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Quantifying Managed Care Impact: A Strategic Overview by Dr. Jonathan Broomberg

In this presentation, Dr. Jonathan Broomberg, Head of Strategy and Risk Management at Discovery Health, explores the impact of managed care on healthcare outcomes and cost-efficiency. The agenda covers Discovery's approach, methodological considerations, and selective reviews of various managed care interventions. Key topics include the management of admission rates, length of stay, hospital tariffs, and medicine pricing strategies. The findings highlight significant cost savings and ROI estimates, alongside strategies to enhance healthcare quality while managing expenses effectively.

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Quantifying Managed Care Impact: A Strategic Overview by Dr. Jonathan Broomberg

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Presentation Transcript

    1. Quantifying the Impact of Managed Care Dr Jonathan Broomberg Head: Strategy and Risk Management Discovery Health (Pty) Ltd

    2. Agenda

    3. Discoverys Approach to Managed Care

    4. Discoverys Approach to Managed Care

    5. Methodological Considerations

    6. Which interventions should we evaluate? Specific clinical protocols / interventions Measurable reduction in incidence x cost saved per incident Application of specific rules to individual claims Claimed vs paid Negotiated tariffs and Alternative Reimbursement Models Relative to industry benchmarks Specific price savings due to negotiations

    7. Selective review of some managed care interventions

    8. Selective review of some managed care interventions

    9. Managing the admission rate

    10. Managing the admission rate 1.8% reduction from 2005 to 2006 2.1% reduction from 2006 to 2007 Overall 3.9% reduction over 2 years despite ageing and deteriorating case mix

    11. Managing the admission rate

    12. Interventions to reduce length of stay

    13. Hospital tariffs & Alternative reimbursement models

    14. Surgical Devices: Key Short Term Strategies

    15. Cost effective use of medicines

    16. Significant early progress

    17. Medicine management

    18. Medicine price negotiations

    19. Medicine Management

    20. Summary of managed care cost savings

    21. Comments on ROI Estimates Highly conservative Excludes all standard managed care interventions Hospital pre-auth Bill audit review Length of stay intervention Excludes all interventions with professionals and Pay for Performance initiatives Excludes all disease management interventions HIV Diabetes Others Excludes all quality of care initiatives Hospital Adverse event interventions Rating Index

    22. Conclusions

    23. Quantifying the Impact of Managed Care Dr Jonathan Broomberg Head: Strategy and Risk Management Discovery Health (Pty) Ltd

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