The Integrated health care delivery The Dutch Approach innovative approach to eHealth

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The Integrated health care delivery The Dutch
Approach innovative approach to egtHealth

• Jacob Hofdijk
• Special Adviser Integrated Care to the Ministry
  of Health
• President EFMI

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Welcome from EFMI Jacob Hofdijk EFMI President
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EFMI, The Mission

• The Federation shall be constituted as a
  nonprofit organisation concerned with the theory
  and practice of Information Science and
  Technology within Health and Health Science in a
  European context. We declare that the ten
  delegates here today from the ten national
  societies shall constitute the preliminary
  Council of the Federation which thus hereby
  exists." Copenhagen, 11 September 1976.

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EFMI, The Members

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EFMI Global Position
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EFMI has to offer
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EFMI Family, The Working groups
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EFMI

• Focus on continuous service to our members, the
  national associations
• Add value to the EFMI Community
• Series of MIE and STC Conferences
• Human network of experts, users
• Involving science, application and policy
• Focus on the next generation of knowledge and
  people
• Its all about Health , Stupid

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Yesterday

• Splendid start of the conference thanks to the
  organisers and you
• Many prize winners
• unforgettable two day trip to Bucaresti
• I give you also a free trip to the Netherlands

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This is Holland
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The Netherlands
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The key elements of the Presentation
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Table Hippocrate The start of modern medicine
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It is all about the Patients Health Issuestill
packed in Silos
Homecare
Tertiary care
Primary Care
Hospital care
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Hans Brinker saved the countrycan we also save
health care
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1994 - 2005

• Biesheuvel Report Modernisation Curative Care
• Hospital is an integrated health care facility
  providing healthproducts to patients
• Paradigm Shift Supply to Demand
• The hospital product focuses on Health Issue
  Patients and pays Physician and Hospital
• Diagnosis Treatment Combination (DBC)
• Insurance Company CONTRACTS on price and quality

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Waddeneilanden
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Dutch Strategy for Change

• Care providers / Health Insurers More policy
  space and responsibilities, level playing field
  and comparable challenges
• Citizens more options, responsible partner in
  care process
• Government towards regulator of the health care
  markets and governor
• Guarantee the public interest for universal
• Accessibility
• Affordable care
• Quality

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The Paradigm Shift

• From Supply
• to
• Demand
• From Institution to Patient centered
• From Cost to Value

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First focus on inpatient care
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The DBC approach
CASE DBC Care Product
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Hospital financing since 2005
Transitional phase from a budgeting system to a
performance related contracting system
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Financing
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Around the IJsselmeer
Leeuwarden
ENKHUIZEN
Amsterdam
Zwolle
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The Dutch experiment shows

• More market and public guarantees bring
  value for the money
• DBC-systems works, but needs to be further
  improved

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Following Porter / Teisberg principles

• The principles of health care competition
• Improving value for patients
• Results driven improvements
• Focusing health care delivery on full care cycles
  for medical conditions
• Focus on quality the best way is to lower costs

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Vital Triagle in Health Care
Coverage Package CVZ
Insurance Act 2006
Health Insurance and Access
Standards for Coverage
Structure of Health Care Delivery
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Randstad
DEN HAAG
AMSTERDAM
ROYAL FAMILY
UTRECHT
ROTTERDAM
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Projection increase of chronic diseases(2005-2025
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Bron RIVM, juli 2007
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2005 National Diabetes taskforce

• Focus on managing the growing need for Diabetes
  Care
• The NDF Diabetes Care Standard
• Agreed by all professionals and patient
  organisation
• Only applied to 40 of the patients
• Measures need to be taken.
• Introduce DBC contracting to Diabetes care
• By a Care Group a legal entity
• Based on the NDF Care standard

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Start Diabetes Care Standard
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The health cycle
Curbing the number of people with a chronic
condition
Preventing or delaying complications
Achieving the best possible quality of life
Self Management
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The Diabetes care crosses borders
GP
Home care
Pharmacy
Fysio therapy
S P
S P
Dietary
S P
Hospital
S P
O
O
O
S P
S P
O
I
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Diabetes care (delivery and funding!)
I
O
O
I
T
T
T
I
I
T
T
T
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The Chronic Care Model
Professionals Guidelines
Patients Lifestyle
Process Outcome Patient CQ
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eDiabetes
National Diabetes Database
Accountability
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eDiabetes recordthe vision
verzekeraar
verzekeraar
National Diabetes Database
Quality Assurance
Insurers
Virtual diabetes Information system
Internist
Familiy Doctors
Diabetes Patient
Fysiotherapist
National IT Infrastructure
Huisarts informatiesysteem
patient informatiesysteem
afdelings informatiesysteem
Diabetes informatiesysteem
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Integral Carestandard
Carestandard Modules Semantics Concept Contracting
/ Insurance
eHealth Specifications Continuity/
Knowledge Benchmarking
Billing Price Quality- Co en Multimorbidity
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Integrated Care Funding 2010

• Functional Funding for Disease related Prevention
  based on Care Standards
• Diabetes
• Cardio Vascular Risk Management
• COPD
• Heart Failure
• Main contractor contracts care with Health
  Insurer Price Quality
• Process and Quality Indicators key
• Integrated ICT vital egtHealth
• Part of the Silent Revolution

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EVIDENCE BASED APPROACH Like the Map of Medicine
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The South
Oosterschelde kering
Den Bosch
Maastricht
Middelburg
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Silo Killing Approach
Integrated DBC funding Diabetes , COPD, Heart
Failure, CardioVascularRisc Managemen
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Vital Triagle in Health Care
Coverage Package CVZ
Insurance Act 2006
Health Insurance and Access
Standards for Coverage
Structure of Health Care Delivery
Integrated Care funding
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Take Home Message

• Focus on Health Issue Patient
• Redesign Health Delivery System based on
  integrated care standards ( Clinicians Consumer
  Patients) ICT standards included
• Integrate the funding systems
• Find the local incentives
• Start now it is for the next generation
• European Approach seems needed !

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Future EFMI Events
2009 STC Antalya
2010 STC ICELAND
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JOIN the EFMI eHealth Experts, Come to Sarajevo
AUGUST 30th Sept 2th www.mie2009.org
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Further Contact
For more information surf on the EFMI
portal http//www.EFMI.org Contact Rolf
Engelbrecht Press and Information
Officerengelbrecht_at_efmi.org Cristina Mazzoleni
mazzoleni_at_EFMI.info Institutional Office
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Remember eHealth is all about e gt Health

• It needs people and policy
• So all of us
• Join the party
• And enjoy the Finale Tonight

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Dont forget, why we are doing this