XXII jornada de la SocietatCatalana de Farmacia Clnica

28 de Junio 2016

Rafael Bengoa

INTEGRATS O DESINTEGRATS ?

DEMOGRAPHY

Ms pacientes crnicos.

Ms pluripatologa

EPIDEMIOLOGY. CHRONIC

1992 1997 2002 2007

CLINICAL COMPLEXITY

13.500 diagnsticos

4.000 procedimientos quirrgicosComplejidad 6.000 medicamentos22 profesionales/ paciente

20.000.000 de actos clnicos

FRAGMENTATION. SILOS

No se puede hacer medicina del siglo XXI con el chasis de 1.970 . Bengoa

EXPECTATIONS ECONOMIC

1.500.000

2.500.000

3.500.000

4.500.000

5.500.000

6.500.000

7.500.000

8.500.000

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

(*)

2012

(**)

2013

2014

2015

2016

2017

2018

2019

2020

2021

2022

Realistic case Best case Worst case

CONTEXTO: + 4 % DE DEMANDA ..

Perfil de morbilidad por grupos de edad

Envejecimiento de la Poblacin:Nmero de personas mayores (+65) por 100 en

edad 16-64

Source: NISRA (Mid-Year Population Estimates (1971-2009); Population projections (2015-2061)Male/female icons for illustration only and do not reflect sex balance

1971

1999

2009

2015

2023

2031

2041

2061 50

19

2122

24

3037

44

Tanto cambio en losprximos 8 aos como en

los anteriores 40 aos

2015 2020 2025 2030 203590+ 2,701 3,274 4,015 4,856 6,01980-89 13,357 14,047 15,355 17,043 18,46570-79 23,436 24,789 26,118 29,751 34,81060-69 31,217 35,257 40,890 42,567 40,603

0

20,000

40,000

60,000

80,000

100,000

120,000

Source: NISRA

FRAGMENTACION

DISCRIMINACIN LETAL

GRAHAM THORNICROFT

Physical health Disparities and Mental Illness: the scandal of premature mortality

DISCRIMINACIN!

DIABETES

Poblacin General 16% Personas con Psicosis 27 %

Poblacin General 8% Personas con Psicosis 21%

1/3 estn a riesgo de un eventocardiovascular en 5 aos.

Expectativa de vida 15-20 aosMENOR

Cardiaco

RESULTADO

TOCA INTEGRAR

NUEVAS POLTICAS (12 PASES)

NUEVAS ORGANIZACIONES INTEGRADORAS

NUEVA FORMA DE ASIGNAR RECURSOS

BUENAS NOTICIAS1. Existen marcos que nos ayudan en la gestin de toda esta complejidad del cambio necesario, con visin de sistema.

2. Tenemos un arsenal de gestin que est probando su evidencia en la contribucin hacia el movimiento deseado.

MS EN CASAMS EN

ATENCIN PRIMARIA

MENOS EN HOSPITALES

MS EN LA COMUNIDAD

HOJA DE RUTA

MAS PREVENCION

!!Disponemos de un Gran Arsenal de Gestin!!

Historia clnica electrnica

Receta electrnica

Telemedicina, telecuidados, telemonitorizacin

Estratificacin poblacional

Nuevos modelos de financiacin

Cuidados integrados

Coordinacin sociosanitaria

Nuevos Roles profesionales (enfermera)

Empoderamiento de pacientes (autogestin)

Fortalecimiento del tercer sector

Transformacin Centros de subagudos

Formulas para mayor participacin de los profesionales

Nuevas formas de Liderazgo distribuido/facilitador

Estructura Sistema

RESISTIR Y

REZAR

Vs. PACIENTE

Transformar

15

UTILIZAR MODELOS = LGICA DE SISTEMA

MEDICINE POPULATION HEALTH

EFFICIENCY

RISK STRATIFICATION OF THE BASQUE POPULATION

TELETODO

Telemedicine, telecare, telemonitorization...

Coordinated & integrated care

Precision management

WE HAVE THE TOOLS ..

Basque OSABIDE GLOBAL:

ELECTRONIC MEDICAL RECORD . EMR

PATIENT EMPOWERMENT

Electronic Prescription .

