LA FE: 260.000 population ≥ 3 admissions 2.500 15 CASE MANAGEMENT 13.000 75 ≤ 2 admissions DISEASE MANAGEMENT 115.500 675 No admissions SELF CARE HEALTH PROMOTION AND DISEASE PREVENTION
  18. 18. Key elements 1. Identify and stratify population 2. Planning and coordinate care within all health care levels, using case management methodology 3. Specific guidelines and protocols for each disease 4. Specific educational disease programmes 5. Integrated Information Systems 6. Evaluate and improve quality, cost and service 7. Align resources and incentives
  19. 19. The New Model TRADITIONAL CARE MODEL CHRONIC CARE MODEL Counsel re: Deal with • Care is Proactive Lifestyle Acute Attack Review Changes of Disease Reinforce • Care delivered by a health care Labs team Access Positive Social/Other Health Services Behaviours • Care integrated across time, place Talk with and conditions Reassure Family • Care delivered in group Complete Diagnose Forms appointments, nurse clinics, telephone, internet, e-mail, remote General Consultation Review Referral 10 minutes Care care technology Plan Reviwe/Adjus Review • Self-management support a t Rx and Tx Routine Modify and/orHistory responsibility and integral part of the Preventive Negotiate Care Care Plans delivery system
  20. 20. The New Model Sase Level 3 High complexity management 60% Level 2 High risk Disease management self care Level 1 Low risk Self care support/ management 40% Healthy promotion Level 0, Healthy
  21. 21. The New Model Coordinated & Integrated Care En resumen Modelo de gestión de enfermedades crónicas del departamento La Fe de la Agencia Valenciana de Salud: Actividades más importantes Actor Nivel 3 Nivel 2 Nivel 1 Nivel 0 • Autocuidado Pacient • Automonitorización  Autocuidado,  Autocuidado, Primary Care Paciente / Cuidador • Telemonitorización  Automonitorización.  Automonitorización. Hábitos de vida saludables Carer • Uso adecuado de los recursos y de la medicación  Telemonitorización  Telemonitorización • Formación e información • Formación e información • Formación e información Primary Equipo de Atención • Atención domiciliaria y ambulatoria programada y urgente • Atención domiciliaria y ambulatoria programada y • Atención domiciliaria y ambulatoria programada y • • Formación e información Atención domiciliaria y Care Primaria • Elaboración plan de cuidados con urgente urgente ambulatoria programada y UHD • Comprobar inclusión en el • Comprobar inclusión en el urgente • Comprobar inclusión en el programa programa programa • Formación e información • Formación e información Case Gestora de casos • • Seguimiento del paciente Resolución de dudas del paciente • • Seguimiento de 6 meses Resolución de dudas Manager • Coordinación con todos los recursos asistenciales • Coordinación recursos asistenciales • Formación en domicilio (3 dias) y Hospital at Unidad de Hospitalización • evaluación inicial del paciente Elaborar el plan de cuidados con AP • • Medico de enlace Atención a domicilio en Secundary Care Home Domiciliaria • Medico de enlace crsis de PP DESCOMPENSACION • Atencion a domicilio en crisis de PP • Evaluación del riesgo de PP • Evaluación del riesgo de PP • Atencion crisis de PP • Atencion crisis de PP Acute Geriatric Unidad Médica de Corta Estancia • Soporte a especialistas en la asistencia de PP • Soporte a especialistas en la asistencia de PP • Derivación de pacientes • Derivación de pacientes • Información y formación al paciente • Seguimiento de la • Información y formación al Specialist Servicios • Seguimiento de la evolución del evolución del paciente paciente Especialidad paciente • Atención en consulta • Atención en consulta • Atención en consulta programada programada programada 09-30-00044-Departamento La Fe- Modelo de crónicos 02-VF4 –PP – Paciente Pluripatológico Página 96 de 142
  22. 22. The New Model Nurse “Case manager”
  23. 23. The New Model Involve patient and family
