Greece: Primary Care in a time of crisis. 2nd VdGM Forum, Dublin 2015Evangelos Fragkoulis
2nd Vasco Da Gama Movement Forum, Dublin 2015
The Effect of the Economic Crisis on the Health Systems of the peripheral countries: Greece, Ireland, Spain, Portugal and Italy.
Ρητορική και πολιτική στην Πρωτοβάθμια Φροντίδα. Η αναγκαιότητα μιας τεκμηριω...Evangelos Fragkoulis
Παρούσιαση μου στα πλαίσια του 13ου Health Policy Forum, με θέμα:
"Πρωτοβάθμια Φροντίδα Υγείας: Προϋποθέσεις Ανασυγκρότησης και Ανάπτυξης"
Αρχαία Ολυμπία, 15-17 Απριλίου 2016
http://www.healthpolicy.gr/13%CE%B7-%CF%83%CF%85%CE%BD%CE%AC%CE%BD%CF%84%CE%B7%CF%83%CE%B7-%CE%B1%CF%81%CF%87%CE%B1%CE%AF%CE%B1-%CE%BF%CE%BB%CF%85%CE%BC%CF%80%CE%AF%CE%B1-2016/
This document discusses processes that have been implemented at a rural hospital with 1200 births per year to improve obstetric patient safety and outcomes. Some of the key processes discussed include establishing a team approach involving all hospital personnel, conducting regular simulations to improve communication and adherence to protocols, implementing mentorship programs for nurses and managers, standardizing communication using SBAR, leveraging electronic medical records and data to monitor quality and outcomes, and promoting a culture of accountability and professionalism. The goal of these initiatives is to reduce errors, minimize harm, and improve outcomes through multidisciplinary collaboration and a systems-based approach. While changing healthcare culture and achieving measurable outcomes can be challenging, continuous monitoring and refinement of processes may help advance safety and quality of
This study evaluated the implementation of a value-driven outcomes tool at University of Utah Health Care to measure costs, quality, and outcomes at the individual patient level. The tool identified high variability in costs for certain conditions like sepsis and joint replacements. For three clinical projects using the tool (total joint replacement, hospitalist laboratory testing, and sepsis management), costs decreased 7-11% and quality improved. The tool was associated with reduced costs and better outcomes when used to provide clinicians information on resource use and performance for defined patient populations.
Dr. Edward Wagner, Director (Emeritus) MacColl Center, Senior Investigator, Group Health Research Institute addresses the 2014 Weitzman Symposium on The Future of Primary Care
This document provides an overview of transitions of care, including definitions, models, and best practices. It describes transitions as the movement of patients between healthcare settings or providers. Poor transitions can lead to adverse outcomes for patients and increased costs. Several evidence-based models are described that aim to improve transitions through elements like medication reconciliation, discharge planning, and post-discharge follow up. These models have demonstrated reductions in readmissions and healthcare utilization. The document provides resources for additional information on improving the quality of patient transitions.
The document discusses Project ECHO and its mission to expand access to specialty healthcare for common and complex diseases in rural and underserved areas. Project ECHO uses teleconferencing and case-based learning to train primary care clinicians to treat and manage conditions like hepatitis C. An evaluation showed primary care clinicians trained through Project ECHO achieved similar treatment outcomes for hepatitis C as specialists at a university medical center, improving access to care for rural and minority populations.
Weitzman 2013: PCORI: Transforming Health CareCHC Connecticut
This document summarizes a presentation given by Joe Selby on the Patient-Centered Outcomes Research Institute (PCORI). It discusses PCORI's mission to fund comparative clinical effectiveness research that is guided by patients and other stakeholders. Key points include: PCORI's focus on research questions of interest to patients and providers; its criteria for funding proposals, including patient-centeredness and engagement; and its plans to significantly increase funding for such research over time. Examples are given of funded pilot projects involving community health centers.
Greece: Primary Care in a time of crisis. 2nd VdGM Forum, Dublin 2015Evangelos Fragkoulis
2nd Vasco Da Gama Movement Forum, Dublin 2015
The Effect of the Economic Crisis on the Health Systems of the peripheral countries: Greece, Ireland, Spain, Portugal and Italy.
Ρητορική και πολιτική στην Πρωτοβάθμια Φροντίδα. Η αναγκαιότητα μιας τεκμηριω...Evangelos Fragkoulis
Παρούσιαση μου στα πλαίσια του 13ου Health Policy Forum, με θέμα:
"Πρωτοβάθμια Φροντίδα Υγείας: Προϋποθέσεις Ανασυγκρότησης και Ανάπτυξης"
Αρχαία Ολυμπία, 15-17 Απριλίου 2016
http://www.healthpolicy.gr/13%CE%B7-%CF%83%CF%85%CE%BD%CE%AC%CE%BD%CF%84%CE%B7%CF%83%CE%B7-%CE%B1%CF%81%CF%87%CE%B1%CE%AF%CE%B1-%CE%BF%CE%BB%CF%85%CE%BC%CF%80%CE%AF%CE%B1-2016/
This document discusses processes that have been implemented at a rural hospital with 1200 births per year to improve obstetric patient safety and outcomes. Some of the key processes discussed include establishing a team approach involving all hospital personnel, conducting regular simulations to improve communication and adherence to protocols, implementing mentorship programs for nurses and managers, standardizing communication using SBAR, leveraging electronic medical records and data to monitor quality and outcomes, and promoting a culture of accountability and professionalism. The goal of these initiatives is to reduce errors, minimize harm, and improve outcomes through multidisciplinary collaboration and a systems-based approach. While changing healthcare culture and achieving measurable outcomes can be challenging, continuous monitoring and refinement of processes may help advance safety and quality of
This study evaluated the implementation of a value-driven outcomes tool at University of Utah Health Care to measure costs, quality, and outcomes at the individual patient level. The tool identified high variability in costs for certain conditions like sepsis and joint replacements. For three clinical projects using the tool (total joint replacement, hospitalist laboratory testing, and sepsis management), costs decreased 7-11% and quality improved. The tool was associated with reduced costs and better outcomes when used to provide clinicians information on resource use and performance for defined patient populations.
Dr. Edward Wagner, Director (Emeritus) MacColl Center, Senior Investigator, Group Health Research Institute addresses the 2014 Weitzman Symposium on The Future of Primary Care
This document provides an overview of transitions of care, including definitions, models, and best practices. It describes transitions as the movement of patients between healthcare settings or providers. Poor transitions can lead to adverse outcomes for patients and increased costs. Several evidence-based models are described that aim to improve transitions through elements like medication reconciliation, discharge planning, and post-discharge follow up. These models have demonstrated reductions in readmissions and healthcare utilization. The document provides resources for additional information on improving the quality of patient transitions.
The document discusses Project ECHO and its mission to expand access to specialty healthcare for common and complex diseases in rural and underserved areas. Project ECHO uses teleconferencing and case-based learning to train primary care clinicians to treat and manage conditions like hepatitis C. An evaluation showed primary care clinicians trained through Project ECHO achieved similar treatment outcomes for hepatitis C as specialists at a university medical center, improving access to care for rural and minority populations.
Weitzman 2013: PCORI: Transforming Health CareCHC Connecticut
This document summarizes a presentation given by Joe Selby on the Patient-Centered Outcomes Research Institute (PCORI). It discusses PCORI's mission to fund comparative clinical effectiveness research that is guided by patients and other stakeholders. Key points include: PCORI's focus on research questions of interest to patients and providers; its criteria for funding proposals, including patient-centeredness and engagement; and its plans to significantly increase funding for such research over time. Examples are given of funded pilot projects involving community health centers.
Lannes - Improving health worker performance The patient-perspectivelaurencelannes
PBF programs in developing countries aim to improve health worker performance through financial incentives tied to meeting targets. This document analyzes data from a PBF program in Rwanda to assess its impact on patient satisfaction. It finds that PBF had a positive effect on satisfaction with clinical services by improving productivity, availability, and competencies of health workers. PBF also positively impacted satisfaction with non-clinical dimensions, suggesting it incentivized improvements in those areas as well. The study concludes PBF can be an effective strategy for increasing patient satisfaction if programs include assessing satisfaction in their incentive mechanisms.
the paradigm is changing; the dominant focus for the next decade at least will be value, or to be precise triple value
The Aim is triple value & greater equity
• Allocative value, determined by how the assets are distributed to different sub groups in the population
• Technical value, determined by how well resources are used for all the people in need in the population
• Personalised value, determined by how well the decisions relate to the values of each individual
If you want to see more please look at http://bettervaluehealthcare.weebly.com
- Hoag Memorial Hospital transformed care delivery from service lines to physician-led programs focused on specific conditions to improve outcomes and lower costs.
