RIBERA SALUD: From Hospitals to Population Health System

RIBERA SALUD: From Hospitals to Population Health System

RIBERA SALUD:
From Hospitals to
Population Health System
Adapting International Care Models Conference
London, May 12th, 2016
A Reflection…
We have to face big challenges in the short and medium term in our health
systems.
These challenges are not only for Europe or Spain, they are global challenges. In
fact, many countries all over the world are already carrying out reforms.
In my opinion, the common objectives of these reforms in progress are:
 To provide quality healthcare and social welfare to all citizens. In one word: public
values.
 To make this healthcare system sustainable in the long term. In one word:
responsibility.
 To apply the best practices, using techonology and coordinating all levels of care
as well as social services: in one word: change/specialization.
Therefore, the main objective of the reforms in healthcare is to
move forward in a system with public values, economic responsibility,
and highly specialized.
The Spanish Healthcare Model





The Spanish NHS is a universal system that covers the entire population.
It is financed by taxes.
It is inspired by the British NHS.
Decentralized system. 17 regions are in charge of its management.
Each region is divided into health departments. In the Valencia Region there
are 24 health departments.
 Each health department consists of 1 hospital + PC centers.
 The employees of the Spanish NHS are civil servants.
SPAIN
The Ribera Salud Model. Key Ideas
PPP Model
Capitated
Payment
Healthcare
Integration
Networking
A POPULATION HEALTH MANAGEMENT
An Integration Model
Capitated payment ….
Objective:
“To achieve the best health conditions for the citizens”
Strategic tool : H E A L T H C A R E I N T E G R A T I O N
Most importantly: cultural change of the politician and healthcare organization
managers.
 The most important thing is not the hospital.
 What really matters is to stand by the whole healthcare network, its professionals
and other agents involved (City Councils, Schools, Nursing homes, old people’s
homes, etc)
 To create a corporate culture: Population Health Management
R i b e r a S a l u d i s t h e p r e c e d e n t f o r t h e ACO’s i n US
The Evolution of our
Health Model Approach
The Evolution Of Our
Health Model Approach
The Evolution of Our
Health Model Approach
Triangle for Success
1 Clinical Management:
Citizen
Patient
HR
IT
Care Giver
To achive stronger
professionals´comitment in
decision-making processes.
Do the correct in the best
place with the best quality
&Efficiency
Chronic Health Plan.
Proactivity in Care
Home care, social and
healthcare network.
.
Patient Safety
Demand Management
2 - People Management:
Training financed by the
Organization,
Teaching (University and MIR)
and Research
Incentives system.
Career and professional
development
Information Technologies:
Full EMR (all departments and levels integrated)
Relationship doctors-patients (Health Portal)
Relationship betwen profesional (hospital-Primary Care)
Business Intelligence System (from professional to corporate
manager).
Benchmarking. Cost analytics and what-if capabilities.
Clinical Management
Objective: Achieving a stronger professionals’ commitment
in decision-making processes
1
2
3
4
Population Healthcare Management:
5 Variability decrease in clinical practice
Proactivity
• Healthcare processes, Medical paths
• To promote preventive and health promotion
• High resolution
activities
• To be proactive in patient’s care
6 Healthcare continuity
• Healthcare management of demand and
• Care longitudinally
needs
• IT integration
• Challenge: Chronic Diseases Management
• Segmentation of population
7 Management of Demand vs Needs
Self management tools
Professional Alignment: Primary Care Doctor –
• Health website
Hospital Doctor
• Florence Direct. To know “all” about
your patient
Nurses: new roles, competences and
• Inter-consultation
responsibility: emergency triage case history
• Algorithms; Specialist Consultant (link
management, etc.
doctor)
• Predictive models
Health objectives alignment across the whole
organization
Best Quality & Efficiency
H.R. Strategy
Private employees
Diversity Management
Government’s old employees
Financed by the
organization
Civil Servants
District Council’s employees
Hospitals with MIR (Resident Medical
Intern) and University accreditation
; Professionals as University teachers.
research projects and
performance of clinical trials
PRIVATE
EMPLOYEES
Flexible incentive
plan
Personalized compensation, “flexible incentive schemes ”
PUBLIC
SERVANTS
Variable salary
Fix salary
Variable salary
Fix salary
Quantitative work
objetives
Variable salary depending
on activity and aims
achieved by the
professional.
