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Direction Générale
Disease Management
DEVELOPMENT
The Independent Health Insurance Funds
Brussels,05.07.2010
Strategic context
1. Why introducing DM ?
Challenges on the macro-level:
Dramatic increase of the number of patients
with chronic conditions;
High costs to health and social systems
Improve care quality
Improve efficiency in use of the available
resources for treatment of chronic diseases
2
Réunion - Date
Strategic context
Why introducing DM ? (2)
Challenges on the process-level:
Systematizing the use of guidelines by
physicians
Improving coordination of care
Improving patient compliance in medication
and life style adoption
Systematizing the use of ICT in care
Systematizing data input/analytics on
treatment process and outcome
3
Réunion - Date
Strategic context
Disease Management Company
Vision
Integration Need
Medical Integration Mgmt
Information Integration Mgmt
Financial Resources Mgmt
Daily operations Mgmt
New entity of Disease Management
4
Réunion - Date
Unique position MLOZ and NM in HCS
Free and independant from others
20% of market
Fast growing (2.4%)
Open for new partnerships with providers, industry
Innovation central strategy
5
Réunion - Date
Strategic context
Disease Management Company
Vision
Integrated Care Solutions =
IT supported Care Path + Medical Call centre
New elements of care:
A.
Enrolment system based on the risk stratification and the
Evidence Based Practice Guidelines
B.
Patient self management support tools
C.
Providers support tools (IT based)
D.
Process and outcomes measurement
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Réunion - Date
Strategic context
Activities
1.
Care plans development – integration/relation other initiatives
2.
Individual Care plan management
3.
Education/coaching/monitoring for each pathology and
combined pathologies
4.
Care plans IT support and maintenance
5.
Promotion of care plans and IT support with physicians
6.
Training of physicians in system use
7.
Facilitating of medical telephone support to patients
outsourcing with Home Care/Call centre’s
8.
Data processing and analysis
9.
System quality monitoring and care plans upgrading
10. Communication
Réunion - Date
7
Strategic context
Services
Patient <= individualized health path; personal electronic
record with variety of tools (information/ education/
coaching/monitoring/ authorization and sharing)
Physicians
<=
Health Insurer <=
availability of the evidence based clinical
guidelines/E-learning/ secure information
exchange within the Care Teams / decision
support
services for members/ process en
outcome measurements/efficiency tools
8
Réunion - Date
Disease Management Development Program
From Consortium to DMC
DMC Services
DMC DEVELOPMENT
P0: DMC operating
system
requirements
& architecture
Requirement
Analysis
MOU
April 2010
Réunion - Date
Negotiations
DMC legal advise &
Foundation
DMC
Business
plan
DMC
Installation
DMC
Operations&
Marketing
plan
DM C
implementation
Consortium
Consortium
DMC
Communication
DMC OPERATIONS
Pre
conditions
Project Execution
P1: Tele-Coaching Service Dvpt
Agreement I
June
2010
Agreement II
1st Q
2011
Project
Delivery
Market Launch
1st Q 2011
9
Specialist
Nurse
Pharmacist
GP
Consultation
Mediscal
Follow -up
Move
DM analysis
Enrolement
DM
PT
Informed consent
DM
Care Plan
Agreements
GP - DM
Coordination
Planning
Feedback
Dietcian
Pharmacist
Po
HIF DATA
Stop
DM planning
Technical
equipment
Education/
coaching
Specialist
Monitoring
Lab
Pharmacist
Information
Call centre
Hospital
Social link
Welfare
Strategic context
Value chain model
Suppliers
Others
Consortium
Projects
Customers
Integrator
Coordinator
Solutions
D
M
C
HIF’s;
Companies
GP
associatons
Hospitals
Nurses
associations
Patients
GP’s
Specialists
Nurses
Pharmacist
associations
Pharmacies
Strategic context
Goals
1.
Build a Disease Management System and
integrate the existing applications/ initiatives
into the system (focus on the selected
pathologies)
2.
Facilitate political lobbying for the
implementation of this solution (financing/ legal
framework/ adoption by professionals and
patients)
3.
