The Analytical Support for Revision Benchmarking methods of

The Analytical Support for Revision Benchmarking methods of providers production used to in VZP ČR VZP Open House Prague, 4 th-5 th June 2015 Robert Gos, email: robert. gos@vzp. cz

CONTENT 1) ECONOMICAL AND CLINICAL INDICATORS IN HOSPITALIZATION 2) ECONOMICAL AND CLINICAL INDICATORS IN AMBULATORY SECTOR 3) PROJECT TO EVALUATE QUALITY AND EFFICIENCY OF DENTAL CARE 4) CONCLUSION 2

THE SUBJECT OF MEASURING � key to the every s uccess measuring and comparison of The production by the providers is the right definition of a unit of the production � output of this defin ition is items, which groups either The clinical and economical features of production to the „dataset of items“ to every patient, on which are services banished � Every measuring is ce ntered to patients on the basis of his banished main diagnoses � For ambulatory and la boratory patients we make clusters by statistical functions, for hospitalization patients we use DRG grouper 3

THE SUBJECT OF MEASURING � his is what we call Economical and clinical indicators (ECI) of T providers � Now „ECI“ are focused on : � Hospitalizations � Outpatients care � Laboratories � Radiology and imagin g methods 4

SOFTWARE PRODUCTS IN VZP ČR FOR ANALYTICAL, STATISTICAL PURPOSES AND REPORTING WE USE IN VZP ČR THE COMPREHENSIVE BUSINESS INTELLIGENCE AND ANALYTICS PLATFORM : Oracle Business Intelligence Enterprise Edition 11 g (OBIEE) � Makes corporate data easier for business users to access � Provides a common in frastructure for producing and delivering enterprise reports, scorecards, dashboards, ad-hoc analysis, and OLAP analysis � Includes rich visualiza tion, interactive dashboards, a vast range of animated charting options, OLAP-style interactions and innovative search, and actionable collaboration capabilities to increase user adoption 5

OBJECTIVE OF ECI IN HOSPITALIZATIONS „ECI“ in hospitalizations is an instrument for measuring performance of hospitals and reporting effectivity of providing services for board and management of Health insurance company“. o. Chance for longtim e measuring (same DRG grouper) and for comparison of providers on the basis of some statistical methods o. Possible drilling to 6 a „patient level“ to identify improper services

THE LIST OF HOSPITALIZATION INDICATORS We divide indicators at the: � Cost (economic) item s � Time on operating ro om (theatre) - medical services of anesthesia � Number of days on i ntensive care beds and standard care beds vided � Medical services pro during hospitalisation (without anesthesia, laboratories and radiology and imaging methods) � Medical services in l � Medical services of r � Separately charged hospitalisation � Extramural care 7 aboratories provided during hospitalisation adiology and imaging methods provided during stay drugs and medical material provided during

THE LIST OF HOSPITALIZATION INDICATORS And … � Medical items � Average of patie nts � Total casemix (a sum mary of relative weights of cases for a defined unit and period), casemix index (per patient) � of short-time and % long-time outliers, % of short-material and long-material outliers � of hospitalisations % without complications, with complications and with major complications � of transfers to oth % er hospitals � of deaths % � of hospitalisations % with an extramural care 8

METHODS OF COMPARISON IN HOSPITALIZATION ECI Comparison is done between/among hospitals (and their DRG basis) on: • Basic statistical indicators - hospital averages, same-type hospital averages and republic averages • Other statistical indicators – minimum, maximum, median and standard deviation • Then, we can very clearly identify improper services in overuse or underuse of services 9

OBJECTIVE OF ECI IN OUTPATIENT CARE Like „ECI“ in hospitalizations, ECI in outpatient care is an instrument for measuring performance of ambulatory providers and reporting effectivity of providing services for board and management of Health insurance company“. 10

APPROACH TO THE MEASURING OF ECI IN AMBULATORY SECTOR (OUTPATIENT CARE, LABORATORY, …) • Compilation of episodes + assigning primary diagnosis • Cluster analysis for each separately specialities (2 - 4 clusters) » clusters clinically similar providers and excludes significantly different provider » compilation of episodes use International shortlist for hospital morbidity tabulation (ISHMT) instead of International Classification of Diseases (ICD-10) 11

METHODS OF COMPARISON ECI IN AMBULATORY SECTOR • Comparing providers among themselves within a cluster • Calculation of Economic and clinical indicators • Cost benchmarking • Determine relations between/among medical providers • Scoring system 12