Qualitative work objetives
Healthcare quality and efficiency
criteria: mean stay, readmission
rate…
Retribution based on post and professional´s development:
training and experience retribution basis
FUNCTIONAL
INTEGRATION
Technological Development
For
the Citizen
• SMS notice
• Touch screen
• Emergency waiting time
• Simultaneous translation
• Family patient information
• Health Portal
For
the Professional
•
•
•
•
Electronic medical history
and digital radiology
Integrated processes.
“Florence directo”
Medical History access from
mobile phone
Telemedicine. Teleworking
in radiology
For
the Manager
• Quality evaluation
• Emergency response time
• Services and professionals
workloads
• Technology and
management
• Systems innovation
Results
Emergency Distribution
Hospital/ Primary Care
Emergency Activity - Hospital
Primary Care
Hospital
Primary and
Hospital Care
integration
Number of PC referrals to specialties related to
the orthopedic and trauma service
Referrals from PC to specialities.
Utilization rate per 1,000 inhabitants
Referrals (left axis)
Inter consultations (right axis)
Source: Ribera Salud
Waiting lists
Results
Surgical
waiting
list
in 2014
Lista
de espera quirúrgica
(días de
espera)
100
90
80
70
60
50
40
30
20
10
0
(in days)
SNS
90
CV
66
Specialized
waiting
list
Lista
de espera consultas
especialista
(díasinde2014
espera)
(in days)
60
SNS
53
50
CV
41
40
30
20
10
52
39
32
32
0
Alzira
Torrevieja
Denia
Vinalopó
18
31
28
29
Alzira
Torrevieja
Denia
Vinalopó
Source: Conselleria de Sanitat (Alumbra 2014). National Benchmark: Indicadores Clave del SNS: INCLASS 2015”
Average
complexity (DRG) per age group
Complejidad media (peso GRD) global y por grupo de edad
3,00
2,10
2,50
2,00
2,00
1,90
1,50
1,80
Peso medio por hospital
Complexity
Results
Vinalopo; 2,03
Torrevieja; 1,86
1,00
1,70
0,50
1,60
0,00
1,50
0-4 AÑOS
5-14 AÑOS 15-44 AÑOS 45-64 AÑOS 65-74 AÑOS
<75 AÑOS
Average weight (in red RS concessions, in black Spanish
benchmark) per age group. Source: RS MBDS, Spanish
benchmark from DRG Ministry of Health 2013 database.
Denia; 1,78
España; 1,74
GrossAlzira;
and
adjusted mortality rate
1,66
1
Gross mortality rate (left axis)
Adjusted mortality rate (right axis)
Number of bypasses
Número de Bypass
Valve surgery
50
100
150
Mortality in Bypass and Valve Surgery 2014.
Source: BMSD of 29 hospitals. Elaborated by IASIST
0
20
40
60
80
100
120
140
160
180
200
220
Number of bypasses. Source: BMSD of 29 hospitals. Elaborated by IASIST.
Satisfaction Survey
Global satisfaction
Primary
Satisfacción
global en la atenciónin
primaria
2014 care in 2014
Satisfacción satisfaction
global en la atención in
hospitalaria
2014 care in 2014 Sa
Global
Hospital
Vinalopó 8,0
Vinalopó 9,0
Denia 7,7
Denia 8,7
Torrevieja 7,8
Torrevieja 8,6
0
Alzira 8,6
CV 7,8
Alzira 7,8
2
4
6
8
T
10
0
CV 8,5
2
4
6
8
10
Source: Conselleria de Sanitat 2014
Chronic Patient Plan
Results
Fuente: Brookings
“Spain: Global Accountable Care in Action”
MBA Class at the University of
Harvard in Boston (Massachusetts),
where our management model was
presented as a business case study.
