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How incentives work

Improving primary care in Europe and the US: Towards patient-centered, proactive and coordinated systems of care. The Rockefeller Foundation Bellagio Study and Conference Center, Italy April 2 to 6, 2008. How incentives work.

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How incentives work

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  1. Improving primary care in Europe and the US: Towards patient-centered, proactive and coordinated systems of care The Rockefeller Foundation Bellagio Study and Conference Center, Italy April 2 to 6, 2008 How incentives work The Catalan single purchaser integrated care experience: evaluation results Josep M. Argimon

  2. Framework Context: • Chronic disease management Goals: • Promote cooperation among providers • Facilitate the integration process of a fragmented health system Means: • Provider payment mechanisms: Capitation

  3. Purchasing 1.0: competition System: • Per health services lines since early 90’ INCENTIVES Primary Care Adjusted capitation Cost-consciousness Purchaser-provider split Clarity of rules (contracts) Poor incentives for coordination Sum-zero game No risk sharing Specialized Care Activity adjusted by complexity

  4. Capitation pilot Context: • (2001) 5 pilots to test capitation as contract base for integrated services Goals: • To improve healthcare equity, continuity and efficiency through the promotion of territorial alliances among providers Method: • Average per capita expenditure adjusted by “need” proxies

  5. Purchasing 2.0: coopetition System: • Integrated health services for a defined population INCENTIVES Primary Care Strong incentives for coordination Risk sharing Cost-consciousness Purchaser-provider split Identity risks Adjusted per capita expenditure Specialized Care

  6. Evaluation

  7. Evaluation Quantitative study: • Chronic conditions selected: heart failure, COPD.... Qualitative study (2005): • Semi-structured interviews to managers and health professionals • Narrative analysis Results: • Great variability of perceptions and facts • Good alternative to resource allocation • More dialogue and increased trust and transparency. • A service quality improvement tool. • Lack of knowledge in the base line

  8. Conclusions Qualitative study: • Payment mechanisms need to be paired with purchaser’s policy making capacity. • Integrated networks perform better when cost, benefits and risks are shared. • Creating a culture of trust and cooperation needs time • Managers and professionals need to be involved

  9. Thank you

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