direction générale disease management development the independent health insurance funds...
TRANSCRIPT
Direction Générale
Disease Management DEVELOPMENT
The Independent Health Insurance Funds
Brussels,05.07.2010
Réunion - Date
2
Strategic context
1. Why introducing DM ?
Challenges on the macro-level:
Dramatic increase of the number of patients with chronic conditions;
High costs to health and social systems
Improve care quality
Improve efficiency in use of the available resources for treatment of chronic diseases
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Strategic context
Why introducing DM ? (2)
Challenges on the process-level:
Systematizing the use of guidelines by physicians
Improving coordination of care
Improving patient compliance in medication and life style adoption
Systematizing the use of ICT in care
Systematizing data input/analytics on treatment process and outcome
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Strategic context
Disease Management Company Vision
Integration NeedMedical Integration Mgmt Information Integration MgmtFinancial Resources MgmtDaily operations Mgmt
New entity of Disease Management
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Unique position MLOZ and NM in HCS
Free and independant from others
20% of market
Fast growing (2.4%)
Open for new partnerships with providers, industry
Innovation central strategy
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Strategic context
Disease Management CompanyVision
Integrated Care Solutions =
IT supported Care Path + Medical Call centre
New elements of care:
A. Enrolment system based on the risk stratification and the Evidence Based Practice Guidelines
B. Patient self management support tools
C. Providers support tools (IT based)
D. Process and outcomes measurement
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Strategic context
Activities
1. Care plans development – integration/relation other initiatives
2. Individual Care plan management
3. Education/coaching/monitoring for each pathology and combined pathologies
4. Care plans IT support and maintenance
5. Promotion of care plans and IT support with physicians
6. Training of physicians in system use
7. Facilitating of medical telephone support to patients outsourcing with Home Care/Call centre’s
8. Data processing and analysis
9. System quality monitoring and care plans upgrading
10. Communication
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Strategic context
Services
Patient <= individualized health path; personal electronic record with variety of tools (information/ education/ coaching/monitoring/ authorization and sharing)
Physicians <= availability of the evidence based clinical guidelines/E-learning/ secure information exchange within the Care Teams / decision support
Health Insurer <= services for members/ process en outcome measurements/efficiency tools
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Disease Management Development Program From Consortium to DMC
Conso
rtiu
m
RequirementAnalysis
Preconditions Project Execution
ProjectDelivery
DMC Services
DMCCommunication
DMC DEVELOPMENT
DM C implementation
DMC OPERATIONS
P0: DMC operatingsystem
requirements & architecture
P1: Tele-Coaching Service Dvpt
DMC legal advise &Foundation
DMCBusiness
plan
DMCInstallation
MOU April 2010
Conso
rtiu
m N
egoti
ati
ons
Agreement IJune
2010
DMCOperations&
Marketingplan
Market Launch 1st Q 2011
Agreement II 1st Q 2011
GPConsultation
Enrolement DM
PT Informed consent
Education/coaching
DietcianMove
DMCare Plan
Agreements GP - DM
Stop
DM planning
Mediscal Follow -up
CoordinationPlanningFeedback
Technical equipment
Monitoring InformationCall centre
Social linkWelfare
Pharmacist
Pharmacist
Specialist Lab Hospital
Specialist Nurse Pharmacist HIF DATA
DM analysis
Po
D M C
Solutions Projects
ConsortiumOthersS
uppl
iers
Inte
gra
tor
Co
ord
inat
or
Cus
tom
ers
GP associatons
HospitalsNurses
associations
GP’s Specialists Nurses
Pharmacistassociations
Pharmacies
HIF’s;Companies
Patients
Strategic context Value chain model
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Strategic context
Goals
1. Build a Disease Management System and integrate the existing applications/ initiatives into the system (focus on the selected pathologies)
2. Facilitate political lobbying for the implementation of this solution (financing/ legal framework/ adoption by professionals and patients)
3. Create Disease Management Company to bring Solutions to the market
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Governance
2.1. Consortium Structure
Steering Groep Advisory Board (CEO’s/staff of member organizations) (political opinion leaders)
Consortium Management Staff(Project Managers) Office Manager
Financial Controller
Project GroupsMedical
ITBusiness
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Governance
2.2.Advisory board
The role of the advisory board is to give strategic advice and to ensure political endorsement. The advisory board has the important task to put some political pressure on the insurance committee. This paritary committee is responsible for taking decisions whether to reimburse certain activities or not. In order to get structural reimbursements from RIZIV for the services delivered by DMC, the advisory board has to play an active role in the negotiations with this committee.