Satisfaction Survey
91% of the patients show their satisfaction with
the health care provided.
94% do not know the Alzira Model.
Work Environment Survey
93% of our employees recommend Ribera Salud centers as a place to
work in.
84% consider that the organization provides the required information to
do their job in optimal conditions.
The pride in belonging to this Group is the most highly rated indicator. 8
out of 10 employees are satisfied or highly satisfied.
90% of our employees consider they are contributing in a positive way
to the society welfare, 6 points over
the average in the healthcare sector.
Health Department Evaluation
COMPARATIVA
COMPARATIVA
CONCESIONES
CONCESIONES
2011
2011
INDICADOR INDICADOR
Posición ,,,
8,00 ,,,
Posición
Valor …
81,16
Valor …
RIBERA
Tema
Valor
Tema
8,00
4
84,22
81,16
TORREVIEJA
RIBERA
Valor
Valor
54
82,91
84,22
10
5
80,10
82,91
TORREVIEJA
DENIA
MANISES
DENIA
Valor
Valor
Valor
Valor
10
6
82,86
80,10
6
82,86
VINALOPÓ
MANISES
VINALOPÓ
Valor
Valor
Valor
Prestar atención
Prestar
sanitaria
atención
quesanitaria
responda
que
a las
responda
expectativas
a las expectativas
de la población.
de la población.
Satisfacción: Prestar
Satisfacción:
atenciónPrestar
sanitaria
atención
que responda
sanitariaaque
las expectativas
responda a las
deexpectativas
la población.de la población.
Calidad
Calidad
97,58%
98,45%
97,58%
98,85%
98,45%
94,49%
98,85%
92,67%
94,49%
92,67%
2. Índice de calidad
2. Índice
de lade
información.
calidad de la información.
Calidad
Calidad
3. Índice de percepción
3. Índicede
demejora.
percepción de mejora.
Calidad
Calidad
97,05%
86,97%
95,10%
97,05%
93,09%
86,97%
95,75%
95,10%
100,00%
93,09%
95,23%
95,75%
100,00%
89,00%
89,57%
95,23%
96,11%
89,00%
89,57%
96,11%
92,59%
30,67%
25,44%
65,60%
34,91%
97,17%
81,59%
1,17%
3,31%
38,24%
100,00%
94,48%
100,00%
93,49%
80,09%
92,59%
39,81%
30,67%
39,84%
25,44%
62,94%
65,60%
48,62%
34,91%
93,52%
97,17%
77,28%
81,59%
4,84%
1,17%
4,09%
3,31%
44,23%
38,24%
100,00%
94,48%
100,00%
93,49%
92,13%
80,09%
30,46%
39,81%
25,17%
39,84%
45,15%
62,94%
30,91%
48,62%
95,19%
93,52%
71,01%
77,28%
0,07%
4,84%
1,56%
4,09%
33,86%
44,23%
100,00%
99,06%
100,00%
100,00%
92,28%
92,13%
33,04%
30,46%
27,84%
25,17%
70,47%
45,15%
35,75%
30,91%
96,47%
95,19%
80,02%
71,01%
1,86%
0,07%
3,01%
1,56%
38,95%
33,86%
97,23%
99,06%
100,00%
100,00%
91,82%
92,28%
34,41%
33,04%
33,23%
27,84%
55,82%
70,47%
33,03%
35,75%
95,81%
96,47%
86,19%
80,02%
4,11%
1,86%
4,00%
3,01%
44,75%
38,95%
97,23%
100,00%
91,82%
34,41%
33,23%
55,82%
33,03%
95,81%
86,19%
4,11%
4,00%
44,75%
72,12%
65,73%
2,11%
43,23%
72,12%
38,75%
65,73%
5,09%
2,11%
44,49%
43,23%
47,18%
38,75%
0,84%
5,09%
69,35%
44,49%
49,66%
47,18%
2,28%
0,84%
71,17%
69,35%
59,95%
49,66%
6,81%
2,28%
71,17%
59,95%
6,81%
1. Índice sintético
1. Índice
de satisfacción.
sintético de satisfacción.