- The stroke program improved treatment, reduced length of stay and costs, and achieved excellent clinical outcomes like 63% of patients returning to independence.
- The maternity program created specialized units, standardized care pathways, and partnered with OBs and pediatricians to lower c-section rates and improve satisfaction.
- Organizing around programs instead of departments better integrates specialists, coordinates care, and measures value through outcomes and costs rather than just processes.
Creating a standard of care for patient and family engagementChristine Winters
Nationally-recognized governance expert Beth Daley Ullem addresses the state of patient engagement in heathcare and provides a vision for establishing a minimum standard of care for patient engagement programs.
2011 04 Sargen Hooker Cooper Gaps In Physician Supplyrodhooker
If current projections for training programs of advanced practice nurses and physician assistants are realized but physician residency programs are not expanded, the combined supply of advanced clinicians will be 20% less than projected demand in 2025. Increasing the number of first-year residency positions by 500 annually would narrow but not close the gap, which would remain above 15%. Efforts must be made to expand training of physicians, advanced practice nurses, and physician assistants, while also reforming clinical practice models to facilitate task sharing among a broader range of providers.
Strengthening Acute to Post Acute-Care Connection: Cohesively Manage CareCentralPAHEF
WellSpan Health is a large integrated health system in central Pennsylvania serving over 1 million people. It operates 6 hospitals, a medical group with over 1200 physicians, and provides various post-acute services including home health, rehabilitation, and long-term care. WellSpan is working to strengthen connections between acute and post-acute care by standardizing care, improving care coordination and transitions, and developing preferred partnerships with post-acute providers. The goal is to improve patient outcomes and experiences while decreasing healthcare costs through more cohesive management of care across settings.
The Patient-Centered Medical Home Impact on Cost and Quality: An Annual Revie...CHC Connecticut
Dr. Nwando Olayiwola, Associate Director, Center for Excellence in Primary Care, Assistant Professor, University of California, San Francisco addresses the 2014 Weitzman Symposium on The Patient-Centered Medical Home Impact on Cost and Quality: An Annual Review of Evidence
This document discusses value-based care for home healthcare providers. It defines value-based care as outcomes that matter most to patients divided by the total cost of care. This framework helps healthcare providers collaborate to maximize value for patients over their entire care cycle by measuring outcomes and costs in order to iterate and improve over time. Key aspects of implementing value-based care for home health providers include organizing care around patient conditions, measuring outcomes and costs for each patient, enabling integrated technology, and moving to bundled payments for full care cycles.
The document discusses various topics related to physical therapy (PT) practice. It notes that in 2014, PTs can avoid PQRS penalties by reporting 3 quality measures for 50% of patients, and the number of measures required to receive bonuses will increase from 3 to 9. It also eliminates reporting via measures groups through claims. The document discusses focusing on developing quality measures for PT, payment models that promote value, and public policy initiatives to advance the role of PT in areas like disease management. It also discusses improving access, eliminating self-referral profits, and ensuring an adequate PT workforce.
Weitzman 2013 Relative patient benefits of a hospital-PCMH collaboration with...CHC Connecticut
Anuj K Dalal presents information on a PCORI research grant: Relative patient benefits of a hospital-PCMH collaboration within an ACO to improve care transitions.
Can we solve the adult primary care shortage without more physicians? CHC Connecticut
Tom Bodenheimer,of the Center for Excellence in Primary Care at UCSF Dep’t of Family and Community Medicine talks about addressing the primary care shortage at the 2014 Weitzman Symposium
Healthcare -- putting prevention into practiceZafar Hasan
This slidedeck is submitted by Zafar Hasan because one of the trends in medicine for the last 20 years isa focus on prevention and this deck is an outstanding practice primer.
Population Health Management White Paper, Spring 2015Edward Pierce
Population health management (PHM) aims to improve health outcomes for groups of individuals through coordinated care and patient engagement. Key components of PHM include leadership from primary care physicians to develop customized care plans for each patient. Data analysis is used to identify at-risk patients and care gaps, while automation and technology help disseminate information to patients. Referral networks and payment structures incentivize physicians to focus on outcomes over volume. Hospitals are developing PHM strategies starting with their own employees to coordinate benefits, replicate the model, and expand it community-wide to improve affordability.
Closing the Loop: Strategies to Extend Care in the EDEngagingPatients
This HIMSS15 presentation discusses the challenges faced in hospital emergency departments and offers insights for implementing a process to follow up with discharged ED patients to enhance outcomes and satisfaction,while optimizing utilization and reducing risk.
The document discusses the patient-centered medical home (PCMH) model and its potential benefits. It summarizes that the PCMH aims to provide patient-centered, coordinated care through a personal physician leading a team. Data from other countries shows primary care-focused systems have better outcomes and lower costs. The PCMH may benefit primary care physicians through payment reform recognizing care coordination work. It may benefit patients through improved access and chronic disease management support. Subspecialists may also benefit from opportunities to lead medical homes and fewer administrative hassles.
The document discusses New York State's efforts to promote the patient-centered medical home model. It notes that while New York spends a lot on healthcare, the quality and health outcomes are only middle of the pack. The Commissioner of Health believes the PCMH model can help strengthen primary care, improve chronic care management, and reduce avoidable costs. New York has promoted multipayer PCMH initiatives through legislation and programs. Initial PCMH pilot programs showed promising results, and the state has seen significant uptake of PCMH recognition across practices. Evaluations are still early, but results so far are encouraging regarding patient experience and quality measures.
MILLER_WILLIAM_THE VALUE OF UNDERSTANDING COSTS IN HEALTH CARE_HCM598A2William Miller
This document discusses the value of understanding true costs in healthcare using Boston Children's Hospital as a case study. It describes how BCH previously used inaccurate costing methods like ratio-of-cost-to-charges and relative value units that did not reflect the actual resources and time required for different procedures. Two departments began using time-driven activity-based costing to more accurately determine costs. This revealed significant differences in the costs of various procedures and services compared to previous estimates. Understanding true costs is important for value-based care, negotiations, and improving outcomes and processes.
The document discusses various compensation models used by managed care organizations (MCOs) to influence physician behavior and control costs, including capitation, withholds, bonuses, and risk sharing. It provides examples of how capitation, withholds, and bonuses are implemented. It also discusses the advantages of capitation for physicians in terms of financial autonomy and cash flow stability. Finally, it summarizes the rise and fall of large physician practice management companies in the 1990s that aimed to aggregate physician practices but often struggled with integration and cost prediction issues.
Productivity in the health sector -- Peter Smith, United KingdomOECD Governance
This presentation was made by Peter Smith, United Kingdom, at the 6th Meeting of the Joint OECD DELSA-GOV Network on Fiscal Sustainability of Health Systems, held at the OECD Conference Centre, Paris, on 18-19 September 2017
Lannes - Improving health worker performance The patient-perspectivelaurencelannes
PBF programs in developing countries aim to improve health worker performance through financial incentives tied to meeting targets. This document analyzes data from a PBF program in Rwanda to assess its impact on patient satisfaction. It finds that PBF had a positive effect on satisfaction with clinical services by improving productivity, availability, and competencies of health workers. PBF also positively impacted satisfaction with non-clinical dimensions, suggesting it incentivized improvements in those areas as well. The study concludes PBF can be an effective strategy for increasing patient satisfaction if programs include assessing satisfaction in their incentive mechanisms.
the paradigm is changing; the dominant focus for the next decade at least will be value, or to be precise triple value
The Aim is triple value & greater equity
• Allocative value, determined by how the assets are distributed to different sub groups in the population
• Technical value, determined by how well resources are used for all the people in need in the population
• Personalised value, determined by how well the decisions relate to the values of each individual
If you want to see more please look at http://bettervaluehealthcare.weebly.com
- Hoag Memorial Hospital transformed care delivery from service lines to physician-led programs focused on specific conditions to improve outcomes and lower costs.
- The stroke program improved treatment, reduced length of stay and costs, and achieved excellent clinical outcomes like 63% of patients returning to independence.
