Transcript Strengthening community health care

Strengthening community
health care - the new model
for modern hospitals
Rachelle Kaye, PhD.
Bratislava, Slovakia
March 6, 2014
The Major Challenge of
Healthcare
Today
Prevention and Management
of
CHRONIC DISEASE
Meeting Today’s Health Needs and Challenges
Calls for mobilization of a comprehensive range of resources
promotion and prevention
diagnosis and treatment
chronic or long-term home care
social services
Comprehensive and
integrated care for the
bulk of the assorted
health problems in the
community is more
efficient
(The World Health Report 2008: “Primary Health Care – Now More Than Ever”, 47-49
Barriers to “Comprehensive and Integrated
Care
S
Hospital Centered Care
is
the major barrier
(The World Health Report 2008: “Primary Health Care – Now More Than Ever”, p.11)
Toward an Optimal Solution
People centered primary care
•
Community-based
(The World Health Report 2008: “Primary Health Care – Now More Than Ever”, p.47-50)
The OECD reports that Israel has built a
health care system with high-quality primary
health care
OECD REVIEWS OF HEALTH CARE QUALITY: ISRAEL © OECD 2012 (11)
Israeli Healthcare System
Universal compulsory statutory health insurance
Financed by earmarked and general taxation
Citizens pay a healthcare tax – 4.8% of income
Coverage for health care services is provided by 4 competing nationwide
health funds (HMOs)
Public and private providers of services including physicians, hospitals,
pharmacies and other health care professionals
Israeli Health Care System
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%)
The Israeli Health Care System
Ministry of
Health
Health Funds
Clalit
52%
Maccabi
25%
Meuhedet
14%
Leumit
9%
Ministry of
Finance
Hospitals
Acute Care 45
Beds: 14,972
Psychiatric 13
Beds: 3,467
Geriatric 313
Beds: 24,427
Second largest health fund in Israel.
Functions within the framework of the National Health Insurance Law.
Provides insurance cover for all services included in the public basket
of services
Supplies services to its members both via its own facilities and
through outside providers.
5,192 physicians
(83% self employed)
7,500
Employees
2M
members
5 Districts,
300 care centers
Owns 62 Pharmacies
Contracts 712 Pharmacies
Maccabi’s Operational Model
Free patient choice of physician and other providers
Selectively contracts with providers
Organization of Primary Care
Personal Physician
Group Practice
The Changing Role of the Nurse
Emphasis on Prevention and Health Promotion
New Structures and Processes of Managing Chronic
Illness
Disease Management
Integrated Care
Increased Community Orientation; Less Hospital Care
ICT Support Infrastructure
Integrated Care for Prevention and
Management of Chronic Disease
Access of Clinicians and Patients to all necessary information
Defined responsibility for care coordination
Decision support – alerts and reminders
Timely Access to services
“Seamless” transition between all points of care
Care that is guided by the “big picture” –holistic view of patient
problems and needs
The patient receives the care he needs, when
and where he needs it, and up-to-date
information on his condition is available in real
time to the care providers and the patient
Maccabi’s Computerized Information and
Communication System Supports Integrated Care
Maccabi Central Electronic Medical Record
Every transaction computerized
E-Laboratory
E- Prescription
E- Consultation
Telemedicine
Alerts and Reminders
Registries
Patient Website (PHR)
Telemedicine Services
Service from a Distance(cost, time)
Need for 24/7 response
Tele-Diagnosis
Tele-radiology
Tele- ECG/Holter monitoring
Tele-mammography: mobile unit
Tele- ophthalmology
Tele-dermatology: skin ulcers
Tele-Treatment/ Consultation
Video Conference – care giver–patient
Video Conference- home care
Video Conference- service station
Telemedicine Services
Service from a Distance (cost, time)
Need for 24/7 response
Call Centers
Multidisciplinary Telecenter for Chronically Ill Patients
Maccabi Pharm
Nurses Call Center - Triage
Smoking Cessation
Interpreter Services
On line services
Website
Patient health Record
Mobile Phone Applications
Mobile Physician Portal
Mobile Patients Portal
#1 Pregnancy App
in the world
Lab Results
-Referring doctor
- Date
Medication
List
As part of the goal to provide a high quality,
comprehensive, community based service 24/7 –
physically and virtually
and to keep its members as far away as possible
from the entrance to the hospital
Maccabi has established many clinics for
secondary specialist care in the community
Maccabi Hashalom
Outpatient Clinics
Imaging Clinic in Maccabi Hashalom
Urgent Care Center in Maccabi Hashalom
Outcomes
Improved Efficiency and Quality of Care
Tele-ECG -17,000/month – 10 minutes turnaround time
Tele-Holter -1,200/month - from 3 weeks to 2 days for diagnosis
Teleradiology :
Equal Access all over the country
Extended hours -7:30-23:30 7 days/week
Interpretation – Usually 10-30 minutes
Reduction of 10% in radiologists
Savings of over 600,000 Euro/year in cost of film
Digital tools increase diagnosis accuracy
Improved Clinical Outcomes
Better medical practice (DSS and alerts)
Improved Patient Compliance
Increased Patient Satisfaction
Clinical Outcomes
Breast Cancer Screening
Blood Pressure Screening
The Best Health Fund
Macabbi is perceived as the best Health Fund by
far and the difference is statistically significant
Modern-Day Medical Care has moved
away from the hospital and into the
community
away from the clinic to the home of the
patient
This requires a new concept for modernday hospitals
Assuta Medical Centers, Israel
General Background
• Assuta, owned by Maccabi Health Services, is the
leading private hospital and the largest surgical
center in Israel.
• Across the nation in 7 different location, Assuta
operates four hospitals and three outpatient
medical centers.
Assuta Haifa
Distribution of Facilities
Assuta Tel Aviv
Assuta Ra’anana
v
Assuta Ha’shalom
Assuta Ashdod
Assuta Rishon Le-Zion
Assuta Beer-Sheba
Mobile MRI UNIT
2 Mobile Mammography Units
Overall Annual Clinical Volume (2013)
• 98,000 Surgical procedures
• Coronary Angiography: 5,020
• Heart Surgery: 702
• CT Scans: 89,018
• MRI: 44,981
• PET CT: 10,740
• Mammography: 143,899
• IVF: 16,045 cycles
• Nuclear Medicine: 54,549
• Oncology treatments: 33,911
Centers of Excellence
Covering the entire spectrum of medical disciplines, Assuta
specializes in a broad range of treatments and procedures:
Oncology Center
Assuta most experienced oncologists provide advanced diagnostic
tools and a multi-disciplinary approach with a range of advanced
treatment options
 Chemotherapy Unit
 Radiotherapy Unit
 Radiosurgery procedures
 Brachitherapy procedures
Centers of Excellence
Assuta’s Imaging Centers
Assuta has 5 imaging units across Israel equipped with the very
latest technologies including:

