Purchasing%20primary%20Care%20(focus%20on%20GP)

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Purchasing primary Care (focus on GP)

• Amersfoort, 24 May 2005

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Content

• Primary care
• General Practioner
• Market analysis
• Risks analysis
• Targets 2005
• Quality standards
• Definition of standards
• Monitoring of standards

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Primary Care facts figures
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Marktet analysis (1) facts and figures

• supply
• Nationwide 6.150 GPs , of which 1.700 (28)
  concentrated in areas where Agis is most
  important buyer
• Nationwide 600 GP including pharmacy, of which
  190 (32) in Agis area
• Nationwide 95 medical care centres, of which 47
  (50) are in Agis area, and 4 in major urban
  areas in construction (Vinex)
• Nationwide 56 POH, in primair werkgebied Agis
  65 POH
• Nationwide 64 GP-posts, of which 7 in primary
  area of Agis
• Nationwide 24 Regional Support Units (ROS), of
  which 4 are in Agis area

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Market analysis (2)

• Quality
• accreditation and registration of GPs
• No overview of specialisations of GP-practices
• Number of complaints regarding GP-activities is
  limited and focuses mainly on expectations of
  patients regarding what GPs should do and the
  speed the service is available
• Limited choice for insuree
• Quality/performance requirements for GP care are
  being developed

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Market analysis (4)

• Developments short and long term
• Organisation form and contractors will show
  broader variety .
• GP medical care will appear in different forms
• More differentiation of tasks within GP practice
  (GP delegates the easier care tasks to others
  under his supervision and will concentrate on
  new, more specialized tasks)
• Integration acute care (minimal HAP/SEH)
• Introduction of new health insurance system from
  1/1/2006
• 1/1/2006 new financing system for GPs and
  medical care centres (practice plan required to
  get additional finance)
• GP will be more conscious of their role as
  supplier (increasing business attitude)
• Increasing drives for cost control

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Market analysis (5)

• Developments on the long and the short term
• Shift from supply towards demand driven (from
  market segmentation to patient groups)
• Enthousiasm for primary diabetes care, diabetes
  dbcs in B-segment
• Certain type of care will move from care to
  welfare (home care arranged for and financed by
  local governement, people live longer
  independently)
• Drive and needs new GPs differ from GPs that
  will retire in the next few years
• Stronger demand for involvement of insurers in
  new urban areas (Vinex neighbourhoods)

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Risk analysis (1)Risks regarding realisation of
2005 targets.

• GPs distrust insurers
• Changes will lead to major resistance of GPs
• GPs advise negatively about Agis towards
  patients
• Strikes could lead to extra medical costs
• Increase of not registered patients by lack of
  information on practices that could adaccept
  extra patients (freedom of choice for
  insuree/patient)

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Risk analysis (2)

• Insufficient knowledge of the quality of services
  rendered by GPs
• Continuity of service in danger in regions with
  high percenctage of older GPs
• Difficulty in making results of investing money
  in continuity and quality of care visible to
  insurees (existing and potential clients)

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Primary goals 2005

• Create partnership with GPs resulting
• High contracting ratio in 2005/2006 (Agis norm
  95, CVZ 100)
• Succesfull implemantation of new finance and
  insurance system
• Keeping costs in control without loosing quality
  of medical care
• Translate insuree wishes more explicitly into
  contract specifications 2006 by
• Requirments for 2 patient segments
• Minimal 3 requirments in GP contract are client
  driven.
• More promotion of Agis care innovations towards
  our (potential) clients

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Primary quality aspects

• Good quality
• Accessibility
• Affordability of medical care

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Dimensions of quality

• Patient/insuree driven
• good medical service results
• readily available
• good coverage/low premium

Focus on organisation, process or
outcome objective or subjective

• Care providers
• maintain medical standards

• Insurer driven
• Value for money
• Availability to meet contractual obligations

Patients experience
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Definition of quality requirements in basic
contract between Agis and GPs

• GP obliged to participate in training to keep
  knowledge up to date
• to deliver medical care in a effective and
  professional way in accordance with protocols,
  standards and norm agreed upon
• To participate actively in collaboration and
  disccussion meetings with fellow GPs in order
  to maintain and improve GP operations within the
  total medical care system
• To deliver care in accordance to the standards
  which were agreed upon by branche organisations
  of GPs and health insurance companies (LHV and
  ZN)
• Take notice of the patient rights as formulated
  by the branche organisations of GPs and of
  patients (KNMG and NPCF)
• Take into account the requirements diagnostic and
  indication for longlasting fysiotherapy,
  ceasartherapy e.g.

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Definition of quality requirements in basic
contract between Agis and GPs (2)

• Obliged to participate in the local
  pharmatherapeutic meetings
• Obliged to assure continuity of GP service
  (illness , leave, e.g) GP remains responsible
  for the quality of medical service delivered by
  his replacement
• Patient files are kept in accordance with the law
  for privacy protection and kept centrally GPs
  office.
• Majority of medical standards are developed by
  the professional council often in close
  co-operation with patient representation councils
  (NHG, LHV, KNMG)

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Quality reguirements in additonal options
(modules) in contract

• Extra compensation for training
• Compensation for automatisation of the patient
• Compensation for electronical invoicing through
  Vecozo
• Additional bonus if medical care for people in
  nursing homes is efficiently organized (limited
  no. of GPs)
• Compensation for costs made to create a HOED
  (several GP practices in one building)

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Zinnig en Zuinig focuses on prescription for
efficient use of medicins

• Mirror information on prescription behaviour of
  GPs
• Focus on use of generic medicins
• Pharmatherapeutic meetings

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Monitoring of quality is hardly developed

• Feedback on quality of GP practices is limited
• Letter of complaints by patients
• Monitoring of continuity of GP-services is
  contracted out to regional support units and will
  be yearly reported
• Quality review program among patients-insurees is
  being developed
• Audits and benchmarking of GP practices takes
  places on basis of invoices

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Our insuree/patientremains our focus