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Dr Jan Van Emelen (MLOZ, Independant Health Insurance Funds - Belgium )

Chronic diseases : impact European priorities – Belgian presidency 1.07 - 31.12.2010 Bukarest 23.09.2010. Dr Jan Van Emelen (MLOZ, Independant Health Insurance Funds - Belgium ). Agenda. Chapter 1 : chronic diseases - impact & management Introduction The global problem

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Dr Jan Van Emelen (MLOZ, Independant Health Insurance Funds - Belgium )

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  1. Chronic diseases : impact European priorities – Belgian presidency 1.07 - 31.12.2010 Bukarest 23.09.2010 Dr Jan Van Emelen (MLOZ, Independant Health Insurance Funds - Belgium)

  2. Agenda • Chapter 1 : chronicdiseases - impact & management • Introduction • The globalproblem • Chronicdiseases : impact & management • Belgiancas of DMC • Chapter 2 : Eu prioritiesBelgianpresidency

  3. 1. Introduction : AIM : international association An international association for universal principles

  4. Membership 41 national federations 27 countries worldwide Europe, Middle-East, Africa, Latin-America Activities Healthcare financing Healthcare provision Social services, pensions For 240 mln citizens Values and principles Health and well-being Autonomous management Not-for-profit orientation Solidarity Objectives Interest representation Knowledge exchange Lobbying Promotion

  5. The New Role of Healthcare Mutuals Director of healthcare Director of care Steering capacity Payer and Provider Payer and provider Pay office Engagement in healthcare management

  6. Decentralize towards personal health Telehomecare Independent, Healthy Living Community Clinic Chronic DiseaseManagement Doctor’s Office ResidentialCare Assisted Living Acute Care Skilled Nursing Facility Specialty Clinic Community Hospital ICU Qualityof Life $1 $10 $100 $1,000 $10,000 Cost of Care / Day Cost of Care / Day 7 Source: Freely adapted from Intel (2007)

  7. Reimbursement principles Criteria of choice: the quality of care safety/risk management (risk of malpractice) collaborative health care processes improved time/healthcare the access to care the economic efficiency of care.

  8. Ehtel • Founded in 1999, EHTEL (the European Health Telematics Association) is a pan European multi-stakeholder forum providing a leadership and networking platform for European corporate, institutional and individual actors dedicated to the betterment of healthcare delivery through eHealth.

  9. 2. The Global Problem Econoshock (G. Noels) - 6 events at the same moment Demographic BRICS ICT Energy crisis Financial Crisis Climate crisis Result : dramatic change needed lnnovation is a duty

  10. …in health Chronic conditions leading cause of mortality and not well « managed» Long Term care Labor shortage Budget restrictions Quality and safety More homecare instead of hospitalisation Lack of coordination IT is a catastrophe Complementary insurances Disease Management

  11. Cost and longevity UC Atlas of Global Inequality

  12. UC Atlas of Global Inequality

  13. 3. Chronic diseases : impact Literature : European Observatory on Health Systems and Policies www.euro.who.int/en/home/projects/observatory Tackling chronic disease in Europe. Strategies, interventions and challenges - Reinhard Busse, Miriam Blümel, David Scheller-Kreinsen, Annette Zentner Managing chronic conditions: Experience in eight countries - Ellen Nolte, Cécile Knai, Martin McKee …/…

  14. Burden of chronic diseases(R. Busse 2009 Berlin TU) Chronic conditions and diseases are the leading cause of mortality and morbidity in Europe, and research suggests that complex conditions such as diabetesand depression will impose an even greater health burden in the future. It has been estimated that in 2005 77%of all Disabiliy-Adjusted-Life-Years (DALYs) and 86% of premature deaths in the WHO European region are related to non-communicable diseases. The condition expected to increase most dramatically is dementia.

  15. Worldwide share of deaths by causes and countries within different World Bank income categories (2002) Chronic diseaseis the major causeof death in allbut the poorestcountries!

