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Action 19 of the Orientation Note AN INTEGRATED VISION ON CARE FOR CHRONIC DISEASES IN BELGIUM

Action 19 of the Orientation Note AN INTEGRATED VISION ON CARE FOR CHRONIC DISEASES IN BELGIUM. Lecture by Guus Schrijvers , em . Professor of public health and health economist at the University M edical Center U trecht. Action 19.

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Action 19 of the Orientation Note AN INTEGRATED VISION ON CARE FOR CHRONIC DISEASES IN BELGIUM

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  1. Action 19 of the OrientationNoteAN INTEGRATED VISION ON CARE FOR CHRONIC DISEASES IN BELGIUM Lecture by Guus Schrijvers, em. Professor of public health and health economist at the University Medical Center Utrecht

  2. Action 19 encourage mixed financing systems supporting the objectives of quality, integration, multidisciplinarity and patient empowerment.

  3. Action 19 encourage mixed financing systems supporting the objectives of quality, integration, multidisciplinarity and patient empowerment. • To provide financial incentives for multidisciplinary and long-term interventions • To provide incentives for improving the quality of care

  4. Otherremarks in the ORIENTATION NOTE: AN INTEGRATED VISION ON CARE FOR CHRONIC DISEASES IN BELGIUM • Fee-for-service is less suited to chronic care • more mixed payment systems • an annual lump-sum based on the patient's needs • personal assistance budget • these new ways of paying for services are to be introduced in stages

  5. First assessment of Action 19 • All is right • It is notworked out • No referenceto the economic crisis

  6. Tip 1-3 toBelgian policy makers in care for persons with a chroniccondition • Make yourown assessment of yourpayment systems for chronic care • Change the economicparadigmof anannualgrowthwithabout 3 – 5% toBetter care for persons with a chronicconditionwith the same money • Discuss the abolition versus continuation of a fee for service system: is it a holycow?

  7. Availablepayment systems for care for persons with a chroniccondition • Triple Aim • DisruptiveInnovation • Bundledpaymentwith shared savings • Pay for performance • Pay for patient’s performance • Drawingrights for patients • The Cappuccino model

  8. Triple Aim: TheoryandModel

  9. 1. Triple Aim Three Aims: • Better health (= Outcomequality) • Betterquality (Processquality) • Lowerinsurance premium

  10. 1. Triple Aim Three Aims: • Better health (= Outcomequality) • Betterquality (Processquality) • Lowerinsurance premium • Insurance companies in the lead • Co-creation of allparties • Consensus and no ennemy thinking betweenparties

  11. Tip 4 to Belgian policy makers in care for persons with a chroniccondition 4. Work Triple Aim out for your consensus thinking

  12. 2. DisruptiveInnovation

  13. 2. DisruptiveInnovation • Financial innovationfollows professional innovation • Three business in health: 1. diagnosticdepartments2. addvaluefirms (therapy) 3. cooperatives, esspecially for persons with a chroniccondition • Disruptive: complete branches disappearedbecause of internet • Diagnoses to GP and patiënts • National andregionalcooperatives • Bundeldpayments for these cooperatives

  14. Tip 5 to Belgian policy makers in care for persons with a chroniccondition 5. Experiment withcooperatives of patientsand professionals for long term care

  15. 3. Bundledpaymentwith shared savings • Affordable Care Organizationintegrateprimary health care andhospital care • Savingsbecause of the cooperation are for e.g. 50% for providers • Ten experimentalgardens in The Netherlands

  16. 3. Bundledpaymentwith shared savings • Affordable Care Organizationintegrateprimary health care andhospital care • Savingsbecause of the cooperation are for e.g. 50% for providers • Ten experimentalgardens in The Netherlands • First results in Holland: no financial integrations; • USA: the devil is in the detail • one person, one team, one system

  17. Tip 6 to Belgian policy makers in care for persons with a chroniccondition • Start pilots with financial integrationand shared savings