The following persons will be part of the advisory board: Bernadette Adnet (Staff member VBO) Yolande Avontroodt (Member of the federal parliament and president of the
management committe of RIZIV) Jo De Cock (General manager RIZIV) Pascal Mertens (General manager MLOZ) Dirk Ramaekers (Medical director ZNA) Michel Vermeylen (General practitioner and vice-president ABSYM) Jan Van Acker (President Pharma.be)
Advisory Board
Consortium
DMC
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Governance
2.2.Advisory board2.2.1.Feedback meeting 21/1 (1)
Services : IT and individual acces
Online data, decision support and suggestions for the GP
Coaching as support for the GP
Telehealth tools – PHR
Homecare functionalities
Social services
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Governance
2.2.Advisory board2.2.1. Feedback meeting 21/1 (2)
Structure : New structure needed Mixed governance National institute supervision Quality system to be developped
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Governance
2.2.Advisory board 2.2.1.Feedback meeting 21/1 (3)
Support by members of AB : Endorsement and communication/marketing
ABSYM/BVASPolitical - legal support and framework Privacy commissionCommunication and promotion
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Feedback advisory board (4.06.2010)
Quality is critical success factor- validation – performance assessment
Legal support for IT necessary
Start mean and lean in socio-demographic advantaged areas
Education/coaching at short term
Not for profit structure necessary
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Governance
2.3.Consortium Principles
The consortium is a temporary partnership between users and suppliers of disease management solutions. Their task is to:
Build a Disease Management System and integrate the existing applications/ initiatives into the system (focus on the selected pathologies)
Facilitate political lobbying for the implementation of this solution (financing/ legal framework/ adoption by professionals and patients)
Create Disease Management Company to bring Solutions to the market
The Consortium has the decision power to initiate projects.
The Consortium consists of three major groups 2 health insurance funds Care providers IT suppliers
Other parties that will play an important role are Associated partners that can provide support during the different projects. These partners
can share their know-how, tools or can contribute financially; Suppliers who provide specific tools (e.g. IT tools).
The procedure to enter and exit a partnerships has to be decided by the consortium.
Advisory Board
Consortium
DMC
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Governance
2.3.Consortium2.3.1.Daily management
Management General Manager : Jan Van Emelen – strategy, communication, medical
work packages Operational Program Manager : Irina Odnoletkova: global program
manager, busines projects, education and coaching IT program manager : Louis Schilders: IT architecture, standard,
integration, applications Staff (financial officer, office manager)
The daily management will execute the consortium program as presented today. The Program starts the day the MOU is signed.
The daily managemen reports to the steering committee. It has to be decided how frequently the steering committee meets.
The consortium functioning is financed by the partners.
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Governance
2.4. Disease Management Company- DMC
DMC is an independent and executive cooperation that facilitates the integration of health care.
The development of DMC will be supported by the consortium members, public and government funds (article 56) and other project-based financing.
In a later stage financing should happen through structural reimbursement, patient contributions and contributions from companies using the DMC services.
The DMC will have a classic corporation structure to run its operations
A governance structure for DMC has to be determined. Which parties should be represented in the Board of DMC and what the different roles and responsabilities are, will need to be defined in the DMC Company setup.
