How to Use Quality Indicators for Improvement and Governance Croatian Health Insurance Fund Siniša Varga, DMD, director Dubravka Pezelj Duliba, MD, MPH, deputy director for health care services ESQH Annual Workshop, Performance measurement in healthcare, Zagreb, May 23-24, 2013 4.8.2013. 1 Vision and Mission of Croatian Health Insurance Fund VISION OF THE HEALTH CARE SYSTEM To become a health system where quality healthcare is available to everyone, according to the principles of comprehensiveness, accessibility and solidarity. MISSION OF THE CROATIAN HEALTH INSURANCE To rationally invest funds of insured persons in quality and efficient health services and programs that will add years to life and life to years. Public Financing of HC – Money Flow Local taxes Co-payment Local authority Capital Investments,, Investments Infastructure Contribution – compulsory HI (13% on wage) CHIF TREASURY Health care Purchasing (contracting contracting)) Different taxes Voluntary HI (supplementary) Purchaser-provider split Health Care Contracting CHIF contracts with health care providers Clarify roles and responsibilities of purchaser and provider Connect input with process, results, output and outcome Input Process Result Output Outcome Invested Gained 4.8.2013. 4 Health Care Contracting HC policy instrument Way of payment encourages HC provider to certain behavior (incentive), Tendency to increase number of payment unit (and price), and decrease expenses per unit (cost of), Capitation Episode of care Fee for service 4.8.2013. 5 Why „New Model” in PHC? The old wasn’t good enough because doctors: Were highly (or fully) dependent on (number of) patients Were not paid according to workload or performed procedures Didn't fulfill the expected "gatekeeping" function 4.8.2013. 6 „New Model” - the basic concept: Fixed amount • Enables financial sustainibility • Ensures the existence of Public healthcare service’s network Variable amount – (limited) • Special payment of the precisely defined procedures • Stimulate providers to perform certain procedures • Financial stimulation in line with the scope of the performed work „Corrective factor” (income correction) Bonus („reward”) • Work evaluation based on monitoring work processes, outcome and output through KPI’s and QI’s • Increasing efficiency of the healthcare services • Encourage certain behaviour patterns (financial stimulation for ‘’extra effort’’) The Goal and Expected Result Better, effective health system Health care of higher quality Rationalization of unnecessary expenditures Transparency PHC in the center of health system Focus on patient Individually tailored revenue Individual approach to the patient 4.8.2013. Satisfaction of doctors and patients 8 Key Elements of New Model’s Doctor’s Revenue in PHC Basic revenue WHAT? • Overheads Fixed amount • Capitation • Diagnostic/Therapeutic procedures (DTP) Stimulating revenue Efficiency and quality • KPI – key performance indicators • QI – Quality indicators HOW? Additional possibilities (5+) 4.8.2013. • Prevention • Group practice • 5 programme 9 Family Medicine - Revenues by Percentage – Standard Team (1.700) „Old” 5.112; 1% 37.614; 9% 18.000; 4% 17.860; 4% „New” 17.860; 4% 209.315; 43% 138.915; 29% 376.139; 86% 99.225; 20% Fixed 63% capitation DTP 4.8.2013. CEZIH adminstration overheads capitation DTP KPI QI 10 kpi (efficiency) efficiency) Reffering to secondary care Reffering to PHC laboratory Proportion of preventive procedures 30% KPI 30% KPI (index 100) (rate 2,5) 30% KPI (test phase) 10% KPI (850 tests per 1.700 patients) - 33% KPI (index 100) 33% KPI (test phase) 34% KPI (250 tests per 1.000 patients) - 25% KPI (test phase ) 25% KPI (300 tests per 6.000 patients) - 50% KPI - 50% KPI Drug prescription index Family medicine (7,5% capitation + DTP) Preschool children HC ( 5,5% capitation + DTP ) Women’s health care ( 7,5% capitation + DTP ) Dental care ( 7,5% capitation + DTP ) Sick leave rate - 25% KPI 25% KPI (index 100) (rate 1,7) - - First Results, KPI Drug Health prescription Nr. (total) center team INDEX <100 >100 1.760 85 559 28 Private practice Sick leave RATE Nr. (total) Health center team Private practice 1.201 57 <2,5 >2,5 1.553 268 484 87 1.069 181 1.400 1.400 1.200 1.200 1.000 1.000 800 800 600 600 400 400 200 200 0 0 Health center team <100 4.8.2013. Private practice >100 Health center team <2,5 Private practice >2,5 12 QI (quality) Activity QI Chronic patient panel Family medicine Description Monthly Patient satisfaction evaluation % of first system examination Children until 2 months with DTP - PD163 Preschool children HC of children until 2 months Patient satisfaction Guestbook evaluation W >50y, with examination GI001 with GI101 TVU W < 30 g. contraception GI001 with GI007 Women’s health care consulting Patient satisfaction Guestbook evaluation Patient with noted DTP DM002 ili DM004 have dental status Dental care Patient satisfaction Guestbook evaluation Guestbook Coverage Payment value % 1 panel daily 85% Y/N 15% 90% 85% Y/N 15% 50% 60% 60% 25% Y/N 15% 80% 85% Y/N 15% Panels – New Approach to Prevention and Chronic Patient PANELS Structured uniformed data for early detection of risk behaviors and situations along with monitoring the complications of chronic patients. I. Preventive panel Screening of patients with risk behaviors and situations II. Panels for chronic patient permanent monitoring hypertension diabetes COPD COPD PANEL Smoking : 14.04.2014 Consulting Leaflet Alarm Ex smoker Spirometry Give Refferal Alarm FEV1 value ( % ) : 15.04.2014 62% Rp. Rp. for antibiotics Own entry Alarm Nr of acute exacerbations with antibiotic use: 2 Refferals realised (Nr) Nr) Own entry Alarm Nr. Nr. of hospitalizations: hospitalizations: 1 Automatically Own entry Alarm Influenza vactination . . Not performed QI performed : 0% 76 % 100 % Panel : COPD Patient : 117456345 IVAN HORVAT Date of Panel opening opening:: 14.04.2014 Status of Panel: Unlocked Alarm: Influenza vactination Additional Possibilities in Family Medicine (5programme) eHealth Taking blood for lab test Advisory center Ordering Phone consulting additional income (1% per „star”) 4.8.2013. 16 Additional Importance of Quality Measurement for CHIF Directive 2011/24/EU of the European Parliament and of the Council on the application of patients’ rights in cross-border healthcare In order to help patients to make an informed choice when they seek to receive healthcare in another Member State, Member States of treatment should ensure that patients from other Member States receive on request the relevant information on safety and quality standards enforced on its territory as well as on which healthcare providers are subject to these standards. CHIF National Contact Point! 4.8.2013. 17 Thank You for your attention! Contact: [email protected] 4.8.2013. 18