  18. 4. Payfor performance • More paymentwith e.g. better health (Hb1Ac) for diabetes patients • It does notworkbecause of upcoding, patientbehaviour • Rheoretical wrong: professionals have enoughmotivationtoimprovequality

  19. References for statement: P4P does notwork • Flodgren G et al, An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD009255. DOI: 10.1002/14651858.CD009255 • Werner RM et al, The effect of Pay-For-Performance in hospitals: Lessons For quality improvement, doi: Health Aff April 2011 vol. 30 no. 4 690-698 • LindenauerPK, Public Reporting and Pay for Performance in Hospital Quality Improvement,NEngl J Med 2007;356:486-96 • Ryan AM et al, Medicare’s Flagship test Of Pay-For-Performance did not spur more rapid quality improvement among low-performing hospitals, Health Aff 2012 pp 797-805 • LA Petersen et al, Does Pay-for-Performance Improve the Quality of Health Care?, Ann Intern Med. 2006;145(4):265-272. doi:10.7326/0003-4819-145-4-200608150-00006 • Epstein AM, Will Pay for Performance improve quality of care? The answer is in the details,NEngl J Med (367) 2012 1852-1853 • EijkenaarF et al, Uitkomstbekostiging in de zorg: Internationalevoorbeelden en relevantievoorNederland,ErasmusUniversiteit Rotterdam, 2012 • Mullen KJ et al, Can you get what you pay for? Pay-for-performance and the quality of healthcare providers, RAND Journal of Economics, Vol. 41, 2010, RAND pp 64-91 • Christianson JB et al, Lessons From Evaluations of Purchaser Pay-for-Performance Programs: A Review of the Evidence,Medical Care Research and Review, Supplement to Volume 65 Number 6,2008, pp 5S-35S • Woolhandler S & D Ariely, Will Pay For Performance Backfire? Insights From Behavioral Economics, http://healthaffairs.org/blog/2012/10/11

  20. Tip 7 to Belgian policy makers in care for persons with a chroniccondition Do not start experimentswithoutcomefinancing

  21. 5. Payfor patient’sperformance (P4PP) • If persons withchronicconditionsadhereandcomplytoguidelinesand follow courses, theyreceive a small remuneration, e.g. e lowerinsurance premium of 250 euro annually • This is behavourialeconomics • It exist for dental care: no payment for treatment if a persons visitstwice a year the dentist • Initiativeexists in Germany: no copaymentsif a person with diabetes followsone a year a course

  22. Tip 8 to Belgian policy makers in care for persons with a chroniccondition 8. Start experimentstoempowerpatientswith small financial incentives

  23. 6. Drawingrights for patients

  24. 6. Drawingrights for patientswithdaily ADL-disabilities • Long term care is not the same as care for persons with a chroniccondition • Integrated,broadindividual care and support plan • This plan is legalpayment titel for drawingrights on insurance companies andmunicipalities • Tobeintroduced in The Netherlands for all types of long term care • No administration for frailelderly; no frauds

  25. Tip 9 to Belgian policy makers in care for persons with a chroniccondition 9. Follow the developmentswithdrawingrights in The Netherlands and copy the goodthings

  26. 8. The Cappuccino model Mix payment system: • Capitation fee (or bundledpayment or popiulationbasedfinancing) for 80% • A small fee for service (10%) • A small fee for innovation (10%) In The Netherlands for integratedprimary health care In The Netherlands for community nursing

  27. Tip 10 to Belgian policy makers in care for persons with a chroniccondition Read my new book: Guus Schrijvers, ZORGINNOVATIE VOLGENS HET CAPPUCCINO MODEL, in press, forthcoming November 2014

  28. At last: • I thankyou for your attention andwishyou a valuablecongress

  29. Contact? Guusschrijvers: • mail@guusschrijvers.nl • www.guusschrijvers.nl • www.twitter.com/GuusSchrijvers

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