1. Vladimir Zelensky Director, Moscow State Health Insurance Fund
IT tools supporting transition of Moscow public health care to value-based model
Vladimir Zelensky
Director, Moscow State Health Insurance Fund

2. Moscow Health Care Landscape
Mandatory State Health Insurance (MSHI) covers 95% of medical services
Moscow State Health Insurance Fund (MSHIF) is the payer for all medical services included in MSHI for providers located in Moscow
Annually:
> 9 mln patients receiving health services
> 500 mln outpatient services through 350 providers
> 2 mln inpatient services through 100 hospitals
> 4 mln emergency ambulance services

3. Fragmentation leads to waste
Two payment models are used:
Capitation for outpatient services
DRG-like for inpatient services
Lack of coordination between healthcare providers and different payment models result in lack of quality, waste of resources and difficulties in care control

4. Combined efforts are the only way
Well-informed patients choose quality
Providers push high-outcomes through competition
Payer maintains supervision and assistance to both patients and providers
Value-based healthcare
Patients
Payer
(MSHIF)
Providers

5. Creating patient—centered model
From 2015 MSHIF provided free access for all patients in Moscow to data about their clinical encounters which they can evaluate (PANDORA project)
Additional free services – e-pillbox with drug-checking options
Mid 2018 – MSHIF will provide patients with
a unified messenger for interacting with physicians
Value-based healthcare
Patients
Payer
(MSHIF)
Providers

6. Motivation for healthcare providers
In 2018 MSHIF introduced bundle payment for health services regarding pregnancy and delivery
Bundle includes both inpatient and outpatient services with a fixed price
Main conditions to receive a bundle:
Following a certain patient pathway (incl screening tests and pregnancy monitoring)
All health services in one healthcare unit (building a center of responsibility)
Value-based healthcare
Patients
Payer
(MSHIF)
Providers

7. Global payer supervision
MSHIF moving from collection of monthly claims to utilization of clinical data
We use SAS Episode Analytics for grouping individual encounters into episodes of care and identifying services related to potentially preventable complications
Automated Care Quality Control System powered by FairIsaac software is used for identification of suspicious claims and targeting audit procedures
Value-based healthcare
Patients
Payer
(MSHIF)
Providers

8. Changing the way of thinking
IT-systems and alternative payment models are just an instrument
Patients, providers and payers are partners and not enemies
Quality control, provider competition and patient-engagement result in high outcomes

9. Thank you! Vladimir Zelensky
Director, Moscow State Health Insurance Fund