- The maternity program created specialized units, standardized care pathways, and partnered with OBs and pediatricians to lower c-section rates and improve satisfaction.
- Organizing around programs instead of departments better integrates specialists, coordinates care, and measures value through outcomes and costs rather than just processes.
Creating a standard of care for patient and family engagementChristine Winters
Nationally-recognized governance expert Beth Daley Ullem addresses the state of patient engagement in heathcare and provides a vision for establishing a minimum standard of care for patient engagement programs.
2011 04 Sargen Hooker Cooper Gaps In Physician Supplyrodhooker
If current projections for training programs of advanced practice nurses and physician assistants are realized but physician residency programs are not expanded, the combined supply of advanced clinicians will be 20% less than projected demand in 2025. Increasing the number of first-year residency positions by 500 annually would narrow but not close the gap, which would remain above 15%. Efforts must be made to expand training of physicians, advanced practice nurses, and physician assistants, while also reforming clinical practice models to facilitate task sharing among a broader range of providers.
Strengthening Acute to Post Acute-Care Connection: Cohesively Manage CareCentralPAHEF
WellSpan Health is a large integrated health system in central Pennsylvania serving over 1 million people. It operates 6 hospitals, a medical group with over 1200 physicians, and provides various post-acute services including home health, rehabilitation, and long-term care. WellSpan is working to strengthen connections between acute and post-acute care by standardizing care, improving care coordination and transitions, and developing preferred partnerships with post-acute providers. The goal is to improve patient outcomes and experiences while decreasing healthcare costs through more cohesive management of care across settings.
The Patient-Centered Medical Home Impact on Cost and Quality: An Annual Revie...CHC Connecticut
Dr. Nwando Olayiwola, Associate Director, Center for Excellence in Primary Care, Assistant Professor, University of California, San Francisco addresses the 2014 Weitzman Symposium on The Patient-Centered Medical Home Impact on Cost and Quality: An Annual Review of Evidence
This document discusses value-based care for home healthcare providers. It defines value-based care as outcomes that matter most to patients divided by the total cost of care. This framework helps healthcare providers collaborate to maximize value for patients over their entire care cycle by measuring outcomes and costs in order to iterate and improve over time. Key aspects of implementing value-based care for home health providers include organizing care around patient conditions, measuring outcomes and costs for each patient, enabling integrated technology, and moving to bundled payments for full care cycles.
The document discusses various topics related to physical therapy (PT) practice. It notes that in 2014, PTs can avoid PQRS penalties by reporting 3 quality measures for 50% of patients, and the number of measures required to receive bonuses will increase from 3 to 9. It also eliminates reporting via measures groups through claims. The document discusses focusing on developing quality measures for PT, payment models that promote value, and public policy initiatives to advance the role of PT in areas like disease management. It also discusses improving access, eliminating self-referral profits, and ensuring an adequate PT workforce.
Weitzman 2013 Relative patient benefits of a hospital-PCMH collaboration with...CHC Connecticut
Anuj K Dalal presents information on a PCORI research grant: Relative patient benefits of a hospital-PCMH collaboration within an ACO to improve care transitions.
Can we solve the adult primary care shortage without more physicians? CHC Connecticut
Tom Bodenheimer,of the Center for Excellence in Primary Care at UCSF Dep’t of Family and Community Medicine talks about addressing the primary care shortage at the 2014 Weitzman Symposium
Healthcare -- putting prevention into practiceZafar Hasan
This slidedeck is submitted by Zafar Hasan because one of the trends in medicine for the last 20 years isa focus on prevention and this deck is an outstanding practice primer.
Population Health Management White Paper, Spring 2015Edward Pierce
Population health management (PHM) aims to improve health outcomes for groups of individuals through coordinated care and patient engagement. Key components of PHM include leadership from primary care physicians to develop customized care plans for each patient. Data analysis is used to identify at-risk patients and care gaps, while automation and technology help disseminate information to patients. Referral networks and payment structures incentivize physicians to focus on outcomes over volume. Hospitals are developing PHM strategies starting with their own employees to coordinate benefits, replicate the model, and expand it community-wide to improve affordability.
Closing the Loop: Strategies to Extend Care in the EDEngagingPatients
This HIMSS15 presentation discusses the challenges faced in hospital emergency departments and offers insights for implementing a process to follow up with discharged ED patients to enhance outcomes and satisfaction,while optimizing utilization and reducing risk.
The document discusses the patient-centered medical home (PCMH) model and its potential benefits. It summarizes that the PCMH aims to provide patient-centered, coordinated care through a personal physician leading a team. Data from other countries shows primary care-focused systems have better outcomes and lower costs. The PCMH may benefit primary care physicians through payment reform recognizing care coordination work. It may benefit patients through improved access and chronic disease management support. Subspecialists may also benefit from opportunities to lead medical homes and fewer administrative hassles.
The document discusses New York State's efforts to promote the patient-centered medical home model. It notes that while New York spends a lot on healthcare, the quality and health outcomes are only middle of the pack. The Commissioner of Health believes the PCMH model can help strengthen primary care, improve chronic care management, and reduce avoidable costs. New York has promoted multipayer PCMH initiatives through legislation and programs. Initial PCMH pilot programs showed promising results, and the state has seen significant uptake of PCMH recognition across practices. Evaluations are still early, but results so far are encouraging regarding patient experience and quality measures.
MILLER_WILLIAM_THE VALUE OF UNDERSTANDING COSTS IN HEALTH CARE_HCM598A2William Miller
This document discusses the value of understanding true costs in healthcare using Boston Children's Hospital as a case study. It describes how BCH previously used inaccurate costing methods like ratio-of-cost-to-charges and relative value units that did not reflect the actual resources and time required for different procedures. Two departments began using time-driven activity-based costing to more accurately determine costs. This revealed significant differences in the costs of various procedures and services compared to previous estimates. Understanding true costs is important for value-based care, negotiations, and improving outcomes and processes.
The document discusses various compensation models used by managed care organizations (MCOs) to influence physician behavior and control costs, including capitation, withholds, bonuses, and risk sharing. It provides examples of how capitation, withholds, and bonuses are implemented. It also discusses the advantages of capitation for physicians in terms of financial autonomy and cash flow stability. Finally, it summarizes the rise and fall of large physician practice management companies in the 1990s that aimed to aggregate physician practices but often struggled with integration and cost prediction issues.
Productivity in the health sector -- Peter Smith, United KingdomOECD Governance
This presentation was made by Peter Smith, United Kingdom, at the 6th Meeting of the Joint OECD DELSA-GOV Network on Fiscal Sustainability of Health Systems, held at the OECD Conference Centre, Paris, on 18-19 September 2017
Synopsis: Impact of Health Systems Strengthening on HealthHFG Project
Leaders in low- and middle-income countries (LMICs) require timely and compelling evidence about how to strengthen their health systems to improve the health and well-being of their citizens. Yet, evidence on how to strengthen health system performance to achieve sustainable health improvements at scale, particularly toward Ending Preventable Child and Maternal Deaths (EPCMD), fostering an AIDS-Free Generation (AFG), and Protecting Communities against Infectious Diseases (PCID) is limited. The evidence that does exist is scattered, insufficiently analyzed, and not widely disseminated. Without evidence, decision-makers lack a sound basis for investing scarce health funds in health systems strengthening (HSS) in an environment of competing investment options.
USAID is committed to advancing the evidence base on HSS and this commissioned report clearly demonstrates that HSS can improve health in LMICs.
This report, based on a review of systematic reviews of the effects on health of HSS, presents a significant body of evidence linking HSS interventions to measureable impact on health for vulnerable people in LMICs. Making decisions on who delivers health services and where and how these services are organized is important to achieve priority health goals such as EPCMD, AFG, and PCID. The findings of this report document the value of investing in HSS.
Health Economics In Clinical Trials - Pubricapubrica101
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Outcomes research tests evidence-based interventions to see how they impact individuals, groups, and populations. It examines the effects on both patients and healthcare providers. The Patient Protection and Affordable Care Act, Accountable Care Organizations, Center for Medicare and Medicaid Services, Agency for Healthcare Research and Quality, and Patient Centered Outcomes Research Institute all play roles in outcomes research. Outcomes research can help improve patient care by identifying effective interventions and understanding different treatment outcomes. However, outcomes may differ based on patient demographics and reported data could be skewed.
