DR. HADAS LEWY INTEGRATED CARE SERVICE AND OUTCOMES 10/8/2014 1
Maccabi Healthcare Services Second largest and fastest growing HMO in Israel ( 25% of Market) Non-profit mutual Recognized health fund - Israeli National Health Insurance Law Provides public basket of services Offers voluntary supplementary insurance Supplies services via own facilities and outside providers Our Office
2 M members 5,192 physicians (83% self employed) 7,500 Employees Owns 62 Pharmacies Contracts 712 Pharmacies 5 Districts, 300 care centers
Maccabi s Computerized Information and Communication System Supports Integrated Care Maccabi Central Electronic Medical Record Every transaction computerized E-Laboratory Treatment Hospital E- Prescription Diagnoses E- Consultation Telemedicine Alerts and Reminders Medical Visits Medicines & Drugs Registries Patient Website (PHR) Mobile Phone Applications Pathology Tests Imaging Tests Lab Results
IT Platforms Patient Management Operations management Nesher HVA Maccabi Online (PHR) Maccabi Li (Kiosk) Patient Interface Mgt Rimon Interface with Provider Provider Profile Analyzer Applications Clicks (EMR) Registries Multidimensional Information Unified Information Central medical Record Meta-registry Operational Systems Organizational database
Maccabi Online
Clinical Support Alerts and reminders for patients and Doctors Personal Medical recommendations Filter By type Friendly icon for the type (labs, vaccinations) Direct link to the last results
Physical Fitness Smoking monitor Steps Monitor Blood Pressure Monitor Weight Monitor Tips for reducing Blood Pressure Enter Information: Date: Systolic / BP: Diastolic/ BP: Diastolic Systolic Date Measured Ltd. Ideas grow with us
Services and Lab results over time Find a doctor Urgent Care Centers Pharmacy Branch Labs and Clinics Maccabi Natural Maccabi First look -Referring doctor - Date
Diabetic Profile- Disease management Requests to doctor Member;Israel israel ID 123456789 Dr. Leah Lorbin You can make a request only if you visited this doctor in the last Send year Data to e-mail OK Create a new request
Mobile Physician Portal
OUTCOMES Improved Efficiency and Quality of Care Improved Clinical Outcomes Better medical practice (DSS and alerts) Improved Patient Compliance Increased Patient Satisfaction
Improved clinical outcomes Elderly Vaccination Flu 2005 % 52 2013 % 68 Urine Protein Screening Diabetics 65 88 Target Cholesterol in Cardiac Patients 53 67 Good Control of Hypertension in Diabetics 52 73
Trends over time in performance measures MHS, 2003-2009 80 70 60 50 40 30 2003 2004 2005 2006 2007 2008 2009 20 10 0 BMI children Adequate LDL control,, CVD Adequate LDL Control,, diabetes Pneumococcal vaccination Colorectal Cancer solacing Mammography
Trends over time in Screening levels 2003-2009 Blood Pressure Screening Colon Cancer Screening
MOMA- Multidisciplinary Center MOMA is a multidisciplinary Center for treatment of various chronic diseases The Multidisciplinary center is operated by trained nurses providing professional and personal treatment for the patient and their family Integration of nurses in coordinating the treatment of multidisciplinary teams and specialists with the primary physician in treating chronic patients in the following conditions: CHF COPD Diabetes Home care Hard healing wounds Stoma.
