Download - Meir Raz M.D
![Page 1: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/1.jpg)
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
![Page 2: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/2.jpg)
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
![Page 3: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/3.jpg)
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
![Page 4: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/4.jpg)
The Israeli Health Care System
![Page 5: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/5.jpg)
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
![Page 6: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/6.jpg)
![Page 7: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/7.jpg)
![Page 8: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/8.jpg)
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%
![Page 9: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/9.jpg)
![Page 10: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/10.jpg)
![Page 11: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/11.jpg)
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
![Page 12: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/12.jpg)
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
![Page 13: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/13.jpg)
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.
![Page 14: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/14.jpg)
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
![Page 15: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/15.jpg)
The Maccabi Health Fund
![Page 16: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/16.jpg)
(Excluding new technologies)
Age Adjusted Income from Capitation
![Page 17: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/17.jpg)
91% of Maccabi Expenditures are Medical
Physicians24%
Other medical7%
Development1%
Diagnosis 9%
Administration8%
Drugs21%
Hospitals30%
![Page 18: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/18.jpg)
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%
![Page 19: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/19.jpg)
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
![Page 20: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/20.jpg)
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.
![Page 21: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/21.jpg)
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.).
![Page 22: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/22.jpg)
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)
![Page 23: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/23.jpg)
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
![Page 24: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/24.jpg)
Imaging
Visits &Hospitalization
Medications
Lab Results
Treatments
Demographic parameters
MedicalHistory
FamilyHistory
![Page 25: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/25.jpg)
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).
![Page 26: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/26.jpg)
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
![Page 27: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/27.jpg)
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
![Page 28: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/28.jpg)
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
![Page 29: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/29.jpg)
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
![Page 30: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/30.jpg)
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
![Page 31: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/31.jpg)
Quality of Clinical Care
Cardiovascular Disease
Antibiotics
Diabetes
Depression
Asthma
Immunizations
Mammography
Clinical Care Objectives Clinical Care Objectives
![Page 32: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/32.jpg)
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
![Page 33: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/33.jpg)
Expenditures in accordance with Budget:
Expenditures on Hospital Services
Expenditures on Physician Services
Expenditures on Medications
Overall expenditures
![Page 34: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/34.jpg)
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”
![Page 35: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/35.jpg)
Measurement at all levels of the organization:
National
Regional
Local Branch
Physician
Constructive Competition at each level
HVA PrinciplesHVA Principles
![Page 36: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/36.jpg)
Quality Quality indicatorsindicators
DiabetesDiabetes
Members’ Members’ satisfactionsatisfaction
Financial Financial indicatorsindicators
HVA – The ToolHVA – The Tool
![Page 37: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/37.jpg)
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
![Page 38: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/38.jpg)
Major Contributing Factors:
The “Personal Physician”
Comprehensive Health Information and Communication Technology (ICT)
Strategically Focused Objective-based Performance Measurement (HVA)
![Page 39: Meir Raz M.D](https://reader036.vdocuments.mx/reader036/viewer/2022081418/568149cc550346895db6f998/html5/thumbnails/39.jpg)