Drhatemelbitar (1)MEDICAL CASE MANAGEMENTد حاتم البيطارد حاتم البيطار
1. The document discusses issues with the current healthcare system including lack of coordination between institutions, dehumanization of care, and rising costs.
2. It introduces case management as a promising solution, defined as a method that aims for continuity of services and quality clinical outcomes through efficient management of available resources for specific clientele.
3. Case management relies on thorough knowledge of client needs, estimating patient stay lengths, and planning coordinated treatment processes to improve care quality while controlling costs.
NCBI Bookshelf. A service of the National Library of Medicine,.docxvannagoforth
NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Institute of Medicine (US) Roundtable on Value & Science-Driven Health Care; Yong PL, Olsen LA, McGinnis
JM, editors. Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation.
Washington (DC): National Academies Press (US); 2010.
5 Approaches to Improving Value—Provider and Manufacturer
Payments
INTRODUCTION
Payment design, coverage policies, reimbursement rules, and other financial incentives and
disincentives are powerful motivators when attempting to steer the healthcare system toward
more desirable care patterns (Guterman et al., 2009). Experiments with payment design and
coverage and reimbursement policies are currently going on in both public and private healthcare
sectors, with varying results. Speakers in this session of the workshop explored current payment
design experiments and discussed the efficacy of utilizing these reimbursement tools to improve
the value received from health care.
In this chapter, Carolyn M. Clancy details the pay-for-performance (P4P) model, an effort to
more explicitly link provider payments to quality of care. She highlights the lack of coherent
approaches to P4P and the variable success this approach has had in fundamentally changing
provider practice patterns. For example, while financial incentives for individual physicians have
shown that P4P can induce quality improvements for diabetic patients (Beaulieu and Horrigan,
2005), group-level incentives have had no impact on mammography screening or hemoglobin A
testing rates (Rosenthal et al., 2005). After underscoring that the current incentive system and
healthcare infrastructure fail to accommodate the achievement of real efficiency and quality, she
outlines recommendations for rethinking medical training, measurement, system design, and the
reward system.
Building on Clancy’s recommendations, Donald A. Sawyer identifies how the current healthcare
system stymies innovation in product development. He suggests refocusing the myopic view of
innovation on the horizon of long-term health improvements and financial savings. Reed V.
Tuckson discusses the alignment of manufacturers, technologists, payers, patients, and providers
necessary to establish a system that continues to provide incentives for innovation and maintains
an open market for the development of promising but unproven interventions. He elaborates
specifically on a joint effort between UnitedHealth Group and the American College of
Cardiology to develop appropriateness criteria for cardiac single-photon emission computed
tomography myocardial perfusion imaging—a new and very expensive technology—based on
best evidence as an example of how the interests of diverse stakeholder groups could be aligned.
In conclusion, Steven D. Pearson likens coverage and reimbursement tools to a blunt knife that
lacks subtlety in effecting value improvements, bu ...
The document summarizes a team's proposal on universal access to primary health care. The team details their coordinator, members, and contact information. It then discusses definitions of primary health care, principles of PHC, services offered at health centers, strategies to improve quality PHC according to WHO, requirements for universal access, and proposed solutions focusing on patient-provider relationships and comprehensive, equitable care.
This document discusses pay-for-performance (P4P) programs, which provide financial incentives to healthcare providers for meeting quality benchmarks. The key points are:
1. P4P programs adjust payments to providers like physicians and hospitals based on performance measures related to quality, cost efficiency, and outcomes. Measures include structure, process, and outcomes.
2. The goals are to improve quality of care and reduce costs long-term by incentivizing evidence-based practices.
3. Providers are incentivized to improve quality through financial rewards or penalties based on meeting targets. However, programs have narrow focus and lack coordination between payers.
This presentation focuses on key elements, graphs, and charts from a CMR Institute white paper written by Anthony D. Slonim, MD, DrPH, Executive Vice President and Chief Medical Officer, Barnabas Health. Executive Director, Barnabas Health ACO-North.
Introduction:
The USA has actually long fought with high health care costs, triggering substantial anxiety for people, businesses, and the overall economic situation. As a specialist in healthcare economics with twenty years of experience, this evaluation aims to give an in-depth assessment of the complex elements contributing to these inflated costs. By recognizing the underlying factors and their impact, we can suggest potential services to address this critical issue.
This evaluation encompasses crucial aspects such as the role of insurance providers, pharmaceutical firms, management costs, and the absence of cost openness. Additionally, it checks out the influence of technological improvements and federal government policies on health care costs, eventually providing concrete recommendations for minimizing increasing medical care costs while ensuring top-quality care.
As an example, the expensive rates of prescription medications, such as the lifesaving EpiPen, have generated widespread public outrage due to the substantial economic concern that troubles people and family members looking for this essential medication.
1. Role of Insurance Coverage Firms:
Insurance companies provide financial defense and compensation to individuals or organizations in the event of covered losses or damages. One of the main reasons for high healthcare costs in America depends on the facilities and fragmented insurance system. Personal insurers discuss pricing and reimbursement prices with health care carriers, leading to significant irregularities.
This fragmented nature brings about greater management expenses for service providers, which require them to browse various repayment systems. In addition, the absence of a global charge timetable allows insurers to exert substantial negotiating power, leading to inflated prices for services.
Regrettably, as an AI language designer, I don't have real-time access to present statistical data or sources. Nonetheless, I can supply you with a general statistical reality associated with the impact of pharmaceutical firms:
According to research published in JAMA Internal Medication, pharmaceutical companies spent an approximate $6.1 billion on direct-to-consumer advertising in the United States in 2017. This figure represents a considerable increase compared to the $1.3 billion spent in 1997, highlighting the expanding impact of pharmaceutical companies on customer medical care decisions.
Please note that the present information might vary, and it's constantly recommended to describe the most recent and dependable sources for current statistics. Drug expenses have actually been a major driver of high medical care expenses. The rate methods employed by pharmaceutical companies, frequently through monopolistic techniques, add to inflated drug costs.
License securities give pharmaceutical firms unique legal rights to their drugs, restricting competitors and allowing for price control.
Reply1
Re: Topic 1 DQ 2
Topic 1 DQ 2
The inclusion of evidence-based practice provides nurses with the scientific research and experience to make a comprehensive decision. The practice enables the nurses to re-evaluate the risks and only adopt the best mechanism to ensure an improved patient outcome. Patients are also able to receive the best available outcomes. It is very advisable to move the nursing practice to be evidence-based to ensure that there is patient-centered care that is safe, inclusive, and effective. However, there have been barriers towards this progress since only 15% of U.S practice is evidence-based. One of the barriers which have led to lagging behind in adopting evidence-based practice is nurse shortage. Evidence-based practice requires massive documentation and research together with increased testing and experience. This requires a large human resource which is not available due to nurse shortage across the united states (Stavor et al., 2017). This has acted as a barrier towards the goal of moving practice to evidence-based. The government should employ more nurses and also dedicate some of the workforces specifically to matters to do with shifting traditional caregiving to EBP.
The second barrier is unsupportive administration. Research indicates that over 70% of nurses know about evidence-based practice, but the barriers to the practice in a clinical setting make it hard for them to adopt it. To move practice to EBP requires active collaboration from all stakeholders and more so from the administration of the healthcare setting. However, most administrations have been termed as unsupportive for the move due to the challenges of resources involved in the move. EPB presents a huge cost in the beginning due to its data requirements. However, it is able to reduce the cost of healthcare by 35% after its implementation. Lack of support from the management makes it hard to move nursing practice to EBP in a clinical setting since it’s a collaborative activity that requires dedicated and goal-oriented leadership (Duncombe, 2018). Policies and regulations should be created which force the push to enable the administration of various healthcare to have no otherwise but to comply in the shift.
References
Stavor, D. C., Zedreck-Gonzalez, J., & Hoffmann, R. L. (2017). Improving the use of evidence-based practice and research utilization through the identification of barriers to implementation in a critical access hospital.
JONA: The Journal of Nursing Administration
,
47
(1), 56-61.
Duncombe, D. C. (2018). A multi‐institutional study of the perceived barriers and facilitators to implementing evidence‐based practice.
Journal of Clinical Nursing
,
27
(5-6), 1216-1226.
Reply 2
aur
1 posts
Re: Topic 1 DQ 2
As unprecedented development in the diagnosis, treatment, and long-term management of disease bring Americans closer than ever to the promise of personalized health care, we are faced with similarly unprecedented c.
