Conferences archive > 2015 > SPEAKERS & ABSTRACTS

Walter Bergamaschi

New payment models to enable integrated personalised care of chronic patients

Ageing of the population, the growing burden of chronic diseases, and the complexity of associated co-morbidities are major challenges to both quality of care and sustainability of healthcare systems worldwide. The health delivery system needs a unified approach to integrate healthcare delivery to patients with chronic and complex conditions. 
To meet these challenges, within the context of healthcare reform initiatives, important innovations in delivery system organization in Lombardy are discussed, based on a comprehensive population health management perspective to provide high-quality and sustainable services to these patients, at different levels of care. 
These innovations focused on a re-organization process of healthcare services for people affected by chronic conditions, coupled with new payment strategies. Lombardy is beginning to move away from the fee-for-service payment model, adequate for acute diseases, towards a capitation global payment reimbursement scheme based on a set amount per enrolled patient, to cover his entire clinical pathway on a yearly base. 
A novel approach, named CReG (Chronic Related Groups) was developed, based on integrated personalized care, and on a capitation prospective payment system. The pilot CReG-project, currently ongoing, concerns care integration for less complex patients at primary care level, and a similar project is being developed for chronically-ill patients that require multiple complex interventions and specialized care in community hospital settings. 
The CReG approach is using a health-based clinical risk adjustment model to identify, classify and stratify the population of patients with chronic disease and set-up a risk-adjusted capitated Prospective Payment System for primary care. Each risk category (CreG Class) is assigned a specific CreG-Rate, estimated on the basis of historical expenditures of patients, to account for a set of predetermined outpatient services (GP visits, drugs, ambulatory specialist care). Preliminary results on 60.000 enrolled patients indicate the effectiveness of the CreG system on reducing hospitalization rates and risk of admissions to emergency departments.
For this innovation the evidence on its performance, the challenges involved, structural barriers and the key factors that might enable diffusion of the model will be reviewed.


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