  24. 24. Key elements 1. Identify and stratify population 2. Planning and coordinate care within all health care levels, using case management methodology 3. Specific guidelines and protocols for each disease 4. Specific educational disease programmes 5. Integrated Information Systems 6. Evaluate and improve quality, cost and service 7. Align resources and incentives
  25. 25. Guidelines and protocols “Innovando los Cuidados de las Condiciones Crónicas”
  26. 26. Guidelines and protocols Educative interventions Factors that exacerbate disease Exacerbation symptoms recognition Knowledge about disease and treatment Therapeutic compliance
  27. 27. Key elements 1. Identify and stratify population 2. Planning and coordinate care within all health care levels, using case management methodology 3. Specific guidelines and protocols for each disease 4. Specific educational disease programmes 5. Integrated Information Systems 6. Evaluate and improve quality, cost and service 7. Align resources and incentives
  28. 28. Healthcare Integrates - ERP -
  29. 29. The New Model Telemonitoring Services Nurse “Case manager” Involve patient and family
  30. 30. Telemonitoring Services (Pilot phase)
  31. 31. Key elements 1. Identify and stratify population 2. Planning and coordinate care within all health care levels, using case management methodology 3. Specific guidelines and protocols for each disease 4. Specific educational disease programmes 5. Integrated Information Systems 6. Evaluate and improve quality, cost and service 7. Align resources and incentives
  32. 32. Policies Models Best practices Scientific evidence
  33. 33. The Results – “Pilots” CASE MANAGEMENT DISEASE MANAGEMENT SELF CARE HEALTH PROMOTION AND DISEASE PREVENTION
  34. 34. The results: CHF Pilot Comparative analysis RESOURCES Pre Manag Average admissions CHF per patient 1,5 0,4 73,3% Density admissions CHF 4,2 1,0 76,2% Average stays per patient 11,4 2,6 77,2% Density stays 43,9 8,6 80,4%
  35. 35. The results: CHF Pilot Comparative analysis RESOURCES Pre Manag Average care atention all causes 3,6 1,4 61,1% Average care atention CHF 1,9 0,4 78,9% Density incidents urgency (all) 9,8 4,7 52,0% Density incidents urgency (CHF) 5,3 1,3 75,5% “Innovando los Cuidados de las Condiciones Crónicas”
  36. 36. The results: Palliative Care Pilot Comparative analysis RESULTS % Exitus location at Home 74,2 % Exitus location in Hospital 25,7 % Sedation exitus at home 23,0 % Hospital readmision 2,7 % Derived to HML 3,4 % “Innovando los Cuidados de las Condiciones Crónicas”
  37. 37. Key elements 1. Identify and stratify population 2. Planning and coordinate care within all health care levels, using case management methodology 3. Specific guidelines and protocols for each disease 4. Specific educational disease programmes 5. Integrated Information Systems 6. Evaluate and improve quality, cost and service 7. Align resources and incentives
  38. 38. Align resources and incentives Strategic Map - Departament Health LA FE To guarantee services of health A that satisfy the necessities and B To guarantee the economic the expectations with the sustainability of the system population Population and Society Patients Financials C. To im prove the health results F. Improve the accessibility J. To m axim ize incom e D. To generate confidence and security G. Lend decisive attendance and to m anage the investments in the system H. Harness personalization K. To optim ize the costs E. To respect environment I. Increase to fidelización and attraction L. Im prove the productivity Promotion of the Suitable use of resources and Clinically Pioneering Development of health optimized processes appropriate development of the the knowledge attendance portfolio of services 1 To make the To harness the promotion of 4 12 To orient domiciliary attention 11 Potenciar healthful and the 7 To harness 9 