Caribbean Health Financing Conference Curacao, 31 October 2012 - PowerPoint PPT Presentation

Caribbean Health Financing Conference Curacao, 31 October 2012

Objective: Embark on the train towards value based health care • Our business is to create value, not (only) to control costs • Episode registration is the cornerstone of our new health system • Data is not enough, information and knowledge is what we need • Investments in integral Interested Aware chronic care programs 3

Objective: Embark on the train towards value based health care • Our business is to create value, not (only) to control costs • Episode registration is the cornerstone of our new health system • Data is not enough, information and knowledge is what we need • Investments in integral Interested Willing to try Aware chronic care programs 4

Objective: Embark on the train towards value based health care • Our business is to create value, not (only) to control costs • Episode registration is the cornerstone of our new health system • Data is not enough, information and knowledge is what we need • Investments in integral Interested Willing to try Embark Aware chronic care programs 5

Agenda • Factors driving the necessity for value added in health • Conceptual framework for focus on value vs cost in health systems • Lessons of experience for Caribbean countries • Implications of value added focus in health programs 6

What is the value of your health? • What is most valuable to you? – Health? – Your family / kids = health • Not true • Have you ever invested in your health? – No  there you go … – Yes  why did you stop? • To get well is our highest value!! Our priorities are set by our reality 7

Agenda • Factors driving the necessity for value added in health • Conceptual framework for focus on value vs cost in health systems • Lessons of experience for Caribbean countries • Implications of value added focus in health programs 8

The care system…. Morbidity Burden of disease… 1 (Burden of disease) 2 Creates demand for care… Complex Chronic Acute Urgent Not urgent Elective Care delivered 3 … care being provided GP Specialist Hospital Dentist Paramedical Pharmacy Lab Home Other &intramural care 4 … paid for and administrated National Health Budget … funded by health Per capita insurance premiums and healthcare costs vs. 5 gov’t funding insurance premium 5 …Sourced from National GDP income (Gross National 9 Product)

Healthy productive population The care system…. Morbidity Burden of disease… 1 (Burden of disease) 2 Creates demand for care… Complex Chronic Acute Urgent Not urgent Elective Care delivered 3 … care being provided GP Specialist Hospital Dentist Paramedical Pharmacy Lab Home Other &intramural care 4 … paid for and administrated National Health Budget … funded by health Per capita insurance premiums and healthcare costs vs. 5 gov’t funding insurance premium 5 …Sourced from National GDP income (Gross National Product) 10

We have to make sure that the health budget is well spent And is considered an investment rather than cost to society COSTS TO VALUE FOR SOCIETY SOCIETY Population Balance between Balance between affordability of care care needs and and funding for quantity and exploitation of care quality of care practices and institutes National Health Budget Care Care WHY DO WE WHAT BURDEN providers products HAVE TO PAY WAS AVOIDED / THAT MUCH? HOW MUCH VALUE WAS CREATED? Balance between what care providers are paid and the care products they deliver

Agenda • Factors driving the necessity for value added in health • Conceptual framework for focus on value vs cost in health systems • Lessons of experience for Caribbean countries • Implications of value added focus in health programs 12

Data gathering  information  knowledge is essential A. No complete balance B. Balance between costs for society and income of care providers – Exploitation costs are covered Population – Salary cap BUT: B D C. No balance between what is paid and A what is delivered: Care Care – Care activities instead of care products C providers products D. No match between care needs and the care delivered (quality / quantity): – Care needs are not met – Too much work for too little payment 13

What is the importance of data gathering and analysis? • Monitor health risks – Infectious diseases (HIV/Aids - STD - Dengue) – NCD – Lifestyle • Monitor care consumption Monitor health risks 14

Health budgeting and spending is an ongoing game of balancing the budget From here we drill down to find out : What’s the cause / How can we improve balancing the budget

What is the importance of data gathering and analysis? • Monitor care consumption Costs of care in 2009, per category* 35,0 • Monitor morbidity and care needs 32,9 – How healthy is SXM? 30,0 – Care needs of the population Other private 25,0 Fatum 22,2 • Monitor quality of care FZOG – Process and outcomes 20,0 Subsidies 15,0 SVB BZV 8,4 10,0 8,6 5,7 5,9 5,8 5,0 2,1 2,5 1,1 0,0 Intramural Pharmacy Specialists GP's Care Lab Other Transport Paramedic Home abroad Care Monitor health risks 16

