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Health Services in the Cayman Islands. Government- H S A The Private Sector. Physician/1000 pop=4Nurses/1000 pop = 7. Support Services available on Island. CTs, MRI, digital mammograms3D-ultrasound, echocardiographyGI endoscopy, cystoscopyChemotherapyHospice and in-home nursingPharmacies
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1. CAYHEALTH Initiative Cayman Islands Government
Health Services Authority
3. Support Servicesavailable on Island CTs, MRI, digital mammograms
3D-ultrasound, echocardiography
GI endoscopy, cystoscopy
Chemotherapy
Hospice and in-home nursing
Pharmacies -well-stocked
4. The Government Health Services Authority (H.S.A.) Reports to the Government through the Ministry of Health
Is an Authority vs a Department
Self Regulated own HR Department
Responsible for own financing
Staff: 750
Nurses 250
Physicians 58 GP: Specialists 1: 4
Dentists 8
5. The H S A cont. 125-bed Cayman Islands Hospital on Grand Cayman
18-bed Faith Hospital on Cayman Brac
Primary Healthcare & Public Health Services
Distric Health Clinics - 5 in Grand Cayman
1 DHC in Little Cayman
Dental and Ophthalmology Services are provided on site at the Health Service Complex in Little Cayman
7. Specialist Services Pediatrics, internal medicine dermatology gynecology & obstetrics
public health, psychology, psychiatry
neurology, nephrology cardiology
radiology, pathology
anesthesiology
surgery, orthopedics, reconstructive surgery
ophthalmology, otolaryngology, period ontology
maxillofacial surgery, and urology
8. Access to Health Care - current
9. Access to Care (presently costly and not patient centered) Client may access care through multiple Primary care Physicians
Through a specialist
Through the Specialist and Primary Care Physician
Through the Hospital via the A&E Department
Hence a New Initiative in Health Care
CAYHEALTH
10. What is CayHealth? CayHealth is a new initiative between the Ministry of Health and Ministry of Community Affairs and Housing (through Dept of Child and Family Services) to provide personalized, quality Healthcare services.
11. What is CAYHealth? Prgramme to provide patients with access to a preferred general practitioner who will be their primary physician.
This primary physician teams with the patient to improve their access to healthcare, coordinate any specialist referrals (local and overseas), and direct health screening intervention and education programs
12. What is CAYHealth? Patients will have the benefit of accessing care at the health centre in the district in which they reside
Schedule all appointments with their personal general practitioner and the health care team at that Health Centre.
13. What Does CayHealth Offer? Access to preferred primary care physician
Access to care in the districts of residence
Access to medication at the District Health Centre
Access to Health education & healthy lifestyle programs
14. Improved Access to Preferred Primary Care Physician Continuity of care for chronic conditions
Coordinated referrals to specialists
Evidence based chronic disease management
Use of Quality care metrics
15. Access to care in the districts District Doctors Clinics
Monday to Friday 8:30 a.m. 4:30 p.m.
Saturdays at some clinic locations
16. Access to Medication at the District Health Centre Pharmacy opened during doctors clinic days
Urgent medication through nurses
Enhancement of pharmacy services as needed
17. Improved Access to Pharmacy Services
18. Improved Access to Health Education & Healthy Lifestyle Programs
Lifestyle health and fitness programs undertaken by the Public Health Department
Diabetic education classes
Other health education and health promotion activities undertaken by the Public Health Department or coordinated with other agencies
19. The Referral Process The personal physician will determine the necessity for specialist referral
Patients will receive their appointment times before they leave the clinic
Such referral orders will be specially designated as Cayhealth.-Priority Access
The Specialist will relegate care of those stable patients back to the GPs
20. Outpatient referrals contd Currently appointments require visits or telephone calls to Georgetown Hospital Appointments Office--Problematic
Cay Health patients have appointments made at the clinic before leaving for home
There are four referral priorities
STAT- To Emergency Dept.
Within seven days-Urgent
Within four weeks, or
Within three months
21. CAYHealth Model
22. Initial Target Population Initiate the strategy with persons managed by the DCFS
23. Why this group? It is already a well-defined patient group ~1100
We have data and metrics to facilitate their management
High-risk healthcare conditions are common in this population group diabetes, hypertension, dialysis etc.