MRI Institute

PET-CT Institute

Computerized Tomography (CT)

Nuclear Medicine Institues

Interventional radiology units

Ultrasound

Mammography and Women’s Health Centers

X-Ray & Fluoroscopy
Centers of Excellence
In Vitro Fertilization Centers
Assuta’s IVF Clinic is amongst the top 5 IVF units worldwide in terms
of size and success rate. The country’s leading gynecologists and
infertility experts treat both male and female infertility, with a
range of advanced techniques.
Wards, Recovery and ICU
Scheduling
Admission
Billing
Reading
Diagnose
Dictating
Reporting
Signature
Anesthesia
Assuta Ashdod Public Hospital –
May 2017
“A Community that has a hospital”
The hospital will accommodate
300 beds (650 in the future).
Centers of excellence:
● Heart Disease
● Oncology
● Children
● Women
● Ambulatory and Endoscopic
(minimally invasive) Procedures
For the first time in 40 years
A new public Hospital in Israel is being built,
as a result of a new law signed in 2002 and a
mega campaign led by the City of Ashdod.
Assuta won the tender at 2011 to be the first
public hospital financed, built and operated
by a private company.
FUNCTIONS
Intensive care
Emergency room
Operating Rooms
Maternity
Inpatient wards
12
INSTITUTES and CLINICS
Pain Unit
Physiotherapy Institute
Gastroenterology Unit
Eye Institute
Heart Institute
Institute for angiography
Breast Health
Imaging Institute
Genetics
Heart Catheterization
Nuclear Medicine
Clinics
Phototherapy Institute
INNOVATIVE VISION
To build and run an innovative, most advanced general public
hospital, affiliated to a medical school, which provides the
community with the highest standards of medical services.
The hospital, working closely with the community, will meet both the
health and social community's needs. The goal is to form a full
integration with the community's medical services, meeting the special
needs of the patients and their families, both within the hospital and at
home.
ASSUTA ASHDOD
Thank You
MOMA
MultiDisciplinary
Call Center
The Target
Population
6000
complex
chronic
clients
Home care of
stable chronic
clients
CHF & COPD
Levels 2
unstable,
3-4
4000
stable chronic
clients
Stoma& chronic
wound
Diabetes
Oncology patients