What is the importance of data gathering and analysis? • Monitor morbidity and care needs – How healthy is SXM? – Care needs of the population Costs of care in St. Maarten 2009, per category* 35,0 32,9 30,0 Other private 25,0 Fatum 22,2 FZOG 20,0 Subsidies X ANG MLN 15,0 SVB BZV 10,0 8,4 8,6 5,7 5,9 5,8 5,0 2,1 2,5 1,1 0,0 Intramural Farmacy Specialists GP's Care Lab Other Transport ParamedicHome Care abroad Monitor health risks Monitor care consumption 17

From Standards of care towards individual care plans When? Individual Individual Individual & Patient care needs Care plan By whom? Client How ? Caregroup Care program Health & District problems Care teams Who ? Region National Standards of care What ? Diagnosis norm 18

The care standard in the care continuum Risk Risk Individual Care Coaching Identification assessment profile care plan modules patients Smoking Overweight Alcohol Stress Hypertension Cholesterol DM2 Depression 19

Visualize risk profile Smoking 10 COPD exacerbations Overweight Exercise tolerance Physical (in)activity 8 COPD LIFESTYLE Pulmonary function / 6 Nutrition dyspnea 4 Retinopathy Alcohol 2 0 Neuropathy Stress Diabetic foot Depression Glucose Anxiety DIABETES MELLITUS PSYCHOLOGICAL COMPLAINTS Nefropathy Somatisation Blood pressure Cholesterol T0 T1 VASCULAR RISK 20

Make an individual care plan based on assessment Health issues Stepped-care modules Smoking Sc module 1 Sc module 2 Sc module 3 Sc module 4 Disease specific Fhysical activity Unhealthy Sc module 1 Sc module 2 Sc module 3 Sc module 4 Disease specific lifestyle Alcohol Sc module 1 Sc module 2 Sc module 3 Sc module 4 Disease specific Nutrition Sc module 1 Sc module 2 Sc module 3 Sc module 4 Disease specific Depression Sc module 1 Sc module 2 Sc module 3 Sc module 4 General Stress Sc module 1 Sc module 2 Sc module 3 Sc module 4 wellbeing Participation Sc module 1 Sc module 2 Sc module 3 Sc module 4 Obesity Sc module 1 Sc module 2 Sc module 3 Sc module 4 Hypertension Cardiovascular Sc module 1 Sc module 2 Sc module 3 Sc module 4 risk-management Dyslipidemidia Sc module 1 Sc module 2 Sc module 3 Sc module 4 Nefropathiy Sc module 1 Sc module 2 Sc module 3 Sc module 4 Glucose Sc module 1 Sc module 2 Sc module 3 Sc module 4 Retinopathtjy Sc module 1 Sc module 2 Sc module 3 Sc module 4 Diabetes mellitus Neuropathy Sc module 1 Sc module 2 Sc module 3 Sc module 4 Feet Sc module 1 Sc module 2 Sc module 3 Sc module 4 21

Organization individual CVRM: case management Patient Risk and Individual Feedback & Intake Follow up recruitment care profiles care plan Benchmark Smoking Cessation therapy Physical Psychologist therapist Central care provider Pharmacist Dietician Specialist 22

Feedback & benchmark every 3 months Patient Risk and Individual Feedback & Intake Follow up recruitment care profiles care plan Benchmark 23

What is the importance of data gathering and analysis? • Monitor quality of care – Process and outcomes Most patients with diabetes are not controlled BMI in patients included in CariCare Majority of patients have HbA1c > 9 75% of patients have overweight Number of patients HbA1c in patients with DM2 Number of patients 250 250 200 200 150 150 100 100 Costs of care in St. Maarten 2009, per category* Smoking Aggregatingpatient profiles… … insightinto type and volume of care 35,0 10 32,9 Nephropathy 8 Overweight 50 30,0 6 Other private 50 4 25,0 Fatum Hypertension 2 Physical activity 22,2 FZOG 0 20,0 Subsidies X ANG MLN 15,0 SVB Cholesterol Nutrition BZV 10,0 8,4 8,6 Stress Alcohol 5,7 5,9 5,8 5,0 2,1 2,5 1-mrt-09 1-mrt-10 0 1,1 0,0 Intramural Farmacy Specialists GP's Care Lab Other Transport ParamedicHome Care 0 abroad Monitor morbidity Monitor HbA1c < 6.5 Monitor care HbA1c 6.5 - 7.4 HbA1c 7.5 - 9 HbA1c >=9 BMI < 20 BMI 20 - 24.9 BMI 25 - 29.9 BMI 30 - 34.9 BMI 35 - 40 BMI > 40 24 and care needs health risks consumption 30 32