Take a look: future is what comes next

Tanel RossChairman of the Board

Estonian Health Insurance Fund21.09.2017

Future healthcare is determined by globaltrends

• Technological progress Easily accessible services (mHealth, FP-specialist communication via e-channels)

More complex and precise services (high technology, targeted personal care)

• Increasing demand for healthcare due to wealthy and ageing society

• Expectations are rising Individuality – growing consideration of fenotype factors and individual needs of every

patient

Solidarity – growing expectations for provision of fundamental social Security

• Rapid development of high quality (e-)services in other areas of every-day life

What do we as people expect fromhealth(care)?

We expect a good health (we can consider it as a personal responsiblity, butultimately we believe is is the responsiblity of the system)

• Access to our own health data

• Knowledge and opportunities to actively engage in acitivities to support our good health

• Ensured access to healthcare immediately, when I feel „the need for it“

We expect services, which take into account our problems and specific conditions

• Medical care

• Overall care and attention

We don’t expect barriers between healthcare and social care stand as obstaclesreceiving good services

What changes must be made in the system tomeet these expectations?

• New opportunities to use data Patient’s medical history available to all authorised professionals

Patient’s own data input (activity monitors, health applications) ise used to maketreatment decisions

Free movement of data and people across EU

• Precise and personalised prevention programs and medical treatment(precision medicine)

• Effective population based screening programs

• Effective delivery models More care and services at home

More services in primary care

Significantly more services in day-care

Combined models of health and social care

UHC – the necessity of the XXIst century

• Universal Health Coverage can be achieved with Uniform principles of financing Uniform principles for availability and accessibility

• Transparency and accountability Focus on quality of care

• Reduce inequalities

• Risk sharing will ensure wellbeing of all people

The future challenges – a Plan for Estonia

It is an imperative to develop and implement a JointAction Plan by Medical Pofession, Providers, and theState

Primary care accessibility and services

• Primary Care Health Centers Easy access (appointment on the first day of acute illness, appointments after

work), fast health assessments, prevention and counceling Supporting infrastructure – 90 centers across Estonia Holistic service package – physiotherapy, midwifery, home nursing E-services (e-consultation, e-referral) plus remote e-services

• Supportive services Care coordination for patients with non-communicable diseases Primary Care Advisory Hotline (phone-based counseling)

• Primary care and social sector collaboration emphasis on sustainability and not project-based collaborations

Primary health care centers in Estonia – thefuture

• 57 areas• 89 centers• 46 smaller branches

in locations withpoor publictransportation ordistance > 27km

Networking in specialized care – cooperationbetween hospitals

• 19 strategic hospitals

• Divided into different levels based on responsibilities of geographical access(regional, central, county hospitals)

• Networking – cooperation process among hospitals to ensure evenavailability of services

• Regional level hospitals ensure the provision of services in county hospitalservice area

• Positive outcomes: Better accessibility Better quality Gains in efficiency

Networking between Estonian hospitals

Developing strategic purchasing models

Primary care

• Motivating primary care physicians to join primary care centers throughadequate funding

• Strenghtening QBS in collaboration with family doctors

• Differentiating capitation payment (rural, patients with chronic diseases etc)

• Implementing clinical decision support system

• Implementing integrated care models in primary and cpecialist care

Developing strategic purchasing models

Specialist care – more value-based purchasing

• Expanding case based payment models, developing episode-based paymentmodels,

• Expanding the DRG-based payment system (by integrating acute and post acutecare, bundling pre-admission diagnostic tests to DRG-s)

• Considering quality/outcome in purchasing models

• Integrated nursing care – collaboration between the social sector and healthcare system

• Integrated purchasing models for primary care and specialist care (also socialcare)

Developing new e-services

Appropriate infrastructure to support e-services

• The state - health information system, insurance claims, central eRegistration

• Providers – partner management portal, everything from invoicing to day-to-day communication with the health insurance fund

• Patients – self-service portal for everything related to health insurance, expanding the options in the patient portal (invoices, prescriptions, history)

E-services in development

• The state – clinical decision support systems (using persnalized data, oincl. Genotype), interaction database for pharmaceuticals, e-consultation

• Providers – remote services and teleservices

• Patients – mHealth solutions

How is this related to more personalizedprevention and treatment?

The first advisor and contact within the system is the FP

• Knows the people in their registry

• Monitors their health throughout different stages of life

• Coordinates the patient through the system

• Provides a wide package of services, including teleservices or remote services

• To motivate high quality work, quality indicators are monitored and quality based(financial) bonus systems are implemented

Secondary care focuses on specific high-technology services

• Bigger emphasis on personalized prevention and care, using more risk sharing

• Developing care integration, for example the patient’s journey from acute care tofollow-up care and rehabilitation

• Monitoring healthcare quality – the right treatments in the right places at the righttime

How to achieve universal health coveragewithout degrading current system?

• Long-term forecast suggests thatcurrent financing model (based on social security tax) of healthcare isnot sustainable

• Additional financing is needed tomeet the demand for healthcareservices

• First step towards healthcaresustainability is taken – additionalallocation from state budget from01.2018.

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Revenue long term forecast (mio eur)

Revenue Revenue with additional state budget allocation

Thank you!