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Meir Raz M.D .

The Impact of Information Communication Technology on Healthcare Management. Meir Raz M.D. Czech Healthcare Forum Prague, Czech Republic Sep 2008. ISRAEL. Established in 1948 as a social democracy with a parliamentary multi-party system.

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Meir Raz M.D .

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  1. The Impact of Information Communication Technology on Healthcare Management Meir Raz M.D. Czech Healthcare Forum Prague, Czech Republic Sep 2008

  2. ISRAEL • Established in 1948 as a social democracy with a parliamentary multi-party system. • A history of armed conflicts with neighboring Arab countries and large scale immigration have placed continuing heavy burden on Israel's economy. • Income inequity is among the highest of developed countries.. • Decreasing public financing for the health system

  3. ISRAEL • National Health Insurance (1995) Patient Rights act (1996). • Formal priority setting process for revising the benefit package based on solid information and a structured decision-making procedure (1997). • National Quality Measures for Health Funds (2000).

  4. The Israeli Health Care System

  5. Health Funds provide a uniform legally defined basket of services to which every citizen is entitled Every citizen is a member of one of four nationwide health funds Citizens are free to choose and move between health funds Health funds must accept all applicants for membership Health funds are financed by government via age-related capitation payments (90% of total), patient charges and other income (10%) National Health Insurance Law of 1995

  6. Basic Demographic & Health Sector Data

  7. Maccabi Healthcare Services • Maccabi is the second largest health fund in Israel. • Maccabi functions within the framework of the National Health insurance Law, and is therefore limited by constraints imposed by the Law. • Members are free to choose their physician and other services provider from a wide range of participating providers and may go directly to specialist physicians without the referral of a family physician

  8. Members receive services from Maccabi facilities and from independent suppliers. 90% of physicians are independent . More than 50% of medications purchased by members are supplied through Maccabi pharmacies Maccabi is remunerated on a capitation basis but methods of payment to providers varies:* Physicians: Quarterly visits within global budget* Hospitals: Negotiated Caps within a National Cap* Other providers: Fee-for-service Co-payments exist for medications, visits to physician specialist clinics and some other services. Maccabi Healthcare Services

  9. Maccabi’s Vision Israel's leading and most advanced healthcare organization aims to achieve Total Health for its members, providing integrative and personally- tailored health care to each and every member, and encourages excellence in the quality of medical care, knowledge and service.

  10. Maccabi Statistics • 1,800,000 members (24% of total membership of all funds) • 9,150 employees , of whom 7,438 are full-time position • 3,560 physicians. Most of them are independent physicians. • 3,109 clinics. • Maccabi's budget –1.35 billion euro

  11. The Maccabi Health Fund

  12. Age Adjusted Income from Capitation (Excluding new technologies)

  13. Development 1% Other medical Physicians 7% Diagnosis 24% 9% Administration 8% Hospitals Drugs 30% 21% 91% of Maccabi Expenditures are Medical

  14. NIS 409M NIS 430M NIS 879M NIS 435M NIS1,579M NIS 1,141M Budgetary Efficiency Processes 30% 24% 9% 21% 7% 9% Payment Oversight Guidelines Purchasing Purchasing Agreements Increased efficiency Increased efficiency Policy Guidelines Other medical Physicians Diagnostics Drugs Hospitals Admin.

  15. Health Funds’ Financial Performance 2000-2006 Millions NIS

  16. Basic Principles of Health Care Management • Physicians generate the majority of healthcare expenditure: • Equipping the physicians with means to help them execute the health fund policy is vital (via intelligent decision support system). • In order to influence market prices one has to be involved in the market: i.e. Pharmacies, Hospitals, Ambulatory secondary care. • Competition, in order to reduce costs and increase quality mandates selective contracting with healthcare providers. Two levels of competition: 1.between the providers in the organization. 2.between the health funds.

  17. Basic Principles of Health Care Management • In order to maintain a balanced budget : • one needs to manage all parts of the system simultaneously (multi piston) • one has to use a variety of methods . • shift between the methods periodically in order to avoid “gaming”. • Effective health fund managing necessitates comprehensive Health Management Information Systems (H.M.I.S.).