Ciudadanos: Generar
Ciudadanos:
confianza
Generar
y seguridad
confianza
en el
y seguridad
sistema. en el sistema.
Ciudadanos: Generar
Ciudadanos:
confianza
Generar
y seguridad
confianza
en el
y seguridad
sistema. en el sistema.
Penalización OE.3Penalización
Ciudadanos:
OE.3Generar
Ciudadanos:
confianza
Generar
y seguridad
confianza
en el
y seguridad
sistema en Penalizaciones
el sistema
Penalizaciones
Promover la salud
Promover la salud
4. Indicador de
4. Cobertura
Indicadorvacunal
de Cobertura
de poliovacunal
a los 6 de
meses.
polio a los 6 meses.
Salud Pública
Salud Pública100,00%
5. Indicador de
5. Cobertura
Indicadorvacunal
de Cobertura
de Triple
vacunal
Vírica de
a los
Triple
15 meses.
Vírica a los 15 meses.
Salud Pública
Salud Pública100,00%
6. Indicador de
6. Cobertura
Indicadorvacunal
de Cobertura
DTP a los
vacunal
18 meses.
DTP a los 18 meses.
Salud Pública
Salud Pública
7. Cribado de 7.
HTACribado
de riesgo
deelevado
HTA de riesgo elevado
Salud Pública
Salud Pública
8. Control de hipertensión
8. Control de hipertensión
Salud Pública
Salud Pública
9. Indicador de
9. Cribado
Indicador
de diabetes.
de Cribado de diabetes.
Salud Pública
Salud Pública
10. Control de diabetes
10. Control de diabetes
Salud Pública
Salud Pública
11. Calidad en el
11.Seguimiento
Calidad en el
delSeguimiento
Embarazo endel
Atención
Embarazo
Primaria.
en Atención Primaria.
Salud Pública
Salud Pública
12. Niños con examen
12. Niños
de con
salud
examen
completo
de salud
en SIAcompleto
por Atención
en SIAPrimaria.
por Atención Primaria.
Salud Pública
Salud Pública
13. Valoración 13.
del riesgo
Valoración
vascular
del riesgo vascular
Seguridad
Seguridad
14. Indicador de
14.abandono
Indicadortabáquico
de abandono
en pacientes
tabáquico
deen
alto
pacientes
riesgo de alto riesgo
Salud Pública
Salud Pública
15. Indicador de
15.registro
Indicador
del Índice
de registro
de Masa
del Índice
Corporal
de Masa Corporal
Salud Pública
Salud Pública
16. Pacientes con
16. diagnóstico
Pacientes con
correcto
diagnóstico
de EPOC
correcto de EPOC
Seguridad
Seguridad
17. Seguimiento
17.delSeguimiento
puerperio del puerperio
Registro AP
Registro AP
18. Indicador de
18.cobertura
Indicador
vacunal
de cobertura
del VPHvacunal del VPH
Salud Pública
Salud Pública
19. Indicador de
19.cobertura
Indicador
vacunal
de cobertura
del virus
vacunal
de la gripe
del virus de la gripe
Salud Pública
Salud Pública
20. Cribado de 20.
tabaquismo
Cribado de tabaquismo
Salud Pública
Salud Pública
Penalización OE.3Penalización
PromoverOE.3la salud
Promover
- Vacunaciones
la salud - Vacunaciones
Penalizaciones
Penalizaciones
Penalización OE.3Penalización
PromoverOE.3la salud
Promover
- Niño ylaembarazo
salud - Niño y embarazo
Penalizaciones
Penalizaciones
About RIBERA SALUD
Leading a
Process of Change
RIBERA SALUD…
Is the only Spanish Company exclusively dedicated to the Administrative Concessions in healthcare
sector.
