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Purchasing integrated Diabetes Care Indicators for good health care.

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Presentation on theme: "Purchasing integrated Diabetes Care Indicators for good health care."— Presentation transcript:

1 Purchasing integrated Diabetes Care Indicators for good health care

2 Costs and costs-coverage

3 Prevalence Agis insurees medicinal treated diabetics, conform age, 1999 t/m 2002 (database Agis)

4 Diabetic chance insurees with diabetic (4%) Growing prevalence Growing costs Incomplete coverage

5 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 – patiënts –Group level

6 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

7 Value based purchasing

8 Medical outcome –Health improvement Quality of life Patiënt Experiences BPR Costprice Pay for performance- bonus

9 Value based purchasing Commitment HIC Commitment care providers Partnership HIC – Care provider Diabetes contract Continous improvement

10 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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18 Health improvement Risk profile Diabetic Group Indicators Diabetic group t0 –t1

19 Health improvement 1% < HbA1c 25% lowering microvasc. compl mg/dl < LDL 8% - 10% lowering card. vasc. event glucose < 1% 25% lowering amputations vet < 4-5 mg/dl 10% lowering MI

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21 Patiënt experiences CAHPS diabetes

22 Cumulatieve respons t/m 18/1, relatief t.o.v. uitgezette lijsten

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25 Huisarts: Diabetesspecifieke communicatie N = 328 N = 339 N = 340 N = 345

26 Huisarts: overige vragen N = 334 N = 227 N = 321 N = 307

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28 HbA1cCAHPSDiabcare < 979%87% 9 or up21%13% RRCAHPSDiabcare < 9074%80% 90 or up26%20% < 14047%45% 140 or up53%55%

29 CAHPSDiabcare Eye controle70%68% feetcontrole60%65% Urine control60%82% RR90%92% HbA1c87%

30 complications 10 % one or more severe hypo’s 15% treated for retinopathie 2% any form of amputation 9% kidney problems 5% CVA or MI

31 parameterprocesUitkomstenPunten HbA1c 93% HbA1c measeurement in the last 12 months 55% < 8% ≤ 21% ≥ 9,5% 5 10 Lipiden profiel85% lipid profile measurement in the last 12 months 63% LDL ≤ 130 mg/dl 20 Risico profiel 90% riskprofile known 10% improvement 40

32 parameterprocesuitkomstbonus Patiëntexperience s 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

33 contract Price per patiënt per year –Excluding medicin, measurement equipment Cost price after bussiness proces redesign Three years Risk sharing

34 monitoring Indicators –health outcome –health improvement Patiëntexperiences (CAHPS) ttp


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