  18. Towards HMIS - Milestone Decisions • Decision to move towards a fully computerized organization (1983). • Using State I.D. Number as the Maccabi I.D. Number and then introduction of the Magnetic Membership Card to be used in every point of service (1989). • Joint decision by Maccabi and its independent physicians organization to computerize physicians clinics (1988->1994). • Computerization of claims management (1989) . • Computerizing the prescriptions and the pharmacies (1989) - the beginning of the E-prescription era ,controlling utilization and costs. • Computerization of the laboratories (1993)and imaging (1997). • Central Medical Record (1996) • Flexible rule engine (2008)

  19. Doc. Clinic Members Members Members Members Doc. Clinic Medical Control Firewall Pharmacy Main Computer Backup Computer Admin Control Specialist Intranet Internet Consultant Clinic Extranet Payment Control Paramedic Reimburse-ment Control Drug consumption control Labs control Tele radiology Web Services Mgmt. of Insured People Mgmt. of Service Providers Mgmt. of the Fund Diagnostic Center Maccabi’s Integrated Information System

  20. Maccabi Central Medical Record Types of computerized data available for patient’s tracing and follow-up Medical History Family History Demographic parameters Lab Results Visits & Hospitalization Medications Imaging Treatments

  21. Towards HMIS - Milestone Decisions • Telemedicine: Second opinion with Mass General Hospital-Boston (1997) Tele radiology (1997)CT/MRI consultation (2002)Tele E.C.G. & Holter (2004)Tele ophthalmology (2008) Tele consultation with specialists (2008). • Disease Management for chronic diseases: Registries-D.M.(1999),C.V.(2003) Home care(2005)….. Disease management programs-Asthma(1999),D.M(2000), CHF (2007).

  22. Rational & Feasibility in Maccabi • Equal access throughout the country. • On-Line diagnosis . • Extension of service hours. • Reliable diagnosis due to digital tools. • Improved quality control and assurance. • Archiving capabilities for future comparison. • Sharing information among physicians for treatment and consultation. • Lower cost.

  23. Integrated Decision Support Systems for Prescriptions • Medical/Control/Peer review • Organization’s drugs index • Prescribing (Patient details / allergies / interactions) • Generic substitute • Preferred therapeutic alternatives • Patient compliance

  24. Online Imaging Consultation Center • Until 2000, CT utilization rates increased by 20% yearly • 2001 Imaging Consultation Center established • Physician referrals online to the Center • Radiology experts access CMR • Approve proposed test or recommend more appropriate and effective modality

  25. ResultsUtilization rates of CT and MRI between 2000-2003 • CT annual performance rates decreased from 25.9-17.3/1000 (81,223-57,204) -33% decrease • MRI rates decreased from 7-5.6 – decrease of 9% • The cost savings for 2000-2003 were 2.7 million Euro • The set up of ICT support system was 228,000 Euro

  26. Management Through Setting strategic objectives and measuring performance Health Value Added (HVA) Quality of Clinical Care Perceived Quality Member Satisfaction Managing the Organization in order to achieve Total Health Meeting Budgetary Objectives Physician Satisfaction Organizational Processes (Bureaucracy) Employee Satisfaction

  27. Clinical Care Objectives Quality of Clinical Care Cardiovascular Disease Immunizations Antibiotics Depression Diabetes Mammography Asthma

  28. Perceived Quality (Member Satisfaction) Overall satisfaction with health plan Growth in the number of new members Number of members that switch to a competing plan Satisfaction with healthcare services Satisfaction with administrative services

  29. Fiscal Responsibility Expenditures in accordance with Budget: Expenditures on Hospital Services Expenditures on Physician Services Expenditures on Medications Overall expenditures

  30. Consistent measures over time Targets for both clinical care and perceived quality of care Targets based on previous years achievement Progress available “on-line” HVA Principles

  31. Measurement at all levels of the organization: National Regional Local Branch Physician Constructive Competition at each level HVA Principles

  32. Quality indicators Diabetes Members’ satisfaction Financial indicators HVA – The Tool

  33. Health Value Added (HVA) Promoting “total health” through quality-based strategic management utilizing integrated performance measurements To sum up:

  34. Integrated Preventive Health Care Major Contributing Factors: The “Personal Physician” Comprehensive Health Information and Communication Technology (ICT) Strategically Focused Objective-based Performance Measurement (HVA)

  35. Thank you for your attention

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