Kişiye Özel Sağlık Hizmetlerinde Koordinasyon Programının Maliyet Kontrolü Bağlamında Değerlendirilmesi: Amerika Birleşik Devletleri’ndeki Cambridge Health Alliance Örneği

Öz

Amerika’da artan sağlık giderleri, sağlık sektöründeki paydaşlar için büyük bir sorun oluşturmaktadır. Bu yüzden her paydaş, maliyetleri kısma adına yeni stratejiler geliştirmektedirler. Kişiye özel sağlık hizmetlerinin koordinasyonu, bu sorunu çözme adına sağlık hizmeti sunucuları tarafından geliştirilen yöntemlerden bir tanesidir. Cambridge Health Alliance – büyük Boston sınırları içinde hizmet veren kamu güvenlik ağı sağlık sistemi sunucusu – Kasım 2011’den bu yana örnek bir grup için koordinasyon programının pilot uygulamasını yapmaktadır.  Bu makale, bu programın sağlık maliyetleri üzerine etkisini ölçmekte, örmek grup içindeki farklı alt grupların hangisinin maliyetleri daha çok aşağıya çektiğini anlamak için maliyet yapısını analiz etmekte ve en büyük tasarrufu sağlamak için önerilerde bulunmaktadır. Analizler, programın maliyet dağılımını değiştirmede başarılı olduğu ve programın en maliyetli hastaları kapsaması durumunda maliyet artış hızında azalma sağladığı sonuçlarına ulaşmaktadır. Ama, analizlerin daha büyük bir örneklemi ve daha uzun süreli kontrol dönemini içerecek şekilde geliştirilmeye ihtiyacı vardır. Son olarak, programın; koruyucu sağlık, uzun dönemde maliyetleri sürdürülebilir hale getirecek yeni ödeme sistemleri, aile hekimi sistemi gibi başka politikalarla desteklenmesi önem arz etmektedir.  

 

Anahtar Kelimeler

• Sağlık hizmetlerinin koordinasyonu,artan sağlık giderleri,maliyet kontrolü,proje değerlendirmesi

Evaluation of Care Coordination Program on Cost Containment: Cambridge Health Alliance Case in the United States

Öz

Rising healthcare costs in nearly all nations, particularly in the United States, has been posing major challenges to stakeholders in healthcare industry.  Each actor has been developing new strategies to mitigate costs. Care coordination is one of the methods many healthcare providers have been applying to remedy this problem. Cambridge Health Alliance - a public, safety net health care system serving the Greater Boston area- has been piloting a care coordination program for one of its population cohorts since November 2011. This paper evaluates the possible impact of the program on healthcare costs, analyzes cost structure for different sub-populations to understand which groups contribute most to cost reductions, and offer suggestions to achieve the highest saving. The analyses conclude there is room for curbing the cost growth when the program targets the highest cost patient and the program succeeds in changing the cost concentration of healthcare spending. Nevertheless, the analyses need to be developed further, using bigger population and a longer intervention period. Finally, it is important to support the program with other policies such as a gate keeping system, preventive care, and new alternative payment systems to sustain an impact on costs in the long-run.

Anahtar Kelimeler

• Care coordination,rising healthcare costs,cost containment,project evaluation

Kaynakça

1. Centers for Medicare & Medicaid Services, National Health Expenditures (2013), Highlights. Office of the Actuary, National Health Statistics Group, U.S. Department of Commerce, Bureau of Economic Analysis; and U.S. Bureau of the Census. Accessed on December 10, 2014, http://www.cms.gov/mwginternal/de5fs23hu73ds/progress?id=2AXCIAu3e6
2. Conway T. and P. Terrell (2010), “Accountable Care in the Safety Net”, Accessed on December 11, 2014, http://blueshieldcafoundation.net/mwginternal/de5fs23hu73ds/progress?id=/tJyNmVGqB
3. Hacker K., R. Mechanic and P. Santos (2014(1)), “Accountable Care in the Safety Net: A Case Study the Cambridge Health Alliance”, Commonwealth Fund pub. 1756. Vol 13. Accessed on December 11, 2014, http://www.commonwealthfund.org/mwginternal/de5fs23hu73ds/progress?id=dl7nfZL2VR
4. Hacker K., P. Santos, T. Thompson et al. (2014(2)), “Early Experience of Safety-Net Provider Reorganizing in to an Accountable Care Organization”, Journal of Health Politics, Policy and Law, Vol 39. No:4, 901-917.
5. Raymond A.G. (2011), “Lessons Learned from the Implementation of Massachusetts Health Reform”, Boston: Blue Cross Blue Shield Foundation of Massachusetts.
6. Leighton K., E. Jones, P. Shin et al. (2011), “Safety-Net Providers After Health Care Reform: Lessons from Massachusetts”, Achieves of Internal Medicine, August 2011, 171 (15):1379-84.
7. Gosline A. and E. Rodman (2012), Summary of Chapter 224 of the acts of 2012, Boston, Blue Cross Blue Shield Foundation of Massachusetts.
8. Berwick D.M., T.W. Nolan and J. Whittington (2008), “The Triple Aim: Care, Health, And Cost”, Health Affairs, May 2008 27(3):759-69.