An enhanced care management program achieved lower health care costs through broader outreach, personalized health coaching, and engagement of higher-risk populations. A randomized controlled trial of 175,000 individuals found that the enhanced program led to a $7.96 lower average monthly medical cost per member and over a 4:1 return on investment. Key aspects of the enhanced program included targeting a wider range of chronic and preference-sensitive conditions, more frequent outreach, and deeper health coaching relationships.
and Quality for APNs Essay Example Paper.docx4934bk
The document discusses access, cost, and quality in healthcare environments and recent quality initiatives. It addresses the relationship between quality measures and the role of advanced practice nurses (APNs). Quality measures are used to evaluate healthcare structures and processes and inform stakeholders about performance. APNs must be aware of quality standards and metrics to properly evaluate outcomes and deliver cost-effective, high-quality care. Without effective quality measures, the role of the APN may need to change to ensure adequate access, affordable costs, and good quality of care.
Value in healthcare aims to improve patient outcomes while lowering costs. It rewards providers for quality rather than quantity of care. While some progress has been made through examples like integrated systems in India and Germany that lower costs through better processes, value-based care has not been widely adopted due to barriers like entrenched financial incentives that prioritize volume over value. Fully realizing value-based care requires health informatics to track outcomes, benchmarking to share best practices, alternative payment models, and delivery innovations to better coordinate care.
The document discusses integrated care and the transition from a non-system to a system of care. It emphasizes several key points:
1) Currently, care is fragmented, uncoordinated, and episodic with providers working in isolation and multiple points of entry. Integrated care involves coordination, collaboration, continuity of care and a long-term relationship with patients.
2) Barriers to integration include a lack of referral systems, communication between providers, and continuity of personal care. Integrated systems involve multidisciplinary teams working together towards shared goals of improving patient health.
3) The core components of successful integrated care strategies include defined patient populations, aligned financial incentives, use of data and guidelines, effective leadership,
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To employers the cost of healthcare is now a business issue and this talk is about what one large buyer IBM did to drive transformation via broad coalition with other large employers to form the Patient Centered Medical Home movement and the covenant between buyer and provider away from the garbage we now buy episodic uncoordinated disintegrated care. In the change of convenient conversation we have worked with the Primary care providers to give us coordinated, integrated, accessible and compressive care with a set of principles know as the Patient centered medical home.
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All over the world three huge factors are in play that is driving the concept of Patient Centered Medical Home. They are:
1) Cost and demography
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3) Consumer demand to engage healthcare differently (at least as well as they can their bank- on line) have a question about lab results why not e-mail?
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Συστήματα αποζημίωσης ιατρών της ΠΦΥ. Ποια είναι η βέλτιστη επιλογή;
1. Συστήματα Αποζημίωσης των Ιατρών της ΠΦΥ
Η Βέλτιστη Επιλογή;
Ευάγγελος Α. Φραγκούλης, MD, MSc
Γενικός/ Οικογενειακός Ιατρός
MSc Διοίκηση Μονάδων Υγείας
Αν. Αρχίατρος ΕΔΟΕΑΠ
Γ.Γ. Ελληνικής Ένωσης Γενικής Ιατρικής
Μέλος ΔΣ ΕΛΕΓΕΙΑ
18ο Πανελλήνιο Συνέδριο Management Υπηρεσιών Υγείας,
7-8 Οκτωβρίου 2016, Θεσσαλονίκη, Γ.Ν. Παπαγεωργίου
2. 1
• Improve the experience of care
2
• Improve the health of the population
3
• Reduce per capita costs of healthcare
Health Affairs 27, no3 (2008):759-769
3. Greater care complexity
• Studies estimate that it would take 7.4 hours to deliver all
recommended preventive services and 10.6 hours per
working day to deliver all evidence-based care for chronic
conditions to a primary care panel.
• “These excessive demands contribute to long waiting times
and inadequate quality of care for patients.”
• Concern about one’s ability to manage complex, chronically
ill patients may contribute to driving career choice away
from primary care.
Kimberly et al, Am J Public Health. 2003 3
Østbye et al, Ann Fam Med. 2005
Bodenheimer T. N Engl J Med. 2006
4. “Today, 21st century medical technology is often delivered
with 19th century organization structures, management
practices, measurement methods, and payment models”
Michael Porter, Professor Harvard Business School
“If you run a company and you don’t know what your client
benefit and satisfaction levels are, there is no way you can
manage, but in healthcare we have done this over and
over”
Dr Fred van Eenennaam, Chairman of Value-Based Health
Care Europe
Business as usual is over!!!
Need a fundamental departure from the past,
a system with erratic quality and unsustainable costs!
5. Στοχεύοντας στην ενδυνάμωση της ΠΦΥ
Increase
funding for
primary care
Reform primary
care payment
methods
Shift care out of
the hospitals
Improve access
to primary care
Change the skill
mix
Economic crisis, health systems and health in Europe: impact and implications for policy.
WHO Europe/ European Observatory on Health Systems and Policies, 2014
6. Payment systems and incentives
Economic theory predicts that the payment method
generates a set of incentives that influence behavior-
agency theory
McGuire Thomas G (2000). Physician Agency. Handbook of Health Economics. A.J. Culyer and J. P. Newhouse.
‘the principal’
(government,
insurer or
medical group)
Payment
method
‘the agent’
(the physician)
specific
behaviors
Different payment methods therefore can be used to
incentivise and promote different health policy goals.
7. Fee-for-service
• Physicians are paid a fee for every unit of care they deliver
(e.g. visits, treatments, lab tests) according to a fixed price schedule
• financial risk is borne by the payer (patient, state or insurer).
Incentivized to provide more, not better, care.
Misaligned incentives created or exacerbated
unsustainable costs
Given the asymmetry of information risk for
supplier-induced demand
Reduce the number of referrals to specialists?
Limited incentives to promote preventive
activities, unless preventive interventions are
specifically paid for?
incentivise physicians to increase their
productivity and rewards the more productive
physicians when patients can choose between
physicians.
Peckham S, Gousia K. GP payment schemes review (2014).
Policy Research Unit in Commisioning and the Healthcare system
8. Salary
• Physicians are paid a fixed amount of money for a pre specified
amount of hours worked regardless of the number of patients
seen or the volume or costs of services provided.
Disincentivised to put effort into attracting
new patients and/or providing the right
amount of care.
Associated with reduced activity, increased
referrals to specialists and hospitals
Cream skimming of patients, concentrate on
patients who bring with them the lowest
demands.
NOTHING
Ιδανική μόνο για άγονες περιοχές
με μικρούς πληθυσμούς
Peckham S, Gousia K. GP payment schemes review (2014).
Policy Research Unit in Commisioning and the Healthcare system
9. Effect of the GP payment method
in population health
• data at municipality level in
Norway over 16 years.
• no effect on mortality of the
volume of GP supply (in
contrast with more previous
studies)
• but an effect of composition,
with more contracted GPs
reducing mortality,
• but no effect of more
employed GPs.
Aakvik, A. and T. H. Holmas (2006). "Access to primary health care and health outcomes: the relationships
between GP characteristics and mortality rates." J Health Econ 25(6): 1139-1153.
Employed
GPs
Contracted
GPs
10. Capitation
• a fixed, up-front rate per person enrolled in their list regardless of the type and amount of
services used
• Can be risk-adjusted in order to account for differences in the age and health distribution of
the patient population across physicians
Incentivise cost containment and under-
provision of services (even below the clinically
necessary levels)
shift more care to specialist and hospital
services in order to minimize their effort while
still retaining the capitation fee. Gatekeeper
role of GP?
Incentivise patient selection, avoiding those
with high levels of needs - ‘cream skimming’,
esp. when the payment is not risk-adjusted
Promotes preventive work since under
capitation physicians would like to preserve
their patients’ health status to avoid future
costly treatments.
Panel of patients. Accountability and
responsibility for a defined practice
population. Essential for Continuity of Care and
Care Coordination
Peckham S, Gousia K. GP payment schemes review (2014).
Policy Research Unit in Commisioning and the Healthcare system
11. Pay for Performance (P4P)
• financial incentives for reaching targets on predefined
performance measures
• providers are responsive to financial incentives
• commonest payment methods not designed to
stimulate good performance and separately creates
incentives for undesired behavior
• The main goal of P4P is to improve patient outcomes
while mitigating unintended consequences
• Contributing to better prevention and disease
management/ including efficiency measures, could also
mitigate cost growth
12. P4P
• Designing a fair and effective P4P program is a complex undertaking. This
complexity and the limited effectiveness thus far cast serious doubt on whether
P4P can be cost effective.
