Purchasing integrated Diabetes Care Indicators for good health care.
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Transcript of Purchasing integrated Diabetes Care Indicators for good health care.
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Purchasing integrated Diabetes Care
Indicators for good health care
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Costs and costs-coverage
0%
2%
4%
6%
8%
10%
12%
Kosten Personen opbouwLG
FKGinsuline
alle FKG's
Per
cen
tag
e va
n t
ota
le k
ost
en Z
FW
Te dekken kosten
Effect FKG
Effect Lftd/geslacht
Kosten obv aantallen
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Prevalence Agis insurees medicinal treated diabetics,conform age, 1999 t/m 2002 (database Agis)
0
20
40
60
80
100
120
140
160
0 10 20 30 40 50 60 70 80 90 100
Leeftijd (10-jaarsklassen)
Pre
vale
nti
e p
er 1
.000
ver
zeke
rden
1999 2000 2001 2002
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Diabetic chance
• 60.000 insurees with diabetic (4%)
• Growing prevalence
• Growing costs
• Incomplete coverage
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Activities Agis?
• Budgetmodel (income Agis)– focus: financing HIC’s
– Maintenance en improvement
• Purchasing diabetes care– focus: care providers
– Best practice (guidelines and standerds)
– Interaction (‘working together’) between care providers (hospitals, GP’s, homecare, nurses)
• Pay for Performance– focus: interaction care provider – diabetic patiënt
– 2000 – 15.000 patiënts
– Group level
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Indicators for Diabetes
• Ministery of Health Care,Welfare and Sports• Council of inspectors• Dutch Specialist Group• Dutch Diabetec federation (NDF)• Dutch Primary Care Diabetic Guideline• Agis Health care Insurance company• WHO• OECD
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Value based purchasing
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Value based purchasing
• Medical outcome– Health improvement
• Quality of life• Patiënt Experiences
• BPR• Costprice• Pay for performance-
bonus
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Value based purchasing
• Commitment HIC• Commitment care
providers• Partnership HIC –
Care provider• Diabetes contract• Continous
improvement
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Medical Outcome (NDF)
• Diabcare indicators data base - GP’s– Facilitaded bij Agis– GP’s ownership– Agis management information on group level
• D4H organisation– Facilitates GP’s implementing treatment proces
Diabetic care, including information technology
• TTP
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Health improvement
• Risk profile Diabetic Group
• Indicators Diabetic group t0 –t1
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Health improvement• 1% < HbA1c
25% lowering microvasc. compl.
• 4 - 5 mg/dl < LDL8% - 10% lowering card. vasc. event
• glucose < 1%25% lowering amputations
• vet < 4-5 mg/dl10% lowering MI
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Patiënt experiences
• CAHPS diabetes
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Cumulatieve respons t/m 18/1,relatief t.o.v. uitgezette lijsten
0%
10%
20%
30%
40%
50%
60%
70%
0 5 10 15 20 25 30 35 40 45 50
Werkdag na eerste verzending
Agis GE Algemeen Diabetes Ziekenhuis
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Score losse vragen en composiet Communicatie,incl. betrouwbaarheidsinterval 95%
0%
25%
50%
75%
100%
vraag1 vraag2 vraag3 vraag4 composiet
Huisarts Internist Verpleegkundige Diëtist
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Composiet scores Afstemming, Begeleiding, Communicatie en Voorkomendheid,
incl. betrouwbaarheidsinterval 95%
0%
25%
50%
75%
100%
Huisarts Internist Verpleegkundige Diëtist
Afstemming Begeleiding Communicatie Voorkomendheid
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Huisarts: Diabetesspecifieke communicatie
0% 20% 40% 60% 80% 100%
Bloedglucose regulatiewordt met huisarts
besproken
Goede diabetesvoorlichting
Goede begeleidingdagelijkse omgang met
diabets
Besproken of huidigebehandeling optimaal is
Nooit/somsMeestalAltijd
N =
328
N =
339
N =
340
N =
345
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Huisarts: overige vragen
0% 20% 40% 60% 80% 100%
Afstemming metandere zorgverleners
Geen tegenstrijdigeinformatie
Goede begeleiding vandosering van insuline
Niet moeilijk tebegrijpen i.v.m.taalproblemen
Nooit/somsMeestalAltijd
N =
334
N =
227
N =
321
N =
307
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HbA1c CAHPS Diabcare
< 9 79% 87%
9 or up 21% 13%
RR CAHPS Diabcare
< 90 74% 80%
90 or up 26% 20%
< 140 47% 45%
140 or up 53% 55%
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CAHPS Diabcare
Eye controle 70% 68%
feetcontrole 60% 65%
Urine control 60% 82%
RR 90% 92%
HbA1c 87% 87%
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complications
• 10 % one or more severe hypo’s• 15% treated for retinopathie• 2% any form of amputation• 9% kidney problems• 5% CVA or MI
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parameter proces Uitkomsten Punten
HbA1c 93% HbA1c measeurement in the last 12 months
55% < 8%≤ 21% ≥ 9,5%
510
Lipiden profiel 85% lipid profile measurement in the last 12 months
63% LDL ≤ 130 mg/dl
20
Risico profiel 90% riskprofile known 10% improvement
40
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parameter proces uitkomst bonus
Patiëntexperiences
90% is informed about HbA1c, RR en life style
80% knows HbA1c RR, life style advices
20
Working together 80% recieves uniform information from different care providers
20
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contract
• Price per patiënt per year– Excluding medicin, measurement equipment
• Cost price after bussiness proces redesign
• Three years
• Risk sharing
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monitoring
• Indicators– health outcome– health improvement
• Patiëntexperiences (CAHPS)
• ttp