Advisory Board
Consortium
DMC
Marketpotential
Time Commercial Services RIZIV Structural Reimbursement and projects
Compulsory Insurance Adjustment Proposal
Governance2.4. DMC
2.4.1. Market Penetration Strategy
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24DM 2010/0226
How to achieve the State reimbursement?
DMC set-up and System Evaluation Design should be
ruled by HIF’s :
• MLOZ and • Neutral HIF
Health Care Providers Associations : • ABSYM, • APB
Governance
2.4. DMC2.4.2. Political strategy
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Disease Management Development Program From Consortium to DMC
Conso
rtiu
m
RequirementAnalysis
Preconditions Project Execution
ProjectDelivery
DMC Services
DMCCommunication
DMC DEVELOPMENT
DM C implementation
DMC OPERATIONS
P0: DMC operatingsystem
requirements & architecture
P1: Tele-Coaching Service Dvpt
DMC legal advise &Foundation
DMCBusiness
plan
DMCInstallation
MOU April 2010
Conso
rtiu
m N
egoti
ati
ons
Agreement IJune
2010
DMCOperations&
Marketingplan
Market Launch 1st Q 2011
Agreement II 1st Q 2011
Réunion - Date
27
Management Structure
Program Manager Irina Odnoletkova
Project Manager P0 (to be appointed)
DMC Foundation
Project Manager DMC Communication (to be appointed)
Education&Coaching
Development
Consortium Steering BoardPolitical Advisory
Board
Program Sponsor: Jan Van Emelen
WP1 WP2 WP3 WP4 WP5 WP6 WP7Stratification Informed consent Medical reference Careplan Com/feedback Evaluation Edu&Coach
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DMC Legal Advise &
Foundation
DMC Value: Offering
Tele-health Services To the whole Belgian
Populatian (patients and health care
providers)
DMC preconditions definition(by future DMC owners:Independent HIF’s; Neutral HIF’s; Political Physician Association; National Pharmacist Assotiation)
Legal and Financial/Fiscal Advise
Final Agreement by future owners, andCompany Foundation
DMC Foundation
Mei 2010 June 2010 July 2010
Réunion - Date
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DMCCommunication
Development of consequent
CommunicationStrategy and Plan
With all stakeholders
Stakeholders Identification
TO WHOM?
Communication Strategy Development
WHAT?
Communication Plan Development
HOW?
DMC Communication
Mei 2010 June 2010 July 2010
Réunion - Date
30
P0: DMC Enterprise ArchitectureBusiness, System and Technical
blueprints
Business architecture• Strategy• Medical-functional
analysis• Business analysis
System architecture• Data • Application • Infrastructure• Integration
Technical architecture• Standards • Services
DM
C o
pera
ting
syst
em r
equi
rem
ents
& a
rchi
tect
ure
BA Blueprint September 2010
AA+DA BlueprintOctober 2010
TA Blueprint December 2010
By
Independent
Experts
By Consortium Partners
Réunion - Date
31
GPConsultation
Enrolement DM
PT Informed consent
Education/coaching
DietcianMove
DMCare Plan
Agreements GP - DM
Stop
DM planning
Mediscal Follow -up
CoordinationPlanningFeedback
Technical equipment
Monitoring InformationCall centre
Social linkWelfare
Pharmacist
Pharmacist
Specialist Lab Hospital
Specialist Nurse Pharmacist HIF DATA
DM analysis
Po
Réunion - Date
32
Po
Architecture Blueprints
ArchitectureGuiding Principles
Metrics & Measurement
Architecture Repository
Blueprints describe the business requirements and technology components in a way that enables their linkages to be traced from business owner to system developer.
Architecture Guiding Principles serve as guideposts for strategic and tactical technology decision-making.
Architecture Processes document how architecture design is performed and implemented in the organization.
Metrics & Measurements describe the quantitative and qualitative goals for the enterprise architecture to ensure that value is measured and communicated.
Architecture Governance is a comprehensive set of policies, processes and procedures that ensure proper, yet flexible, guidance and approval checkpoints for architecture.