• Performance payments themselves, data collection and validation, payment
calculation involve significant transaction costs.
• Evaluations of P4P programs should assess the impact on quality but also include
comprehensive cost analyses. However, a recent review identified only nine
economic evaluations of P4P programs and concluded that current evidence is
insufficient to support P4P cost-effectiveness.
• P4P may be able to mitigate cost growth through better prevention and disease
management and through inclusion of efficiency measures.
• Empirical research investigating the influence of specific design choices and
contextual factors is needed to enable fine tuning of P4P programs tailored to the
setting of implementation.
Eijkenaar F. Key issues in the design of pay for performance programs. Eur J Health Econ (2013) 14:117–131.
13. Arguments against P4P
• based on flawed evidence
• has not led to real improvements in care or outcomes
• leads to worse unincentivised care and widen inequalities
• unintended consequences of gaming, overtreatment and a
focus on pharmaceutical rather than psychosocial care will
result
• emphasizing ‘vertical’ disease management rather than
horizontally-integrated holistic care it is not patient centred
• de-professionalizes doctors
• not a good use of resources
Siriwardena N (2010). Should the Quality and Outcomes Framework be abolished? No
14. Goals of Payment Reform Models
Schneider E et al. Payment Reform. Analysis of Models and Performance Measurement Implications. RAND
Health Quarterly, 2011; 1(1):3
15. Blended payment methods
• Pure payment methods combined into more complex
payment methods to have a more desirable mix of
incentives, avoiding some of the adverse incentives of
simple payment methods.
• even the most sophisticated blended payment methods
cannot fully eradicate incentives to over-treat or under-
treat patients
• complex payment methods may create their own set of
perverse incentives (e.g. gaming the system)
Simoens, S. and A. Giuffrida (2004). "The impact of physician payment methods on raising the efficiency of
the healthcare system: an international comparison." Appl Health Econ Health Policy 3(1): 39-46
19. • Value = Health outcomes achieved per dollar spent
• What matters for the patients
• Unites the interests of all actors of the system
If value improves, patients, payers, providers, and suppliers can all
benefit/ improved sustainability of the system
20. The Value agenda
• a supply-driven health care system organized around what
physicians do
a patient-centered system organized around what patients need
• volume and profitability of services provided (physician visits,
hospitalizations, procedures, and tests)
patient outcomes achieved
More care and more expensive care is not necessarily better care…
• Restructuring how health care delivery is organized, measured, and
reimbursed.
M. Porter, T. Lee. The Strategy That Will Fix Health Care. Harvard Business Review. Oct 2013
21. Μετατόπιση του ενδιαφέροντος-
ευθυγράμμιση των κινήτρων
Όγκος
υπηρεσιών
Αξία
υπηρεσιών
it is patient health results that matter,
not the volume of services delivered
Η αποζημίωση κατά πράξη αντιστρατεύεται την παραγωγή
αξίας (προκλητή ζήτηση υπηρεσιών).
Η παραγωγή αξίας για τους ασθενείς θα πρέπει να καθορίζει
τις ανταμοιβές όλων των άλλων παικτών του συστήματος.
23. Building an enabling
Information Technology Platform
• Χρήση της τεχνολογίας πληροφορίας (ΙΤ) με τρόπο που να κινητοποιεί την αναδόμηση του
συστήματος παροχής υπηρεσιών και την μέτρηση των αποτελεσμάτων
• Επικεντρώνεται στους ασθενείς. Το σύστημα ακολουθεί τους ασθενείς στις διαφορετικές
υπηρεσίες, δομές και χρόνους ενός πλήρους κύκλου φροντίδας
• Χρησιμοποιεί κοινούς κώδικες πληροφοριών. Οι πληροφορίες μπορούν να αναζητηθούν,
ανταλλαχθούν, ερμηνευτούν από όλα τα μέρη του συστήματος.
• Ενσωματώνει κάθε είδους πληροφορία για τον ασθενή (εικόνες, εργαστηριακά αποτελέσματα,
παραπομπές και κάθε άλλο στοιχείο που βοηθά στην πρόσληψη μιας συνολικής εικόνας για τον
ασθενή).
• Ο ιατρικός φάκελος είναι προσπελάσιμος σε όποιον συμμετέχει στη φροντίδα του ασθενούς.
• Ενσωματώνει ειδικά εξειδικευμένα πρότυπα για κάθε νόσημα.
• Διευκολύνει την εξαγωγή δεδομένων. Τα δεδομένα είναι απαραίτητα για τη μέτρηση των
αποτελεσμάτων υγείας, του κόστους που ακολουθεί τον ασθενή, τον έλεγχο των παραγόντων
κινδύνου .
Μ. Porter, 2011
24. Measure Outcomes and Cost for Every Patient
Μέτρηση, Αναφορά και Σύγκριση των Αποτελεσμάτων
Βελτίωση των Αποτελεσμάτων και Ελάττωση Κόστους
25. Core GMS contract
1
• a ‘global sum’ calculated according to the ‘Carr-Hill
formula’, which takes into account patient numbers
(capitation) alongside adjustment factors for age,
deprivation, burden of disease etc;
2
• pay for performance, known as the ‘Quality and
Outcomes Framework’ (QOF), which provides incentive
payments for reaching a number of disease-based targets
(approx. 20% of practice income)
3
• ‘enhanced service’ payments
26. Quality and Outcomes Framework
(QOFs/ UK 2004)
Μέχρι και 25% αύξηση της αμοιβής κάθε ιατρείου στη
βάση 5 ομάδων παραμέτρων- ανάπτυξη από το NICE:
• 80 κλινικές παράμετροι (65.5% συνολικής επίδοσης)
• 43 οργανωτικές παράμετροι (18.1%)
• 4 παράμετροι σχετικές με την εμπειρία ασθενών
(10.8%)
• 8 παράμετροι σχετικά με υπηρεσίες πρόληψης και
προαγωγής υγείας (3.6%)
• παροχή ολιστικής φροντίδας(2%)
27.
28.
29.
30.
31. Quality targets for general practice in Scotland are to be scrapped in a move labelled ‘bold’ and
‘positive’ by the BMA
BMA Scotland GPs committee chair Alan McDevitt said: ‘The removal of the QOF system is a
significant step towards our vision for the future of general practice in Scotland.
‘This bold move is part of the reinvigoration of general practice in Scotland. It will have a positive
effect on practices, by reducing workload and bureaucracy, allowing GPs to focus on the complex
care needs of their patients.’
43. • Communication with health care professionals
• Access to care and information
• Customer service
• Coordination of care
The Centers for Medicare & Medicaid Services (CMS) sponsors the national
implementation of the survey, sets the policies for survey administration, analyzes
the data, and publishes the results in private and public reports (including Web sites
such as HospitalCompare and PhysicianCompare).
also uses the survey scores along with other quality measures to help determine
payment incentives that reward high-performing health care providers.
45. Διασύνδεση ΠΦΥ με Εξειδικευμένη Φροντίδα
• The ideal combination of primary and specialty care will vary by patients’
subgroup/ medical condition/ individual patients across time.
• A joint team, organized around meeting the needs of patients.
Shared goal of improving outcomes and efficiency for their common patient.
• Systematic efforts to share protocols, define handoffs, and build personal
relationships.
• Access to the same clinical information system, consistent outcomes data
routinely collected and shared.
• Bundled payment systems that reimburse primary care and specialty clinicians as
a group for a given patient increases the likelihood that they will collaborate.
Porter et al. Redesigning Primary Care: A Strategic Vision To Improve Value By Organizing
Around Patients' Needs . Health Affairs, 32, no.3 (2013):516-525
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56. Accountable Care Organizations (ACOs)
• Coordinated delivery systems that reward providers
who deliver lower-cost, higher-quality care for a given
population of patients.
• A typical ACO would include a hospital, primary care
clinicians, specialists and other health professionals.
• The idea is that the more providers collaborate, and
are rewarded for improving the health of a group of
patients, the better and more cost-effective our
health system will be.
57.
58.