Impact : Reduction of adverse effects , duplication.

Precision management

Este tipo de proyectos integradores es lo que va a contratar el pagador

PORQU OCURRIR ESTO ?

New payment approaches ; Bundled payment , global payment ensuring one party is accountable for spending and outcomes for anoverall episode.

FEE FOR SERVICE Bundle PaymentGlobal Payment

REWARDING COORDINATED HIGH VALUE CAREPrecision management

1 2 3 4 5 6 7 8 9 10

1 2 3 4 5 6 7 8 9 10

SIGLO 20

SIGLO 21

Fuente: Muir Gray

Fuerza de Prestadores

Fuerza de Prestadores

Fuerza de Pagadores

Fuerza de Pagadores

Key Value-Based Payment Dates in DSRIP Timeline

Note: MCO = managed care organization.Source: New York State Department of Health, A Path Toward Value-Based Payment: New York State Roadmap for Medicaid Payment Reform Annual Update, March 2016.

Year 0April 2014March 2015

Year 1April 2015March 2016

Year 2April 2016March 2017

Year 3April 2017March 2018

Year 4April 2018March 2019

Year 5April 2019March 2020

April 2014:DSRIP Year 0 begins

June 2015: CMS approves State Roadmap for Medicaid Payment Reform

PPSs submit growth plans outlining the path of their network towards 90% VBP

By year end: At least 10% of total MCO expenditures are captured in Level 1 VBP arrangements or above

By year end: At least 50% of total MCO expenditures are captured in Level 1 VBP arrangements or above At least 15% of total payments are captured in Level 2 VBP arrangements or higher (fully capitated plans)

By year end: 80%90% of total MCO expenditures are captured in at least Level 1 VBPsAt least 35% of total payments are captured in Level 2 VBP arrangements or higher (fully capitated plans)At least 15% of total payments are captured in Level 2 VBP arrangements or higher (not fully capitated plans)

Results seem to support new payment models:

Improvements in quality

The Alternative Quality Contract (AQC)

Desaceleracin de los gastos10% de ahorro en gastos mdicos en el cuarto ao.

The Alternative Quality Contract (AQC)

Este movimiento ya est en marcha

RELEVANCIA DE LO LOCAL: SISTEMA LOCAL INTEGRADO

Holanda: Care GroupsU.S.A: Accountable Care Organizations

(ACO)Escocia: Health & Social Care PartnershipsInglaterra: Integrated care pioneersIrlanda Norte: Integrated care partnershipsNueva Zelanda: Locality clinical partnerships (LCP)Varias CCAA: Microsistemas/ Sist. Local Integrado

Holanda: Care GroupsU.S.A: Accountable Care Organizations(ACO)Escocia: Health & Social Care PartneshipsInglaterra: Integrated care pioneers. Vanguard sitesIrlanda Norte: Integrated care partnershipsNueva Zelanda: Locality clinical partnerships (LCP)CCAA: Microsistemas/ Sist. Local Integrado/Osis

LOS PAISES MIGRAN HACIA UN SISTEMA LOCAL INTEGRADO .

Fuente: http://www.bluecrossma.com/visitor/about-us/affordability-quality/aqc.html

The Alternative Quality Contract (AQC)

http://www.bluecrossma.com/visitor/about-us/affordability-quality/aqc.htmlNmero de diapositiva 1Nmero de diapositiva 2Nmero de diapositiva 3Nmero de diapositiva 4Nmero de diapositiva 5Nmero de diapositiva 6Nmero de diapositiva 7Nmero de diapositiva 8Nmero de diapositiva 9Nmero de diapositiva 10Nmero de diapositiva 11Nmero de diapositiva 12Nmero de diapositiva 13Nmero de diapositiva 14Nmero de diapositiva 15Nmero de diapositiva 16Nmero de diapositiva 17Nmero de diapositiva 18Nmero de diapositiva 19Nmero de diapositiva 20Nmero de diapositiva 21Nmero de diapositiva 22Nmero de diapositiva 23Nmero de diapositiva 24Key Value-Based Payment Dates in DSRIP TimelineNmero de diapositiva 26Nmero de diapositiva 27Nmero de diapositiva 28Nmero de diapositiva 29Nmero de diapositiva 30