Goals Organisation level To provide support network to assist primary physicians To coordinate and integrate care with community-based services To reduce the demand for healthcare services (hospitals, referrals to the ER and other emergency services) Client level To monitor and provide care for diverse client groups with chronic conditions To preserve/enhance clients physical and mental quality of life, performance scores, compliance rates, and satisfaction To empower clients and caregivers that support the care process
Integration with the Team in the Field Primary physician Primary clinic/ personal physician Secondary physician Emergency medicine centers / services Multi- Disciplinary Center Multidisciplinary team Maccabi Nonstop Call Center At-home care units
The uniqueness Team Work Coordinating Care Advanced Technologies Proactive approach, accessibility & availability
TABLET as a Clinical Tool Virtual House Call for Specialist Consultation Monitoring: Blood Pressure, Heart Rate Oxygen Saturation, Resp. Rate Psycho-Motor Mobility Gait Pattern, Range of Movement Timed Up & Go Evaluation: Clinical Evaluation Polypharmacy PAIN (VAS) MOOD (PHQ9) COGNITION (MMSE, MOCA)
Controlling Hba1c- two different cohorts February 2013 August 2013 10 9,8 10 9,8 9,5 9 8,5 8 7,5 9,38 9,36 N=66 7,92 8,43 8,29 8,68 8,02 9,5 9 8,5 8 7,5 9,71 9,47 N=66 8,8 8,4 8,06 8,8 8,1 7 N=401 7 N=257 6,5 N=135 6,5 N=241 6 6 שחרור במומה טרום מומה שחרור במומה טרום מומה member Reached Treatment Target Other
Significant improvement Mental Health PHQ9 10% 7% 8% 14% Moderatemajor Minor depression 61% 59% Minimal depression symptoms Quality Care 16% 26% Negative finding Prior MOMA Intervention
Average Score Physical and Mental Health - SF-12 100,0 SF-12 66,7 63,5 50,0 46,9 46,9 Quality Care Significant Improvement in Mental Health No change in Physical Health 0,0 physical health mental health
Average num days per week Life style Significant improvement in all aspects of patients self care activities 6,5 6,8 4,5 5,5 5,3 4,9 Quality Care 2,0 2,5 0,0 Maintenance of tailored & healthy diet Eating at least 5 vegetables or fruits Physical Activity Taking drugs according to recommendation
Smoking Cessation HELP! 395 smoking patients at entering Moma Ambivalent 25 6% Stopped 78 smoking 20 % 20% 32% 42% Refusal 125 Refferred to Workshop 167
Flu vaccination rate 80% 72% 78% 71% 70% 79% 71% 67% 83% 72% 61% 58% 50% 38% CHF COPD Diabetes Home Care Stoma Wounds Fragile Prior Moma Moma
Average Patient s ability to cope with the disease 7 5,95,8 5,6 5,3 6,2 6,0 6,1 5,7 6,66,8 6,06,1 5,9 5 3 1 Considerin g disease as serious Worried regarding the disease Doctor assisted in coping Has the informatio n to deal with the disease Know how to take drugs Feels there is someone to refer to Moma nurse assisted in coping Significant improvement in patient s ability to cope with the disease
Average Patient s Satisfaction with MOMA Nurse 7 6,64 6 6,83 6,75 6,60 6,43 6,23 5,65 6,25 5 4 3 2 1 General Satisfaction Relation & Respect Explanation s received from nurse Relying on Nurse Nurse Availabilit y Nurse Contributio n Adaptation to community Services Discharge Process Satisfaction from Moma s nurse High Satisfaction in all aspects
Doctors Satisfaction From MOMA Nurses 7,0 6,0 5,0 4,0 6,3 6,5 6,3 Scores 6-7 3,0 2,0 1,0 Quality Care Nurse s availability Nurse doctor interaction Trust in nurse s professionalism Doctor s high satisfaction is defined as 5.5 in Maccabi s surveys
CHF / relative weight of types of expenditures (2011 vs 2013 ) from total cost per patient Relative weight Relative weight Dr visits Hosp exp Pvt clinic exp Macc clinic exp Drug exp Dr visits Hosp exp Pvt clinic exp Macc clinic exp Drug exp Dr visits Hosp exp Pvt clinic exp Macc clinic exp Drug exp CASE reduction of 9% in hospital expenditures CONTROL reduction of 3% in hospital expenditures
Summary of Data per person Change Average Cost 2013 Average Cost 2011 Type of Patient 8% 28,304 26,273 MOMA PT 48% 31,998 21,638 CONTROL 12% 4,319 3,873 Maccabi Average 4% Estimated Savings Relative to Maccabi
Functional assessment-adl
Behavior patterns- MCI, Falls
Taking You Forward