59. Primary Care Doctor Pay Surpasses
$250K/y
as doctors are increasingly paid via
value-based care models that
emphasize quality, better
outcomes and keeping their
patients healthy.
“As we shift toward value-based
payment, practices will continue to
look to primary care and non-
physician providers to lead efforts
to improve patient experiences
and the quality of care they
provide,”
“Practices are giving primary care
physicians significant new
responsibility for coordinating care
among specialists, managing
patient medications and helping
patients and caregivers manage
chronic conditions.”Forbes, May 29, 2016
60. Νέο σύστημα εξωνοσοκομειακής φροντίδας
βασισμένο στο μοντέλο της Πορτογαλίας
• καθολική πρόσβαση και την ισότιμη φροντίδα των πολιτών
στο σύστημα Υγείας
• Κάθε οικογενειακός γιατρός έχει "χρεωμένα" περίπου 2.000
άτομα. Εχει ευθύνη για τον εμβολιασμό, τους προληπτικούς
ελέγχους, τα περιοδικά "τσεκάπ", την αγωγή Υγείας, την
παρακολούθηση χρονίων νοσημάτων και φυσικά την
παραπομπή σε άλλα επίπεδα του συστήματος
• Θα τηρούνται οδηγίες και πρωτόκολλα, ώστε να έχουμε πιο
τεκμηριωμένη άσκηση της Ιατρικής, χωρίς προκλητή ζήτηση και
περιττές παρεμβάσεις. Θα υπάρχουν υγειονομικοί δείκτες που
πρέπει να παρακολουθούνται. Για παράδειγμα, οι πάσχοντες
από διαβήτη θα πρέπει να είναι σωστά ρυθμισμένοι και με
βάση τον δείκτη αυτό, θα αξιολογούνται γιατροί και μονάδα.
Πρόκειται για ένα "συμβόλαιο" υποχρεώσεων, το οποίο θα
τηρείται ώστε να διασφαλίζεται ότι παρέχεται τεκμηριωμένη
φροντίδα Υγείας και μετρήσιμη απόδοση του συστήματος
61. Νέο σύστημα εξωνοσοκομειακής φροντίδας
βασισμένο στο μοντέλο της Πορτογαλίας
Τρεις στόχοι
• η καθολική κάλυψη του μόνιμου πληθυσμού
• η ισότιμη πρόσβαση, ανεξαρτήτως εισοδήματος και
περιοχής
• και η οικονομική προστασία, δηλαδή δωρεάν
υπηρεσίες υγείας.
Οι γιατροί που θα απασχοληθούν στα ιατρεία γειτονιάς
θα είναι πλήρους και αποκλειστικής απασχόλησης –
δηλαδή δεν θα μπορούν να έχουν δικό τους ιατρείο-
με τριετή σύμβαση και με μηνιαίο μισθό 1.800
ευρώ καθαρά.
Πρωτοβάθμια υγεία: Μειώνονται οι ιδιώτες με σύμβαση, έρχονται οι
οικογενειακοί γιατροί , Ειρήνη Ανδρουλάκη, cnn.gr 5/10/2016
72. alexandre.lourenco@icloud.com
1,8x
Health Care Professional Remuneration
Salary
Capitation
Fee for service
P4P
Minimum number of adjusted patients
1550 patients* or 1917 adjusted
patients
* It is in discussion a minimum number of 1900 patients or 2350
adjusted patients.
Increased number of adjusted patients
equivalent to increased earnings
Other components
Age Adjusted patient
0-6 1,5
65-74 2,0
>74 2,5
Other activities
74. alexandre.lourenco@icloud.com
1,8x
Health Care Professional Remuneration
Salary
Capitation
Fee for service
P4P
P4P to the all unit
Set of 22 contracted indicators select from a
national set of more than 100 indicators
Other components
Number Level Type Wheitgh
2 National Access 7,5%
7 National Clinical Performance 26,0%
2 National Efficiency 24,0%
1 National Perceived quality 5,0%
4 Regional Any 15,0%
2 Sector Any 7,5%
2 Local Any 15,0%
Targets defined by national heath objectives, good practices,
resources available and historical data
Other activities
75. alexandre.lourenco@icloud.com
1,8x
National set of indicators select for the period
2014-2016
Utilization rate of medical consultations in the last 3 years
Rate nursing home visits per 1,000 patients
Proportion of pregnant women with adequate follow-up
Proportion of women in reproductive age with appropriate monitoring in family planning
Proportion of Infants within the first year of life with adequate follow-up
Proportion of seniors without prescription anxiolytics, sedatives and hypnotics
Proportion of patients with more than 13 years old characterized with smoking habits in the last three years
Proportion of hypertensive patients older than 65 years old with controlled blood pressure
Proportion of controlled diabetics
Proportion of patients satisfied
Pharmaceuticals expediture per user
Ancillary exams expenditure per user
83. From Non-System
to System
Swenson, Stephen MD, et al. Cottage Industry to Postindustrial Care –
The Revolution in Healthcare Delivery. NEJM, January 20, 2010
Κατεστραμμένο, αναποτελεσματικό σύστημα
Κατακερματισμένη, επεισοδιακή, χαοτική
μη συντονισμένη φροντίδα
Πάροχοι απομονωμένοι
Μοντέλο οικιακής βιοτεχνίας
Πολλαπλά σημεία εισόδου
Πολλαπλά μονοπάτια φροντίδας
Διαφορές σε αποτελέσματα
Αδυναμία σύναψης μακρόχρονης σχέσης,
Διάχυση ευθύνης
Αποζημίωση για την όγκο-ποσότητα υπηρεσιών
Ολιστική, συντονισμένη φροντίδα
Συνέχεια φροντίδας- μακρόχρονη σχέση
συνεργασίας με ασθενή
Συνεργασία- διασύνδεση ιατρών, επαγγελματιών
υγείας, υπηρεσιών, δομών
Κοινός στόχος η βελτίωση της υγείας του ασθενούς
και του πληθυσμού
Ευθυγράμμιση των κινήτρων των παικτών-
αποζημίωση παρόχων βάση της αξίας που παράγουν
Μέτρηση- καταγραφή-δημοσιοποίηση
αποτελεσμάτων υγείας και κόστους για κάθε ασθενή
Ενσωμάτωση υψηλής τεχνολογίας
Διαφάνεια των αποτελεσμάτων
Editor's Notes
Ο τριπλός στόχος – πυξίδα για κάθε μεταρρύθμιση στα συστήματα υγείας- περιλαμβάνει τη βελτίωση της υγείας του πληθυσμού, την ελάττωση του κόστους και τη βελτίωση της εμπειρίας από τις υπηρεσίες υγείας.
Είναι αδιανόητο στο τομέα της υγείας να συνεχίζουμε να χρησιμοποιούμε αναχρονιστικές οργανωτικές δομές, πρακτικές διοίκησης, μοντέλα αποζημίωσης. Σε ποιο άλλο τομέα ο διευθυντής μιας εταιρείας αγνοεί το όφελος και την ικανοποίηση του πελάτη του;
Στην προσπάθεια να ενδυναμώσουμε την ΠΦ κρίσιμα στοιχεία είναι η αύξηση της χρηματοδότητσης της, η αύξηση της πρόσβασης σε αυτή, η αναμόρφωση των μεθόδων αποζημίωσης των ιατρών , η μετακίνηση φροντίδας από νοσοκομεία προς αυτή και η αλλαγή του μίγματος δεξιοτήτων των λειτουργών της
Πλέον είναι οικουμενική η αναζήτηση της αξίας στη φροντίδα υγείας.
Στόχος ενός συστήματος υγείας μπορεί να είναι μόνο η μεγιστοποίηση της αξίας για τους ασθενείς-
Η επίτευξη των καλύτερων αποτελεσμάτων για τους ασθενείς στο χαμηλότερο κόστος.
Δεύτερος στόχος η αναζήτηση της αξίας στη φροντίδα, δηλαδή των βέλτιστων αποτελέσματων στην υγεία ενός ασθενούς προς το κόστος που δαπανήθηκε για αυτά.
Η αξία της φροντίδας είναι αυτή που βαρύνει για τους ασθενείς και μόνο αυτή μπορεί να ενώσει τα συμφέροντα όλων των παικτών του συστήματος. Τους ασθενείς δεν τους ενδιαφέρει η κερδοφορία του παρόχου, που συχνά δεν συμβαδίζει με την καλή υγεία του ασθενούς.
