Meir Raz M.DMeir Raz M.D..
The Impact of The Impact of Information Information
Communication Communication Technology on Technology on
Healthcare ManagementHealthcare Management
Czech Healthcare ForumCzech Healthcare Forum Prague, Prague, Czech RepublicCzech Republic
Sep 2008Sep 2008
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
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).
ISRAEL
The Israeli Health Care System
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
IsraelCzech RepublicTotal population - millions 6.810.2
Annual population growth rate2.1%-0.1%
60 +as % of total 200613.0%20.0%200013.2%18.4%
Life Expectancy at birth, both sexes200681.077.0200078.075.0
Probability of dying under age 5 years20065.04.0per 1000 - both sexes20007.05.0
Health expenditures as % of GDP 20057.8%7.1%20008.0%6.5%
Per capita health expenditures in PPP $ 2005$2,143$1,4452000$1,810$980
Private health expenditures as % of total health expenditures200533.5%11.4%
200030.6%9.7%
Government health expenditures as % of total government expenditures200511.2%14.4%
200011.5%14.1%
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
Maccabi Healthcare Services
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
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.
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
Maccabi Statistics
The Maccabi Health Fund
(Excluding new technologies)
Age Adjusted Income from Capitation
91% of Maccabi Expenditures are Medical
Physicians24%
Other medical7%
Development1%
Diagnosis 9%
Administration8%
Drugs21%
Hospitals30%
Diagnostics Drugs
Purchasing
Policy
21%21%
Physicians
Payment
Guidelines
24%24%
Oversight
Admin.
Increased
efficiency
NIS 879M NIS1,579MNIS 1,141M NIS 409M NIS 430MNIS 435M
Budgetary Efficiency Processes
9%9% 9%9%
Purchasing
Guidelines
Other
medical
7%7%
Increased
efficiency
Hospitals
Agreements
30%30%
Health Funds’ Financial Performance 2000-2006Millions NIS
HealthFunds
Clalit
Maccabi
Leumit
Meuhedet
Total
2000200120022003200420052006
-242-472-413-1064-347-63
-140-528139-13
-111-204-94-2713-75-76
-21-535-58681319
-514-734-474-17894-410-117
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.
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.).
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)
Maccabi’s Integrated Information SystemMaccabi’s Integrated Information System
Clin
icExtr
an
et
Internet
Intra
net
Members Members Members Members
Medical Control
Admin Control
Payment Control
Reimburse-ment Control
Doc. Clinic
Doc. Clinic
Pharmacy
Specialist
Consultant
Paramedic
Diagnostic Center
Firewall
Backup Computer
Main Computer
IDC
Mgmt. of Insured People
IDC
Mgmt. of the Fund
IDC
Mgmt. of Service Provider
s
Drug consumpt
ion control
Labs control
Tele radiology
Web Services
CMRERP
Imaging
Visits &Hospitalization
Medications
Lab Results
Treatments
Demographic parameters
MedicalHistory
FamilyHistory
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).
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.
Rational & Feasibility in MaccabiRational & Feasibility in Maccabi
Medical/Control/Peer review
Organization’s drugs index
Prescribing (Patient details / allergies / interactions)
Generic substitute
Preferred therapeutic alternatives
Patient compliance
Integrated Decision Support Systems Integrated Decision Support Systems for Prescriptionsfor Prescriptions
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
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 EuroThe cost savings for 2000-2003 were 2.7 million Euro
The set up of ICT support system was 228,000 EuroThe set up of ICT support system was 228,000 Euro
Organizational
Processes (Bureaucrac
y)
Perceived Quality Member
Satisfaction
Quality of Clinical
Care
Meeting Budgetar
y Objective
s
Management Through Setting strategic objectives Management Through Setting strategic objectives and measuring performanceand measuring performanceHealth Value Added (HVA) Health Value Added (HVA)
Managing the
Organization in order to
achieve Total Health
Physician Satisfacti
on
Employee
Satisfaction
Quality of Clinical Care
Cardiovascular Disease
Antibiotics
Diabetes
Depression
Asthma
Immunizations
Mammography
Clinical Care Objectives Clinical Care Objectives
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
Expenditures in accordance with Budget:
Expenditures on Hospital Services
Expenditures on Physician Services
Expenditures on Medications
Overall expenditures
HVA PrinciplesHVA Principles
Consistent measures over time
Targets for both clinical care and perceived quality of care
Targets based on previous years achievement
Progress available “on-line”
Measurement at all levels of the organization:
National
Regional
Local Branch
Physician
Constructive Competition at each level
HVA PrinciplesHVA Principles
Quality Quality indicatorsindicators
DiabetesDiabetes
Members’ Members’ satisfactionsatisfaction
Financial Financial indicatorsindicators
HVA – The ToolHVA – The Tool
To sum up:To sum up:
Health Value Added (HVA)Health Value Added (HVA)
Promoting “total health” throughPromoting “total health” through
quality-based strategic managementquality-based strategic management
utilizing integrated performanceutilizing integrated performance
measurementsmeasurements
Major Contributing Factors:
The “Personal Physician”
Comprehensive Health Information and Communication Technology (ICT)
Strategically Focused Objective-based Performance Measurement (HVA)