24. CayHealth Population statistics Total number of population = 1021
Total number registered with H.S.A. = 800
The total number of encounters in the last year = 7158 (9 per person)
Cost $9,755,808
The total number of encounters to specialist clinics = 535 (1 per person) ($101,244)
25. Population statistics Number with diabetes (diagnosed, or with HbA1C >7) = 339 (42%)
Of those with diabetes, the average glycosylated hemoglobin recorded = 7.56
Number with hypertension diagnosed = 543 (68%)
26. Desired Outcomes of CAYHealth Improve Access to all services
Improve appointment availability in the specialist clinics to decrease wait time for patients who need specialty care
Deliver more affordable health care by standardizing internationally accepted Best Practices and Evidence Based Medicine
Decrease Chronic Disease Burden
27. Evidence-based Management With a specified list of patients, the physician is better able to monitor condition management
Point-of-care software support is also being made available to give physicians information on best-practice options while the patient is being seen
28. CayHealth and healthcare delivery This is a programme to improve clinical outcomes by improving access to care, health and well-being.
focus on quality and outcomes through evidence based medicine
29. Advantages of CAYHEALTH Will facilitate more personalized care.
Help to improve chronic medical conditions and consistency of care.
Patients preferred general practitioner will provide quality medical care, and maintain their medical records.
Promote evidence based chronic disease management.
Use of Quality care metrics
30. Who Benefits from CAYHealth? Initially the program is being offered to DCFS clients who receive healthcare benefits through the Health Services Authority
Future plans would extend this plan to the rest of the Government Insured and ultimately to the entire population
31. Chronic Diseases Reducing the Chronic Diseases burden on the CIHSA will be a major benefit of this program
32. Chronic Diseases Leading causes of death and disability worldwide
Disease rates are accelerating globally
Currently account for almost 60% of all deaths and 43% of the global burden of disease
By 2020 their contribution is expected to rise to 73% of all deaths and 60% of the global burden of disease
33. Chronic Diseases Top four: cardiovascular diseases (CVD), cancer, chronic obstructive pulmonary disease and type 2 diabetes
Action to prevent these major chronic diseases should focus on controlling these and other key risk factors in a well-integrated manner.
34. Chronic DiseasesExample: Diabetes in Cayman Total Outpatient Diabetes visits between January 2009 and Sept 2010: 6986
Total Inpatient Diabetes admissions between January 2009 and Sept 2010: 105
3224 (45%) of these persons are >65 years old.
35. Access to Health education & healthy lifestyle programs Lifestyle health and fitness programs undertaken by the Public Health Department
Diabetic education classes
Other health education and health promotion activities undertaken by the Public Health Department or coordinated with other agencies
36. FundingCAYHEALTH Capitation?
Fee for Service?
37. Capitation Healthcare service providers (physicians) are paid a set amount for each enrolled person assigned to that physician or group of physicians, whether or not that person seeks care, per period of time
The amount of remuneration is based on the average expected health care utilization of that patient (more for patients with significant medical history).
Other factors considered include age, race, sex, type of employment, and geographical location, as these factors typically influence
38. Funding- Advantages Capitation
Providers tend to focus on Preventive Care as they will be more financial reward in keeping a person from becoming ill than to treat them once they have become ill
Providers shift away from performing expensive, newly developed, and/or less effective treatment options that may have only a marginally higher success rate than alternatives.
39. Fee-for-Service( FFS) In Health Care- FFS occurs when health care providers receive a fee for each service such as an office visit, test, procedure, or other health care service.
Fee-for-service plans typically allow patients to obtain care from doctors or hospitals their choosing,[
In return for this flexibility they may pay higher copayments or deductibles.
Patients frequently pay providers directly for services, then submit claims to their insurance company for reimbursement
40. Funding CAYHealth Best suited to a Capitated model as opposed to the fee-for-service model currently in use
Numerous studies show that healthcare costs are better managed and contained by capitating the fee
Health care providers are economically motivated towards Evidence Based Medicine and improved outcomes
41. Implementation The patient count and distribution by District was completed in collaboration with DCFS, CINICO and HIC
letter and programme information were sent to patients
Patients were aligned to physicians/nurses.
Promotion through letters, CDs and H.S.A staff encounters.
Patients care plan. A work in progress
42. Stakeholder Presentations/Communications Ministry of Health & Ministry of Community Affairs & Housing
Cabinet & MLAs
CINICO, DCFS Staff & Social Workers
H.S.A Senior management
H.S.A Section Managers
H.S.A Physicians
H.S.A Staff
43. Media Briefing To inform the media about the CayHealth
Create community awareness of the initiative
Provide information to residents about the benefits of CayHealth
44. Media Briefing contd Chamber of Commerce
Civil Service - To provide information to members about the benefits of CayHealth
Community Awareness
Meetings organized through CDs
District meetings sponsored by MLAs
45. Evaluation Of CayHealth Initiation of the project September 1, 2010
Evaluation July 2011
Metrics of Outcome measures are now being finalized to use as program output indicators