  16. Cost & benefits of chronic conditions • A lot of uncertainty : further research needed • How to measure? Cost dimensions: • Cost of illness : direct, indirect, intangible costs • Micro economic level : income and spending, labour productivity and supply • Macro economic level : economic growth : quantifying negative impact of CD • Marc Suhrcke, Rachel A. Nugent, David Stuckler and Lorenzo Rocco for OxHA, (Oxford Health Alliance) • Ellen Nolte, Cécile Knai, Martin Mc Kee,

  17. Cost of illness • Cost-of-illness: quantity of resources (in monetary terms) used to treat a disease as well as the size of the negative economic consequences of illness in terms of lost productivity to society or to a specific sector: • Direct : medical care • Indirect : loss of income • Intangible : pain, sickness

  18. Cost of chronic diseases • The cost of chronic diseases and their risk factors – as measured by cost-of-illness studies – is significant and sizeable, ranging from 0.02% to 6.77% of a country’s GDP. • Relevant? • What about solutions? Integrated care needed : Disease management

  19. Integrated care • At patient level : • Empowerment of patient • Guaranteed service from birth to grave • At professional level : • continuity of care model : prevention, early detection, early treatment, treatment, palliative care. • Real implication in decisions • At organizational level : new financing, new organization

  20. Disease Management Programs Expected RESULTS : • Improving quality of life cost-effectively. • Cost containment Expected COSTS : • Set up costs • Operating costs • Adverse selection costs

  21. Disease management: key elements • Comprehensive care: multidisciplinary care for entire disease cycle • Integrated care, care continuum, coordination of the different components • Population orientation (defined by a specific condition) • Active client–patient management tools (health education, empowerment, self-care) • Evidence-based guidelines, protocols, care pathways • Information technology, system solutions • Continuous quality improvement Source: Velasco-Garrido, Busse and Hisashige 2003.

  22. Lessons learned (Nolte, Knai and Mc Kee) • Coordination: in countries with multidisciplinar primary care : increasing role of nurses • Incentives: Independant primary care - DMP with financial and legal conditions, with incentives for insurers and providers.

  23. DMP : Cost/efficient? N.Bealieu

  24. How effective are Disease Management Programmes? Mattke et al. Am J Manag Care. 2007; 13: 670-676

  25. OECD 2009

  26. Financing health care systems

  27. Methods for paying service provision • Fee for service • Pay for performance • Flat fee • Capitation system for chronic diseases Payment systems can hinder implementation of new services.

  28. Costs of illness in Belgium • Belgium : 10.4% of GDP spending on health care = 65% chronic diseases • Cardiac diseases : 8% of total health care costs • Fee for service • No coordination incentives • No incentives for DMP

  29. Change possible : Telemonitoring Net Benefit (2007) NB! Based on pessimistic assumption: readmission avoidance = 0% Readmission avoidance =10% Break-even is achieved by Readmission avoidance rate = 13%, or Reduction in hospitalization by 2 days IM3 Project (Irina Odnoletkova) 32

  30. 4. Belgian case Disease Managamentdeveloped by MLOZ • Fee for service system, independant and competitive health care providers • Budgets: Vertical silos – co cooperation • 5 competitive Health Insurance Funds • Budget policy, no health policy • 4000 $ per caput

  31. DM History in MLOZ Independant Health Insurance Funds • Complementary insurance : in 2005 platforms launched for chronic diseases (diabetes, obesitas) with specific reimbursements • Experiences : • HIF is not the optimal structure • Healthcare providers not involved

  32. New initiative : creation of DMC New elements of care: • Enrolment system based on the risk stratification and the Evidence Based Practice Guidelines • Patient self management support tools • Providers support tools (IT based) • Process and outcomes measurement

  33. Activities • Care plans development – integration/relation other initiatives • Individual Care plan management • Education/coaching/monitoring for each pathology and combined pathologies • Care plans IT support and maintenance • Promotion of care plans and IT support with physicians • Training of physicians in system use • Facilitating of medical telephone support to patients outsourcing with Home Care/Call centre’s • Data processing and analysis • System quality monitoring and care plans upgrading • Communication

  34. How to start? • Creating trust with stakeholders – pilot project Care Television : implication of all partners : doctors, pharmacists, hospitals, nurses • Political consensus between 4 stakeholders on concept of DM : private governance, equal rights (50% HIF, 50% healthcare providers) • Support by IT companies