Torrevieja Hospital developed FLORENCE (electronic clinical history), which was implemented in 15
Hospitals in Chile.
Torrevieja and Vinalopó Hospitals have implemented a shared services system to foster the multihospital vision.
Has implemented an interactive health portal Patients/professionals.
First project of patients segmentation according to the risk level.
Alzira Model…
Is the first project with a per capita finance system, whose objective is the health promotion.
Establishment of Integrated Healthcare Centers (CSI), joining Primary Care and technology to
Specialized Care.
Is the first PPP considered as a case study by Harvard University.
Alzira Hospital, first public hospital…
In Spain with electronic clinical history and digital radiology (1997).
In Spain with individual rooms and a bed for the companion (1997).
That developed an integration model Hospital /Primary Care.
Committed to CSR Alzira Hospital, first public hospital in Spain with sign Language Interpreter (1997).
Ribera Salud Contribution
25%
34
Employees
(85% permanent)
Saving for the
Administration
Quality
Certifications
Professionals
Trained (Resident
Medical Intern etc…)
625
3.200
Research
Projects
Promotion and
Prevention
Activities
110
+80
1.500
91%-94%
45.000
580
Millions Euros
of Investment
650
Countries Visited
Our hospitales
6.200
Scientific
Publications
Satisfaction and
Unfamiliarity
National and
International
Awards
Patients Use Our
Health Portal
Source:
Conselleria
de Sanidad
Oct. 2015
The Expansion of the Alzira Model
CONCLUSIONS
Conclusions & Challenges
Challenges Faced 16 Years Ago:
For the first time in a NHS, a capitated model in healthcare management was implemented
To assume that a change, an unprecedented new
management model was possible. To start from square
one.
Alignment of Private sector and Public Administration
objectives.
Long-term business perspective. No short-term profit.
Transparency.
Alternative financing methods, constant innovation in
management, new integration models.
Challenges at present
To be able to adapt to the circumstances. The private sector adapts to Government’s needs. To take advantage of
public-private partnership to innovate. To question the bases of the Model (services portfolio, capita including
incentives for health results, etc.).
Corporate identity. “Think globally and act locally” .To attract and train new professionals aligning objectives.
To face 21st century challenges, with 21st century tools. New action plans for chronicity, benchmarking, best
practices…
Patients’ needs have changed. We must adapt to a competitive scene.
Challenges for the Near Future
Shared services.
Global approach to the patient, citizen and caregiver.
Multi-hospital management models.
Development of networked management model.
Ribera Salud Added Value
For the Local Government
Offloading of the public budgets.
A lower-than-average costs public management of a public service (25% less).
Investments are the concessionaire’s responsibility during the management period.
Capitative payment. Transfer of financial risk.
Innovation in technologies and systems management.
Contribution of complementary HR.
For the Professionals
Job security. Innovative salary system.
Opportunity for development and a professional career.
Teaching and Research.
Commitment to technology.
For the citizen/patient
Perceived quality. Humanization of care.
Personalized treatment. Greater privacy and comfort.
Greater accessibility. Quicker response time.
Free choice of hospital and doctor.
Technology informs and educates the patient
94% do not know the Alzira Model.
91% are satisfied with the health care provided
Conceptual Framework
Resources
INPUT
Processes
Products
Products
OUTPUT
OUTPUT
Result
OUTCOME
Public
Administration
and society
Conclusions
Pressure
on the costs
will be increa
REFORMS
sed:
www.riberasalud.com
www.albertoderosa.com
www.modeloalzira.com
@riberasalud