Create Disease Management Company to bring
Solutions to the market
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Réunion - Date
Direction Générale
2. Governance
Advisory Board
Consortium
DMC
Governance
2.1. Consortium Structure
Steering Groep
Advisory Board
(CEO’s/staff of member organizations)
(political opinion leaders)
Consortium Management
Staff
Office Manager
Financial Controller
(Project Managers)
Project Groups
Medical
IT
Business
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Réunion - Date
Governance
2.2.Advisory board
Advisory Board
Consortium
DMC
The role of the advisory board is to give strategic advice and to ensure
political endorsement. The advisory board has the important task to put
some political pressure on the insurance committee. This paritary
committee is responsible for taking decisions whether to reimburse
certain activities or not. In order to get structural reimbursements from
RIZIV for the services delivered by DMC, the advisory board has to play an
active role in the negotiations with this committee.
The following persons will be part of the advisory board:
 Bernadette Adnet (Staff member VBO)
 Yolande Avontroodt (Member of the federal parliament and president of the
management committe of RIZIV)
 Jo De Cock (General manager RIZIV)
 Pascal Mertens (General manager MLOZ)
 Dirk Ramaekers (Medical director ZNA)
 Michel Vermeylen (General practitioner and vice-president ABSYM)
 Jan Van Acker (President Pharma.be)
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Réunion - Date
Governance
2.2.Advisory board
2.2.1.Feedback meeting 21/1 (1)
Services :
IT and individual acces
Online data, decision support and suggestions for the
GP
Coaching as support for the GP
Telehealth tools – PHR
Homecare functionalities
Social services
16
Réunion - Date
Governance
2.2.Advisory board
2.2.1. Feedback meeting 21/1 (2)
Structure :




New structure needed
Mixed governance
National institute supervision
Quality system to be developped
17
Réunion - Date
Governance
2.2.Advisory board
2.2.1.Feedback meeting 21/1 (3)
Support by members of AB :
 Endorsement and communication/marketing
ABSYM/BVAS
 Political - legal support and framework
 Privacy commission
 Communication and promotion
18
Réunion - Date
Feedback advisory board (4.06.2010)
Quality is critical success factorvalidation – performance assessment
Legal support for IT necessary
Start mean and lean in sociodemographic advantaged areas
Education/coaching at short term
Not for profit structure necessary
19
Réunion - Date
Governance
2.3.Consortium Principles
Advisory Board
Consortium
DMC
The consortium is a temporary partnership between users and
suppliers of disease management solutions. Their task is to:
 Build a Disease Management System and integrate the existing applications/
initiatives into the system (focus on the selected pathologies)
 Facilitate political lobbying for the implementation of this solution (financing/ legal
framework/ adoption by professionals and patients)
 Create Disease Management Company to bring Solutions to the market
The Consortium has the decision power to initiate projects.
The Consortium consists of three major groups
 2 health insurance funds
 Care providers
 IT suppliers
Other parties that will play an important role are
 Associated partners that can provide support during the different projects. These
partners can share their know-how, tools or can contribute financially;
 Suppliers who provide specific tools (e.g. IT tools).
The procedure to enter and exit a partnerships has to be decided by the
consortium.
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Réunion - Date
Governance
2.3.Consortium
2.3.1.Daily management
Management
 General Manager : Jan Van Emelen – strategy, communication, medical
work packages
 Operational Program Manager : Irina Odnoletkova: global program
manager, busines projects, education and coaching
 IT program manager : Louis Schilders: IT architecture, standard,
integration, applications
 Staff (financial officer, office manager)
The daily management will execute the consortium program as
presented today. The Program starts the day the MOU is signed.
The daily managemen reports to the steering committee. It has to
be decided how frequently the steering committee meets.
The consortium functioning is financed by the partners.
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Réunion - Date
Governance
2.4. Disease Management CompanyDMC
Advisory Board
Consortium
DMC
DMC is an independent and executive cooperation that facilitates
the integration of health care.
The development of DMC will be supported by the consortium
members, public and government funds (article 56) and other
project-based financing.
In a later stage financing should happen through structural
reimbursement, patient contributions and contributions from
companies using the DMC services.
The DMC will have a classic corporation structure to run its
operations
A governance structure for DMC has to be determined. Which
parties should be represented in the Board of DMC and what the
different roles and responsabilities are, will need to be defined in
the DMC Company setup.
