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Coordinated care – a step into the future or into the gulf?

31st Economic Forum Expert features

Experiences of members of the Association of Employers of Value-Based Co-ordinated Care – SPOIWO

The reform of primary care, introducing coordination, cooperation and information exchange between primary care and AOS providers, is a milestone in the process of gradually restoring the correct pyramid of healthcare services, building systemic value of care and improving the availability of services for patients, especially in depopulated areas. It builds a culture of collaboration between different medical professionals to holistically guide the patient through the system.

It is a return to a traditional and proven system, based on the Hippocratic Oath – examining the patient fairly, making a diagnosis, agreeing a treatment plan with the patient and their relatives.

The solutions developed by the PCH change team are based on the POZ PLUS pilot and international experience. The essence is diagnostic examinations and specialist consultations, according to the individual diagnosis, treatment and care plan, the entrusted budget or rewarding the health effect and quality of care (incentive allowance)The gradual implementation of coordination into the whole system will benefit patients, staff, providers and the payer, as the summary of the POZ PLUS pilot shows. Economic efficiency was difficult to demonstrate in such a short pilot, further shaken by the Covid-19 pandemic. However, higher QALYs indicate further growth in the future. Coordinated care also proved its value during the pandemic.

Patients expect good changes. “First of all, coordinated care. We don’t walk around, we don’t wander. We don’t have to be nervous about forgetting something, because there is simply such a coordinator keeping an eye on it all, to be with us, to support us, to take care of us. Which before, unfortunately, only happened in private facilities or if we had subscriptions to the clinics in question.”

The reform of PHC requires the implementation of modular solutions – adapting tasks and requirements to the organizational capacity of the entity and the funding that goes with it. Rewarding quality and results based on reliable reporting, setting population targets for health care managers will lead to the expected changes – gradual achievement of the European average in terms of excess mortality due to preventable deaths within 5-10 years.

We know how to implement it!

Like any change, implementation of coordinated care also requires preparation, good organization, training of medical and support staff, managers of the entities, as well as monitoring of implementation and measuring patient satisfaction. The process is time-consuming and, as experience presented at international industry conferences indicates, can take many years.

The cornerstones of a good coordinated care organization are:

  1. accepted standards,
  2. active medical care,
  3. transfer of the diagnostic and therapeutic initiative from the patient to the medical professionals,
  4. clear division of responsibilities among the members of the cooperating team of medical professionals and support staff.

What will indicate the success of the changes being implemented?

Any change process must lead to the achievement of specific goals, which, according to the art of good management, should be SMART (specific, measurable, achievable, relevant and time-bound). Changes in HCPs need to be described with specific metrics that should be analysed, both at a system, regional and facility level in a benchmark model. Analysing the dynamics of the metrics and comparing them between regions and entities will help to reduce inequalities in access to and quality of health services. The proposed measures of value in PHC are:

  1. the percentage of patients covered by a disease management programme
  2. the percentage of patients covered by preventive examinations (by programme)
  3. percentage of patients using the ED
  4. ratio of diagnostic costs to revenues

Investments in OPD should foster the improvement of quality indicators and the reduction of inequalities.

We will discuss selected practical aspects of implementing coordinated care in POZ during the session “Increasing accessibility and quality in primary care”.

“You must demand of yourselves even if others do not demand of you ” John Paul II

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