To innovate the investigation docencia e habits hospitalization clinical with the investigación security attention of 2 alternatives chronic activity in line 5 To present Rational use conditions the system of diagnose 8 To impel the 10 12 To order tests 3 Guarantee 6 To adapt use of the to innovate teaching to the pharmaceutical best practices the portfolio of increase its prevention prescription services impact Improve the To align the availability of the Impel the use To manage investments 16 13 strategic 14 and security of 15 with the alliances with intelligence the TIC agents nails strategy To develop the human potential To incorporate To orient the To implant a To plan the the To impel the organization to System of 19 RR.HH for the 20 To improve the 21 sharpshooting 22 organizational 17 18 satisfaction of the strategy Recognitions change professionals knowledge change
  39. 39. Align resources and incentives ......................... MANAGEMENT AGREEMENT ......................... DEPARTAMENT LA FE 20% Departamento de Salud nº 7
  40. 40. Align resources and incentives PRIMARY CARE SECUNDARY CARE Home Care Acute Stay Hospitalitation Emergnecy Emergency Amulatory Care Ambulatorry Complex Care
  41. 41. Align resources and incentives SECUNDARY CARE PRIMARY CARE Case Managers Acute Mediium & Long Case Geriatric Stay Home management Unit Unit Care Hospital at Hospital Support Team Home Disease Emergnecy management Acute Stay Hospitalitation Emergency Ambulatorry Self care Ambulatoriy Care support/ Care Amulatory management Specialist Care Complex
  42. 42. Align resources and incentives Resources “care proactive” 2011 Primary Care Team Doctor 1 / 1.500 Nurse 1 / 2.000 Hospital Home Unit Team Doctor 1 / 20.000 Nurse 1 / 10.000 Case Managers * 1 / 125 *Chronic Level 1 High complex
  43. 43. Align resources and incentives Resources “care reactive” 2011 Hospital Support Teams 2 Acute Geriatric Unit 45 Medium Stay Unit 56 Convalescence Palliatives Care Long Stay Unit 28 Mental Health Unit 28 “Innovando los Cuidados de las Condiciones Crónicas”
  44. 44. Align resources and incentives e-Chronic Disease Management Service
  45. 45. Align resources and incentives e-CDM Service 5% 60% CASE MANAGEMENT 1.500 € year / user 15% DISEASE MANAGEMENT 80% SELF CARE 2.000 Case management 40% HEALTH PROMOTION AND DISEASE PREVENTION 3.000.000 € year
  46. 46. Sumary The introduction The problem The solution Lessons & learnt
  47. 47. Lessons & learnt 20% Technological and 80% cultural
  48. 48. Lessons learnt E-CDM Service 3 HIS 1 2
  49. 49. Align resources and incentives e-CDM Service 5% 260.000 population 60% CASE MANAGEMENT 1.500 € year / user 15% DISEASE MANAGEMENT e-Health & e-Disease 80% 2.000 Case management SELF CARE Management 40% HEALTH PROMOTION AND DISEASE PREVENTION 3.000.000 € year 3.000.000 € year
  50. 50. An introduction Capitation Concepts Expenses % Personal costs 371.962.870,10 68,3% Operating costs 110.761.052,67 20,4% Arrendamientos 2.618.677,60 0,5% Reparaciones 6.625.557,57 1,2% Material oficina e informática 1.619.786,59 0,3% Consumos energéticos, telefonía y ostales 9.416.549,05 1,7% Vestuario y lencería 370.835,45 0,1% ↓ 10% Pharmaceutical and laboratory products 41.376.621,87 7,6% health products and consumables 18.373.486,69 3,4% Otros suministros de material 3.270.195,82 0,6% Otros gastos 1.427.326,23 0,3% Trabajos otras empresas 25.359.426,80 4,7% Dietas personal 302.589,01 0,1% Investments 6.189.361,29 1,1% Concerts costs 30.399.165,41 5,6% Prosthesis and stents costs 14.962.901,26 2,7% Others costs 10.000.000,00 1,8% Total 544.275.350,73 100,0%
  51. 51. Lessons & learnt 20% Technological and 80% cultural
  52. 52. Lessons & learnt Departamento de Salud nº 7
  53. 53. Lessons & learnt
  54. 54. Lessons & learnt Departamento de Salud nº 7
  55. 55. Lessons & learnt

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