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Réunion - Date
Governance
2.4. DMC
2.4.1. Market Penetration Strategy
Market
potential
Commercial Services
and projects
RIZIV Structural Reimbursement
Compulsory Insurance
Adjustment Proposal
Time
Governance
2.4. DMC
2.4.2. Political strategy
How to achieve the State reimbursement?
DMC set-up and System Evaluation Design should be
ruled by
HIF’s :
• MLOZ and
• Neutral HIF
Health Care Providers Associations :
• ABSYM,
• APB
DM 2010/0226
Réunion
- Date
24
3. Program Management
25
Réunion - Date
Disease Management Development Program
From Consortium to DMC
DMC Services
DMC DEVELOPMENT
P0: DMC operating
system
requirements
& architecture
Requirement
Analysis
MOU
April 2010
Réunion - Date
Negotiations
DMC legal advise &
Foundation
DMC
Business
plan
DMC
Installation
DMC
Operations&
Marketing
plan
DM C
implementation
Consortium
Consortium
DMC
Communication
DMC OPERATIONS
Pre
conditions
Project Execution
P1: Tele-Coaching Service Dvpt
Agreement I
June
2010
Agreement II
1st Q
2011
Project
Delivery
Market Launch
1st Q 2011
26
Management Structure
Consortium Steering Board
Political Advisory
Board
Program Sponsor: Jan Van Emelen
DMC
Foundation
Program Manager
Irina Odnoletkova
Project Manager
DMC
Communication
(to be appointed)
WP1
WP2
Stratification Informed consent
Education&
Coaching
Development
Project Manager
P0
(to be appointed)
WP3
Medical reference
WP4
Careplan
WP5
Com/feedback
WP6
WP7
Evaluation Edu&Coach
27
Réunion - Date
DMC Foundation
DMC
Legal Advise &
Foundation
DMC preconditions
definition
(by future DMC owners:
Independent HIF’s;
Neutral HIF’s; Political
Physician Association;
National Pharmacist
Assotiation)
Legal and
Financial/Fiscal
Advise
DMC Value:
Offering
Tele-health Services
To the whole Belgian
Populatian
(patients and health care
providers)
Final Agreement by
future owners, and
Company
Foundation
Mei 2010
June 2010
July 2010
28
Réunion - Date
DMC Communication
Stakeholders
Identification
TO WHOM?
DMC
Communication
Communication
Strategy Development
Development of
consequent
Communication
Strategy and Plan
With all stakeholders
WHAT?
Communication
Plan Development
HOW?
Mei 2010
June 2010
July 2010
29
Réunion - Date
DMC operating system requirements & architecture
P0: DMC Enterprise Architecture
Business, System and Technical blueprints
Business architecture
•
Strategy
•
Medical-functional
analysis
•
Business analysis
By
Independent
System architecture
• Data
• Application
• Infrastructure
• Integration
Technical
architecture
• Standards
• Services
BA Blueprint
September 2010
Réunion - Date
Experts
AA+DA Blueprint
October 2010
By
Consortium
Partners
TA Blueprint
December 2010
30
Specialist
Nurse
Pharmacist
GP
Consultation
Mediscal
Follow -up
Move
DM analysis
Enrolement
DM
PT
Informed consent
DM
Care Plan
Agreements
GP - DM
Coordination
Planning
Feedback
Dietcian
Pharmacist
Po
HIF DATA
Stop
DM planning
Technical
equipment
Education/
coaching
Specialist
Monitoring
Lab
Pharmacist
Information
Call centre
Social link
Welfare
Hospital
31
Réunion - Date
Program
Po
DMC Enterprise Architecture Development
Blueprints describe the business
requirements and technology
components in a way that enables
their linkages to be traced from
business owner to system
developer.
Architecture
Guiding
Principles
Architecture Guiding Principles
serve as guideposts for strategic
and tactical technology decisionmaking.
Organization & Skills details
the structure, capabilities and
qualifications needed to build,
maintain, and implement the
architecture.
Architecture Blueprints
Architecture processes
Organization & Skills
Architecture Governance
Architecture Processes document
how architecture design is performed
and implemented in the organization.
Metrics
&
Measurement
Metrics & Measurements describe
the quantitative and qualitative
goals for the enterprise architecture
to ensure that value is measured
and communicated.
Architecture Repository
Architecture Repository is the control
point for all architectures assets –
blueprints, processes, metrics. The
repository is accessed and managed
through the architecture toolset.
