Introduction to the Disease Management Funding Approach
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Introduction to the Disease Management Funding Approach. Hofdijk J. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
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Introduction to the Disease Management Funding Approach
- 1. Introduction to the Disease Management Funding approach Jacob Hofdijk EFMI president Ministry of Health – Integrated Funding Team
- 2. Care continuum with silo’s
- 3. Reasons for Reform in 1994 • Two contra productive business models • Hospital tries to keep within the budget • Physician on fee for service • Involvement of Government too restrictive • Growing costs, but no metrics of the outcome • 1994 Biesheuvel Report Modernising Curative Care • The start of Paradigm Shift from supply to demand orientation
- 4. Performance based hospital funding • Demand orientation Health issue patient • Combine diagnostics and treatment • Payment of Hospital / Medical specialist • Requires data collection by patient by health issue • New dimension in health information systems • System designed by major stakeholders • After preparation introduction for funding 2005
- 5. Health Insurance Act 2006 • Mandatory Insurance scheme for all • After 30 years of political discussion ! • Competing private insurance companies • Insurance company contracts health providers of choice • Central role for Insurance companies • Focus on Quality Improvement • Sustainable health care system
- 7. The Dutch DBC Funding results More market and transparency Patients can choose Process of CHANGE ! DBC-systems works 7
- 8. 10 20 30 40 50 60 70 80 % 90 0 Di ab ete Di s ab +B M Ha I r ti Be nf ro ar er ct te (C VA ) Ha r tf Co ale lo n nk an ke Lo ng r ka nk Bo er rst ka nk er As tm a CO Os PD te op or os e growth of chronic diseases since 2005 The 2030 Long Term Care Crisis Mannen Vrouwen
- 9. Chronic Disease Costs > 70%
- 10. Major Causes of Chronic Diseases
- 11. Diabetes Care Standard 11
- 12. Care Standard is Special • Developed by Care Providers and Patients • Based on Guidelines / Protocols / Lifestyle • Defines what Good Chronic Care is for patiënt • Not who should perform • Combines Prevention and Care • Defines Quality Performance Indicators • Base for Task substitution • Involvement Patient
- 13. 2005 National Diabetes taskforce • Diabetes Care is growing • The system will not be able to cope • The NDF Diabetes Care Standard • Agreed by professionals and patient organisation • Only applied to 40 % of the patients ACTION is needed 13
- 14. 2006 Diabetes funding Experiment • Performance based funding for Diabetes • Based on the Care Product Approach • Contracting by Insurance Companies • With Multidisciplinary Care Team • Represented by a Care Group, a legal entity • Reporting of Process and Outcome • Care based on the NDF Care standard • First step to Integrated Care Delivery • Experiment with 10 groups
- 15. The Dutch Chronic Care Funding Model Process Carestandard for Outcome Good Diabetes Care Patient CQ Caregroup Insurer Contract Patient Care Providers 15
- 16. Result Experiment • Care group responsible for outcome • Focus on education and continuous learning • Documentation of care process and outcome • IT support still in its infancy, but good examples • Quality improvement process stimulated • The contracting process is new for all
- 17. First indications of result In Green en White areas with lower then expected foot amputations a disease mgt approach was applied. The black and red areas have Higher then expected amputations
- 18. Next Step Integrated Care Funding introduction for chronic diseases Preparation started in 2009 18
- 19. Integrated Care Funding 2010 • Integrated Funding for chronic conditions 1. Diabetes 2. Cardio Vascular Risk Management 3. COPD • Based on Authorized Care Standards • Contract on Price / Performance Indicators • Free pricing • Transparency by Reporting Chronic Dataset • Focus on Prevention • Patient part of the team – Lifestyle changes 19
- 20. Integrated Care in and exclusions Incidental Medical Specialist Care Indication In clusion Integrated Care Product Ex clusion Indication Physiotherapy program
- 21. Integrated care & care standard GP Pharmasists Dietist Physiotherapies Podotherapist Medical Care Standard Specialists Home Care Laboratory Imaging Dept PATIENT 21
- 22. A meta standard for care standards • Care standard development was hot • National Platform for care standards • Develop a model for care standards • Define what care should be provided • Care standard base for individualised care • Define Obligate Parameters • Process and outcome measures • Implementation aspects 22
- 23. Focus Care Standard Chronically Ill 23 Diagnosis At Risk Healthy
- 24. Care Standard Model Indexed Care related Prevention Prevention & treatment
- 25. IT requirements • Multidisciplinary team of primary (GP’s, Nurses , paramedical specialist) and secundary care ( medical specialist) • Patiënt is part of the care team • Individual Proactive Treatment plan • Semantic Interoperable Data • Cross institutional solution • Annual Reporting Dataset by patient
- 26. Documentation Parameters (DCM) Each submodule has a number of Obligate Parameters Document these in a Detailed Clinical Model DCM The DCM is the base for registration , Exchange of Data and Reporting DCM are part of the care standard DCM will be maintained nationally DCM have two dimensions Modeling clinical content to clinical datamodel Translating Clinical datamodel to implementation standards
- 27. Care Standard Model + I N Indexed Care related Prevention Prevention & treatment T E G R A T Implementation Dimensions E Specification Reporting eHealth D Parameters DCM Datasets Requirements
- 28. Result • Care standard Care Process Interventions Quality Indicators • Annex to the Care Standard • Funding arrangement • Contracting • Documentation • Specification Clinical Parameters • Reporting dataset • ICT requirement
- 30. New health delivery model – phase 1 Integrated DBC funding Diabetes CardioVascularRisc Management
- 31. Chronically Ill Diagnosis At Risk Take Home Message Healthy • Active involvement of Patient, individual treatment plan based on • Care standards ( Clinicians Consumer Patients) with integrated eHealth standards • Interlinking of prevention and care • New business model focused on quality • Reorientation Health Delivery System substitution • Challenges providers and insurers • European Approach seems needed ! 34