Download - The Dutch disease management funding approach€¦ · 7. It’s the patient’s problem , stupid ! Larry Weed. The Problem oriented approach. Subjective, Objective, Assessment and

Life is a trip

leading to the

future

generation

Introduction

4

The supply oriented HC budgetThe supply oriented HC budget

1. GP 2. Specialist 3. Hospitals 4. Dentists 5. AliiedNurses

6.Drugs 7. Lab 8. Homecare

9. MentalCare

9,5 % of GNPStill growingNational Care

Budget

Burden ofDiseases

Outcome

?

Supply

Demandorientation

Citizens require Better healthOutcome

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It’s the patient’s problem , stupid ! Larry Weed

The Problem oriented approach

Subjective, Objective, Assessment and Planning

The clinical care

process

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Principles of the value chainPrinciples of the value chain

Quality

Focus on Outcome

will control

cost

9

Drivers of reformDrivers of reform

Consumers

Zorgaanbieders VerzekeraarsCare providers Insurers

From Budgets to contractsBased on outcome Focus on patientsA healthy workforce Transparency and Governance

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The Dutch Health Issue Approach Step 1The Dutch Health Issue Approach Step 1

Diagnose

Health Issue Intake

Diagnos tics

TherapyHealthy

Hospital care Hospital care Setting independentSetting independent

An overview of CONTsys2007‐04‐25

11

episode of care

mandate to export personal data

care mandate

demand mandate

care plan

health care provider activity

contact element

record component

subject of care

health issue thread

EHR extract

health care party

health issue

0..11is focus for

0..1 is centred on1

0..*0..* is topic for

0..*has topic0..*


0..*has topic1..*


0..*has topic1..*

0..*1..*is addressed by

0..* addresses1..*

0..*1..*is addressed by

0..* addresses

1..*

0..*1determines

0..* is determined by1

0..11..*is labeled by

0..1 is label for1..*

11..* concerns

1is subject of1..*

0..*

1..*

is referenced by0..*

links 1..*

0..10..* is labeled by

0..1is label for0..*

10..* is identified or stated by

1identifies or states0..*

clinical guideline1..*

0..* is centred on1..*is focus for

0..*

Health issue according to Contsys

From budget to contract

0102030405060708090

Diabete

sDiab

+BMIHart

infarc

tBero

erte (

CVA)Hart

falen

Colonk

anker

Longk

anker

Borstka

nker

Astma

COPDOste

oporo

se%

MannenVrouwen

The Dutch 2030 Long Term Care CrisisGrowing Chronic Care PatientsDecreasing Health workforce

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Chronic Care ModelChronic Care Model

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Traditional organisation Traditional organisation

HIS

ZIS

AISLIS

DIS

PIS

DVKInternistLab

Dietary

Pharmacy

GP/POH

Patiënt

Podotherapist

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Who is accountable ?Who is accountable ?

Market 1

Market 2

Insurer

CareStandard

StructureProcessOutcome

Care Group

DietaryGP InternistNurse

The Care Group !The Care Group !

Integrated Care Program !

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Blank pageBlank pageHealthylifestyle

Cardiovasculair

risk‐

management

Diabetes

mellitus

Wellness

Roken

Bewegen

Alcohol

Voeding

Stemming

Stress

Participatie

Obesitas

Hypertensie

Dyslipidemie

Nefropathie

Glucose

Retinopathie

Neuropathie

Voeten

submodule 4submodule 3submodule

2

submodule 1

submodule 4submodule

3

submodule 2submodule 1

submodule 4submodule 3submodule 2submodule 1


3







3








Ziektespecifieke addities

Ziektespecifieke

addities



Ziektespecifieke

addities

Ziektespecifieke

addities

Ziektespecifieke

addities

DiabetesDiabetes

Clinical & ProcessParameters

InteroperableSystems

Coordination of care

ClinicalDatasets

IndicatorsProcess Outcome

Quality

Care-standard

Norm

Care-program

Care group

IndividualCare Plan

Patient

From model to patient !From model to patient !

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The issues of the patient !The issues of the patient !

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Involve the patient in the team!Involve the patient in the team!

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Individual Care and Self management plan

Multidisciplinary team

Central Care Provider Patient

Integrated care requires !

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Traditional IT dimensionTraditional IT dimension

HIS

ZIS

AISLIS

DIS

PIS

DVKInternistLab

Dietary

Pharmacy

GP/POH

Patiënt

Podotherapist

Single provider systemsSingle provider systems

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From messages to coordinationFrom messages to coordination

IntegratedManagement

DB

Individual Care Plan

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The Care Plan for Jan Jansen The Care Plan for Jan Jansen

IntegratedManagement

DB

The Jan Jansen Care Plan

FysioModule 2

DietaryModule 3 Glucose

Neuropathy

Retinopathy 3

Self MgtStop Smoking

Retinopathy 3

GlucoseNeuropathy

DietaryModule 3

FysioModule 2

Self MgtStop Smoking

Careplan

Jan Jansen

An overview of CONTsys2007‐04‐25

31

health care provider activity

health care contributing activity

health care automated activity

health self care activity

health care goal

health care actorprogramme of care

subject of care

local health record

health care activity

1..*1..*substends

1..* is subtended by1..*

11..* is performed by

1performs1..*

1..*

0..*

1..*

0..*

1..*1receives

1..* is performed for1

0..*0..* is registered in

0..*registers0..*

episode of care1..*

1..*is time frame for1..* has time frame

1..*

Contsys concepts availableContsys concepts available

Approach to IT issues integrated care

34

Health 2.0 management sceneHealth 2.0 management scene

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Care standard links to eHealthCare standard links to eHealth

Indexed Prevention

Care related Prevention & treatment

ClinicalParametersDCM

Implementation Dimensions

Reporting Datasets

Stepped CareModules

INTEGRATED

eHealthRequirements

Patient U

Provider 3

Provider 1Provider 2

The care plan brings structure , but

the Holistic Clientthe Holistic Client‐‐Centric ViewCentric View

GP

CommunityNurse

Hospital

Care/NursingHome

Physiotherapy

Pharmacy

Laboratory

DentistOpticianSpecialist Clinics

HealthCare

Personal Support

Housing

Community ServicesHome Safety

SocialCare

LearningNeeds

Leisure

Voluntary Services

Private sector support

Diagram after P. Hill

Chiropody

The point on the horizon The point on the horizon

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So siloSo silo’’s will break,s will break,

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The Free Message The Free Message Healthy

At Risk

Diagnosis

Chronically Ill

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Is this a good reason ! A sustainable system for my grandson Mick and yours

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