INDICATORS FOR OUTPATIENT SPECIALIST • • • Number of patient visit Average costs of own care per patient Average of patients The average time of medical services per patient Separately charged materials value and separately charged medical devices value per patient Expenditure on prescription drugs per patient • • Expenditure on medical devices per patient Number of comprehensive physical examination per patient Number of control physical examination per patient Value of requested care in laboratories per patient Value of requested care in X-ray providers per patient Number of “Minimal contact” between doctor and patient per patient Number of “Telephone consultation” between doctor and patient per patient 13

INDICATORS FOR LABORATORIES, RADIOLOGY, …. Number of patient visit Average of patients • • Average time of medical services per patient Separately charged materials value and separately charged medical devices value per patient Average costs of own care per patient Average distance from inducing doctor to complementary healthcare facilities • • • Average time gap from the doctor´s visit and visit to laboratories rays Average number of medical services per patient Calculation of deviations from the mean (economic, medical and deviation) 14 and X- narrow

SCORING SYSTEM OF LABORATORIES AND X-RAYS 15

A PROJECT TO EVALUATE QUALITY AND EFFICIENCY OF DENTAL CARE

A PROJECT TO EVALUATE QUALITY AND EFFICIENCY OF DENTAL CARE • The aim of the project was to find how effective the dental facilities are. • Certain indicators were chosen, each indicator got a weight. A highest sum of weights was 100. • Dental facilities with a high score got a bonus, facilities with a low score were subjects to review activities (because of a low quality and efficiency) • 17 The project was going in years 2012 - 2014

INDICATORS IN THE PROJECT -> 6 indicators were chosen. For scoring each indicator got a weight (points) according to a precise calculation. The indicators were: Indicator In I 1 dicator description Weight (points) 20 I 5 Percentage of patients with 1 preventive check-up in amount of all treated patients Percentage of patients with 2 preventive check-ups in amount of all treated patients Percentage of tooth decay treatments - fillings - in amount of all treated patients Index of tooth decay retreatment (fillings) in the same tooth location Fillings and subsequent extractions of milk teeth I 6 Fillings and subsequent extractions of permanent teeth 6 I 2 I 3 I 4 18 10 8 50 6

RESULTS OF THE PROJECT • As the project started, the indicators were monitored in 6 consequent years 2007 – 2012 (alike next years) • Percentage of dental facilities with a score lower than 40 fell from 2. 4% in 2012 to 0. 8% in 2014. This was the consequence of the review activities. • Percentage of dental facilities with a score higher than 80 rose from 12. 2% in 2012 to 19. 4% in 2014. 19

RESULTS OF THE PROJECT Overal evaluation - scoring by facilities in years 2012 - 2014 2012 2013 Interval of Number of scoring Share in % facilities Cumulative Number of % facilities Share in % 2014 Cumulative Number of % facilities Share in % Cumulative % (90; 100>56 0, 9 102 1, 7 120 2, 0 (80; 90>683 11, 3 12, 2 945 15, 7 17, 4 1 044 17, 4 19, 4 (70; 80>1 952 32, 2 44, 3 2 207 36, 6 54 2 275 37, 9 57, 4 (60; 70>1 483 24, 4 68, 8 1 517 25, 2 79, 2 1 489 24, 8 82, 2 (50; 60>1 202 19, 8 88, 6 844 14, 0 93, 2 732 12, 2 94, 4 (40; 50>548 9, 0 97, 6 329 5, 5 98, 7 287 4, 8 99, 2 (30; 40>123 2, 0 99, 6 69 1, 1 99, 9 41 0, 7 99, 9 100 9 0, 1 100 8 0, 1 100 6 022 100 5 996 100 (0; 30>22 0, 6 069 20 4 100

PROGRESS OF 2 MAJOR DENTAL SERVICES • Progress of 2 major dental services in years 2012 - 2014: tooth decay treatments • • preventive check-up 3 800 000 Number of services 3 600 000 3 400 000 3 200 000 3 000 2 800 000 2 600 000 2 400 000 2 200 000 2012 2013 tooth decay treatments 21 2014 preventive check-up

THE MAIN CONCLUSIONS � measures must be aimed at the patient and his clinical All situation (comorbidities) � These patients must be clustered to the more general groups � Only in these cluster s you can measure diversities between providers and make benchmarking on the basis of best practicies � The pace of adjustme nt differ among providers, the key role has the revisional system � have now develop ed the ECI for aprox. 2/3 of our We expenditures � With the SW OBI EE 1 1 g we can implement elements of artificial intelligence 22

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