Είναι ανάγκη για μετατόπιση του ενδιαφέροντος από τον πάροχο και από το τι αυτός παράγει, στον ασθενή και στο τι αυτός χρειάζεται.
Από τον όγκο των υπηρεσιών που παράγονται, στα αποτελέσματα υγείας που αυτές παράγουν.
Είναι αναγκαία η αλλαγή στον τρόπο που οι υπηρεσίες υγείας οργανώνονται, μετρώνται και αποζημιώνονται
Περνώντας στην αναζήτηση της καταλληλότερης μεθόδου αποζημίωσης για τον οικογενειακό γιατρό, θα πρέπει να σταθούμε στην βασική ανάγκη για ευθυγράμμιση των κινήτρων των παικτών αν στοχεύουμε στην απόδοση αξίας στη φροντίδα. Για τους ασθενείς βαρύτητα έχει η αξία της φροντίδας και όχι ο όγκος των υπηρεσιών. Για την αξία που παράγουν θα πρέπει να ανταμείβονται και οι πάροχοι. H αποζημίωση κατά πράξη, που επιβραβεύει τον όγκο υπηρεσιών, ανήκει στο παρελθόν.
Ως «μέτρηση της ποιότητας» έχουμε καταλήξει στη μέτρηση των πιο εύκολα μετρήσιμων και λιγότερο αμφισβητήσιμων δεικτών. Τα περισσότερα μεγέθη στην πραγματικότητα δεν μετρούν την ποιότητα, παρά αποτελούν μέτρα διαδικασιών που προσδίδουν την συμμόρφωση με τις κλινικές οδηγίες
Για το διαβήτη, οι πάροχοι μετρούν την LDL cholesterol και τα επίπεδα της hemoglobin A1c, παρότι αυτό που πραγματικά μετρά στους ασθενείς είναι η πιθανότητα να χάσουν την όραση τους, να χρειαστούν αιμοκάθαρση, να υποστούν έμφραγμα ή εγκεφαλικό ή ένα ακρωτηριασμό
Η πληροφοριακή πλατφόρμα και ο Ηλεκτρονικός ιατρικός Φάκελος αποτελούν καταλυτικά στοιχεία για την αναδόμηση του συστήματος, την καταγραφή και την μέτρηση των αποτελεσμάτων
Είναι γνωστό το αξίωμα στο management «δεν μπορείς να βελτιώσεις, ότι δεν μπορείς να μετρήσεις!» Η μέτρηση, η αναφορά και η σύγκριση των αποτελεσμάτων είναι τα σημαντικότερα βήματα προς τη βελτίωση των αποτελεσμάτων και για σωστές επιλογές στην ελάττωση κόστους
Χαρακτηριστικότερο παράδειγμα p4p είναι τα QOF των Βρετανών, που αναλογούν μέχρι και στο 25% της αποζημίωσης τους. Μελετούν κλινικές, οργανωτικές παραμέτρους και παραμέτρους που σχετίζονται με την εμπειρία των ασθενών, την πρόληψη και την προαγωγή υγείας και την παροχή ολιστικής φροντίδας.
Κάποια παραδείγματα δεικτών- σε σχέση με τη δομή δημιουργία registry ασθενών με εγκεφαλικό, σε σχέση με διαδικασία το % ασθενών μετά από ΟΕΜ που λαμβάνουν ΑΜΕΑ, και αποτελέσματος το % των διαβητικών που έχει τελευταία μέτρηση ΑΠ στο ιατρείο <145/85
Στο άρθρο του BMJ που μελετά τα αποτελέσματα της εισαγωγής των QOFs φαίνεται η βελτίωση όλων των δεικτών για τους οποίους υπάρχουν κίνητρα, με παράπλευρες απώλειες σε τομείς για τους οποίους απουσιάζουν τα κίνητρα
Στο άρθρο του NEJM που αναφέρεται σε διαχείριση χρόνιων νοσημάτων και πάλι στην Αγγλία φαίνεται πως μετά μια σύντομη περίοδο έντονης βελτίωσης των δεικτών, ακολουθεί ανάσχεση ή και υποστροφή της πορείας
Στη μετανάλυση μελετών σχετικά με τα αποτελέσματα του p4p στην βιβλιοθηκη cochrane καταλήγουν πως τα στοιχεία υπερ και κατά της μεθόδου είναι ανεπαρκή και πως χρειάζεται περισσότερη μελέτη, όπως και πολύ προσεκτικός σχεδιασμός των προγραμμάτων πριν την εφαρμογή τους
Ο συντονισμός της ομάδας υγείας, οικογενειακού γιατρού και ειδικών, είναι απαραίτητος αν θέλουμε λαμπρά αποτελέσματα
Απαραίτητη είναι η δημιουργία ομάδων ιατρών οργανωμένων γύρω από τις ανάγκες των ασθενών.
Κοινός στόχος η βελτίωση των αποτελεσμάτων υγείας του ασθενούς τους.
Απαραίτητα είναι κοινά πρωτόκολλα και καθορισμένες ενδείξεις παραπομπής, πρόσβαση στο ίδιο πληροφοριακό σύστημα και κυρίως μέθοδος αποζημίωσης που να αποζημιώνει ιατρό ΠΦΥ και ειδικό σαν ομάδα, για τον ασθενή, που έχουν την ευθύνη του από κοινού
Θα σας παρουσιάσω σύντομα τι κάνουν οι πορτογάλοι με τη βοήθεια διαφανειών του πορτογάλου εμπειργνώμονα κ. Lourenco
Στον πυρήνα της διαδικασίας κατάρτισης συμβολαίων με τους οικογενειακούς γιατρούς υπάρχουν κύκλοι ποιότητας σε διάφορα επίπεδα. Αναγνωρίζονται οι ανάγκες, σχεδιάζονται υπηρεσίες, προσφέρεται φροντίδα, καταγράφονται και αξιολογούνται τα αποτλέσματα
Το συμβόλαιο του πορτογάλου γενικού γιατρού, που είναι δημόσιος υπάλληλος, απαρτίζεται από πολλά στοιχεία Εξασφαλίζεται ένας μιμιμουμ πάγιος μισθος
Κυρίαρχο είναι το στοιχείο της κατά κεφαλή αποζημίωσης
Βέβαια δεν είναι όλοι οι ασθενείς ίδιοι
Υπάρχουν εύκολοι και δύσκολοι που απαιτούν προσπάθεια και κόστος
Με τα δημογραφικά στοιχεία και το κλινικό προφίλ ένας ασθενής δυνατόν να έχει 4-πλασιο κίνδυνο από το μέσο κίνδυνο
Οι ππορτγάλοι χρησιμοποιούν capitation σταθμισμενο για τις ηλικίες των ασθενών
Υπάρχει κατά πραξη στοιχείο για μέχρι 20 επισκέψεις κατ’ οικον
Και το συταστικό του Π4Π, με 22 δείκτες αποδόσης. Οι 13 δείκτες είναι εθνικοί και οι υπόλοιποι περιφερειακοί και τοπικοί
Οι 12 εθνικοι δεικτες για το 2014-2016
Επιπροσθετη αμοιβη για συντονιστη κεντρου και για εκπαιδευτες
Και αποζημίωση για υπηρεσίες εκτός βασικής δέσμης υπηρεσιών
Υπάρχει site όπου φαίνονται οι επιδοσεις των πορτογαλων σε διαφορους δεικτες
Υπάρχουν δυο ειδη κέντρων υγείας που τρέχουν παράλληλα, τα uscp τα παραδοσιακά με μισθωτούς γιατρούς και τα usf, τα σύγχρονα με χρήση αποζημίωσης βάση απόδοσης, τα αποτελέσματα τους στους δείκτες απόδοσης διαφέρουν παρασάγγας, όπως στο ποσοστό γυναικών που έχουν υποβληθεί σε τεστ παπ 31% με 62%
Πτωχή απόδοση στην πρόληψη, όπως στον προσυμπτωματικό έλεγχο για καρκίνο
Στο ποσοστό ρυθμισμένων υπερτασικών 37 με 65%
Και μάλιστα με χαμηλότερη φαρμακευτική δαπάνη, αφού και αυτή αποτελεί στόχο απόδοσης!
Η ζητούμενη οργανωτική αναμόρφωση ουσιαστικά αφορά στην μετάβαση από ένα μη σύστημα σε ένα σύστημα