Architecture Repository is the control point for all architectures assets –blueprints, processes, metrics. The repository is accessed and managed through the architecture toolset.
Organization & Skills details the structure, capabilities and qualifications needed to build, maintain, and implement the architecture.
ProgramDMC Enterprise Architecture Development
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BusinessStrategicPlanning
EnterpriseArchitectureBlueprinting
Project Release Planning
Portfolio Mgmt
Project Execution
Business Operations
Metrics
Approved Projects
As-Built architecture
EA Governance
Objectives&measurements Indicators
Architecture benefits results
Business benefits results
Program
DMC Lifecycle
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Programme
IT Architecture (2)
WEB Based Architecture
Security & confidentiality – Authentication of patients & Healthcare Professionals (eHealth & EID) Authorisation (standard eHealth – application/disease specific DMC)
Patient Informed Consent
Upload of Medical Patient Summary (cross diseases)
Collection of disease specific parameters/values
Secured Sharing of information both medical and personal between members of the Care Team
Education of enrolled patients – eLearning - ZorgTV
Coaching of enrolled patients – Personal Health record
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Coaching&Education Service Development
Functional Requirements & Preconditions Analysis
Make or buy?Fit into the System
Design? Service Development
•Operational plan•Marketing Plan
Service Implementation
Co
ach
ing
&E
du
cati
on
Ser
vice
Dev
elo
pm
ent
September 2010 December 2010Market Launch 1st Q 2011
The objective is to develop Services • B2B2C to members of MLOZ&NZ – via complementary insurance products (25% of the Belgian market) • B2C – to non-members.The Service will be offered to other HIF’s on B2B2C basis.
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International trend in chronic care
90% of chronic care = selfcare Symptoms monitoring + appropriate actions (adjust medications,
schedule a doctor visit); Major lifestyle changes (e.g., stop smoking, reduce alcohol consumption,
modify diet, lose weight, and increase exercise); Medication compliance; Office visits for lab tests, physical exams, and clinician consultations.
=> Self-Management Support is necessary!
Telecoaching aims to change patient behavior
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Self-management support
is “the systematic provision of education and supportive interventions by health care staff to increase patients’ skills and confidence in managing their health problems, including regular assessment of progress and problems, goal setting, and problem-solving support.”
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Chain of self-management support effect
Patient Behaviour
Disease Control
Health Outcomes
Patient Satisfaction
Health Care Utilization
Less Costs
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Own experience: pilote project CareTV
Problem with patient education paid by RIZIV
(diabetes 2): too late no standard efficiency loss on nurse traveling Information “push”
Preliminary conclusion CareTV: Distant coaching is feasible; Travel time becomes patient contact time; Individual coaching based on behavioral change theory is efficient
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Design Options for a Self-Management Support Program
Place within the health care system (who offers the service?)
Enrolment procedure
Role and background of the coaching staff
Content of the support
Patient population served
Communication tools (Website/ telefone/ combination)
Protocols for how staff is to provide the support.
Staff training
Communication between physicians and coaching staff
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Target groups
Belgium MLOZDiabetes 500.000 95.000Asthma 600.000 114.000COPD 385.000 73.150Cardiovascular 400.000 76.000Cancer 300.000 57.000Depression 900.000 171.000TOTAL 3.085.000 586.150PregnancySmokersetc.
• Patients
• GP Circles: +/-260• Hospitals: +/- 250• Data collectors: Pharmaceutical industry, IMS, Cegedim, academic centres, scientific organizations
Réunion - Date
43
P0: DMC Enterprise ArchitectureBusiness, System and Technical
blueprints
Business architecture• Strategy• Medical-functional
analysis• Business analysis
System architecture• Data • Application • Infrastructure• Integration
Technical architecture• Standards • Services
DM
C o
pera
ting
syst
em r
equi
rem
ents
& a
rchi
tect
ure
BA Blueprint September 2010
AA+DA BlueprintOctober 2010
TA Blueprint December 2010
By
Independent
Experts
By Consortium Partners