9. Bodenheimer T. (2008), “Coordinating Care-A Perilous Journey Through The Health Care System”, N Engl J Med 2008 Mar 6, 358(10):1064-71.
10. Agency for Healthcare Research and Quality (2010), Car Coordination Measures Atlas, 11-023-EF, Accessed On March 15, 2014, http://www.ahrq.gov/legacy/qual/careatlas/careatlas2.htm
11. Coleman E.A., J.D. Smith, J.C. Frank, et al. (2004), Preparing Patients and Caregivers to Participate in Care Delivered Across Settings: The Care Transitions Intervention. J Am Geriatr Soc. 2004; 52(11):1817-25.
12. Sweeney L., A. Halpert, and J. Waranoff (2007), Patient-Centered Management of Complex Atients Can Reduce Costs Without Shortening Life, Am J Manag Care, 2007, 13:84-92.
13. Boult C et al. (2011), The Effect of Guided Care Teams on the Use of Health Services: Results From a Cluster-Randomized Controlled Trial, Arch Intern Med, 171(5):460-6.
14. Peikes D, A. Chen, J. Schore, et al. (2009), Effects of Care Coordination on Hospitalization, Quality of Care, and Healthcare Expenditures Among Medicare Beneficiaries, JAMA; 301(6):603-18.
15. Peikes D. et al. (2007), “The Evaluation of the Medicare Coordinated Care Demonstration: Findings for the First Two Years. Mathematica Policy Reseach, Inc. 8756-420
16. Coleman E.A, C. Parry, S. Chalmers, S.J. Min (2006), The Care Transitions Intervention, Archives of Internal Medicine, 166:1822-1828.
17. Engelhardt J.B, K.P McClive-Reed, R.W Toseland, et al. (2006), “Effects of a Program for Coordinated Care of Advanced Illness on Patients, Surrogates and Healthcare Costs: A Randomized Trial”, The American Journal of Managed Care, 12:93-100.
18. Social Work Leadership Institute (2008), “Toward the Development of Care Coordination Standards: An Analysis of Care Coordination in Programs for Older Adults and People with Disabilities”, New York Academy of Medicine.
19. Nelson Lyle (2012), Lessons from Medicare’s demonstration projects on disease management and care coordination, Congressional Budget Office, Working paper series, 2012-01.
20. Musich S. and S. Paralkar (2007), “A Comprehensive Literature Review of Studies on Care Coordination and Other Health Management Programs”, White paper. Reden&Anders. Accessed on May 2, 2014, http://www.unh.edu/healthyunh/sites/unh.edu.healthyunh/files/pdf/A%20Comprehensive%20Literature%20Review%20of%20%20Studies%20on%20Care%20Coordination.pdf
21. Dartmouth Atlas of Health Care (2008), “Tracking the Care of Patients with Severe Chronic Illness”, Accessed on March 18, 2014, http://www.dartmouthatlas.org/downloads/atlases/2008_Atlas_Exec_Summ.pdf
22. Milstein A. and Elizabeth Gilbertson (2009), American Medical Home Runs, Health Affairs, 28, no. 5.
23. Ferris T. G. et al. (2001), Switching to Gatekeeping: Changes in Expenditures and Utilization for Children, Pediatrics: 108(2):283-90.
24. Cohen J. et al. (2008), “Does Preventive Care Save Money? Health Economics And The Presidential Candidates”, New England Journal of Medicine, 358:661-3
25. Bradford L. and L. Kirkman (1990), “Physician Payment and Cost-Containment Strategies in West Germany: Suggestions for Medicare Reform”, Journal of Health Politics, Policy and Law, Volume 15, Number 1:69-99.