  35. How to start? • Financial incentives for stakeholders • Open and large consultation and large tenders • Concrete services : • Tele-education/coaching of chronic patients • Hospital service : pre- and post intervention management (coronary interventions) • PHR & Datamanagment

  36. Temporary Consortium • 4 founding partners : Independant and Neutral HIF, BVAS - Belgian Doctors association, Belgian Pharmacist Association • 4 supporting IT companies, financing consortium

  37. Cross Border Care Healthcare workforce in EU Pharmaceutical package Ageing and chronic diseases Service Directive (Bolkestein) and social services of general importance Europe 2020-strategy A digital agenda for Europe CH 2 . Priorities in EU

  38. 1. Cross Border Care Directive • Aim: more legal support for mobile patient + more cooperation Member states • Content : • New rules for reimbursement • Responsabilities of each Member State : information on quality, safety and accessebility of services, procedure medical error • Creation National point of contact • Recognition of prescription • Creation of Reference network • Cooperation chronic diseases and HTA

  39. Texte of Directive • 3 versions of Directive : • European Commission July 2008 • Europ.Parliament: 1st reading April 2009 • European Council : compromis June 2010 • Belgian presidency : consensustext • Application : 2014

  40. 2. Healtcare Workforce • Common problem EU: shortage nurses • End 2008: Green book : public consultation • Need for EU initiative • Need ethical rules • Need HRM • Aim : concrete initiatives EU commission and member states.

  41. 3. Pharmaceutical Package • 3 directives (propositions) • Information topatients • Direct toconsumer information • Critics : ethical? validation? • Pharmaceutical control • Falsifications • Pharmacovigilance • monitoring pharmaceuticals • Simplification of existingregulation

  42. Pharmaceutical Package • Change of competency • Before: DG industry • Now: DG SANCO (health) • Belgian Presidency: • Pharmacovigilance: vote EP on 22/09 • Pharmaceutical control : BE compromise Parliament and council • Patient information: discussion continues

  43. Pharmaceutical Package • Events: • Ministerial Conference « Innovation and solidarity on pharmaceuticals » • Conference «generics for sustainable health • 17/11, Brussels • European mobilisation day for correct use of antibiotics • 18/11, Brussels

  44. 4. Ageing and chronic diseases • Priorities • Employment : keepingolderpeople at work : Europe 2020-strategy. • Chronicdiseases : prevention, special attention for Alzheimer anddemency. Strategic actionplan “Togetherfor health: a strategic approach for the EU 2008-2013”. • EU partnership Action against Cancer : Research, treatment andpalliative care, prevention. • Program AmbientAssisted Living : improvingquality of life of care dependentelderly (fall prevention, demention support) • Action plan againstsocialexclusionandpoverty. • Pensions :howtoguarantee pension system in silver EU. Green bookjuly 2010. 2012 = EU year of ageing

  45. Ageing& chronic diseases • Belgianpresidency : 3 themestobehighlighted • Emplyomentolderworkers • Sustainability pension systems • Chronicdiseases – special Alzheimer « workandageing society pact » - conclusions • new types of carrier planning • New white job creation

  46. Ageing and chronic diseases • Events: • ‘Innovative approaches forchronicillness in Public Health and Health care systems” Interministerial conference 19 en 20/10, Brussels • Conference on demency ( MLOZ supported film – “Lost in the memory palace”.) Neurodegenerative diseases such as dementia will be back on the European agenda during the Belgian Presidency of the EU. The conference will follow on from the formal commitments made at European level to improve the treatment of these conditions. 25 en 26/11, Brussels

  47. Events http://ec.europa.eu/health-eu/events_nl.htm • European Strategy for Chronic Conditions workshop (9 December 2010) One day open event will focus on the challenges faced by patients with chronic diseases. It will point out the specific burdens that chronics conditions put on patients, in comparison with other acute diseases; these burdens go beyond the commonly mentioned one financial impact. • 08-12-10 High Level Conference on monitoring and evalution of EU and MS strategies on nutrition, overweight and obesity

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