Architecture Governance is a
comprehensive set of policies,
processes and procedures that
ensure proper, yet flexible,
guidance and approval checkpoints
for architecture.
32
Réunion - Date
Program
DMC Lifecycle
As-Built architecture
Approved Projects
Business
Strategic
Planning
Enterprise
Architecture
Blueprinting
Project
Release
Planning
Portfolio Mgmt
Project
Execution
Business
Operations
EA Governance
Objectives&measurements Indicators
Architecture benefits results
Metrics
Business benefits results
33
Réunion - Date
Programme
IT Architecture (1)
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Réunion - Date
Programme
IT Architecture (2)
WEB Based Architecture
Security & confidentiality –
 Authentication of patients & Healthcare Professionals (eHealth & EID)
 Authorisation (standard eHealth – application/disease specific DMC)
Patient Informed Consent
Upload of Medical Patient Summary (cross diseases)
Collection of disease specific parameters/values
Secured Sharing of information both medical and personal between
members of the Care Team
Education of enrolled patients – eLearning - ZorgTV
Coaching of enrolled patients – Personal Health record
35
Réunion - Date
Coaching&Education Service Development
Coaching&Education Service Development
The objective is to develop Services
Functional
Requirements &
Preconditions
Analysis
Make or buy?
Fit into the System
Design?
• B2B2C to members of MLOZ&NZ – via complementary
insurance products (25% of the Belgian market)
• B2C – to non-members.
The Service will be offered to other HIF’s on B2B2C basis.
Service Development
•Operational plan
•Marketing Plan
Service
Implementation
September 2010
Réunion - Date
December 2010
Market Launch
1st Q 2011
36
International trend in chronic care
90% of chronic care = selfcare

Symptoms monitoring + appropriate actions (adjust medications,
schedule a doctor visit);

Major lifestyle changes (e.g., stop smoking, reduce alcohol consumption,
modify diet, lose weight, and increase exercise);

Medication compliance;

Office visits for lab tests, physical exams, and clinician consultations.
=> Self-Management Support is necessary!
Telecoaching aims to change patient behavior
37
Réunion - Date
Self-management support
is “the systematic provision of education and supportive
interventions by health care staff to increase patients’ skills
and confidence in managing their health problems,
including regular assessment of progress and problems,
goal setting, and problem-solving support.”
38
Réunion - Date
Chain of self-management support effect
Patient Behaviour
Disease Control
Health Care Utilization
Health Outcomes
Patient Satisfaction
Less Costs
39
Réunion - Date
Own experience: pilote project CareTV
Problem with patient education paid by RIZIV
(diabetes 2):
 too late
 no standard
 efficiency loss on nurse traveling
 Information “push”
Preliminary conclusion CareTV:
 Distant coaching is feasible;
 Travel time becomes patient contact time;
 Individual coaching based on behavioral change theory is efficient
40
Réunion - Date
Design Options for a Self-Management Support
Program
Place within the health care system (who offers the service?)
Enrolment procedure
Role and background of the coaching staff
Content of the support
Patient population served
Communication tools (Website/ telefone/ combination)
Protocols for how staff is to provide the support.
Staff training
Communication between physicians and coaching staff
41
Réunion - Date
Target groups
• Patients
Belgium
Diabetes
500.000
Asthma
600.000
COPD
385.000
Cardiovascular 400.000
Cancer
300.000
Depression
900.000
TOTAL
3.085.000
Pregnancy
Smokers
etc.
MLOZ
95.000
114.000
73.150
76.000
57.000
171.000
586.150
• GP Circles: +/-260
• Hospitals: +/- 250
• Data collectors: Pharmaceutical industry, IMS, Cegedim,
academic centres, scientific organizations
42
Réunion - Date
DMC operating system requirements & architecture
P0: DMC Enterprise Architecture
Business, System and Technical blueprints
Business architecture
•
Strategy
•
Medical-functional
analysis
•
Business analysis
By
Independent
System architecture
• Data
• Application
• Infrastructure
• Integration
Technical
architecture
• Standards
• Services
BA Blueprint
September 2010
Réunion - Date
Experts
AA+DA Blueprint
October 2010
By
Consortium
Partners
TA Blueprint
December 2010
43
L’Union Nationale des Mutualités Libres regroupe :