The Israeli Public Health Care System Health Funds provide a uniform legally defined basket of services Every citizen is a member of one of four natio...
The Israeli Public Health Care System Health Funds provide a uniform legally defined basket of services Every citizen is a member of one of four nationwide health funds (free to choice ) Health funds are financed by government via age-related capitation payments (90% of total), patient charges and other income (10%) Coverage for health care services is provided by 4 competing nationwide health funds (HMOs) Public and private providers of services including physicians, hospitals,
pharmacies and other health care professionals
Maccabi Healthcare Services Second largest and fastest growing HMO in Israel ( 25% of Market)
Non-profit mutual Recognized health fund - Israeli National Health Insurance Law Provides public basket of services Offers voluntary supplementary insurance Supplies services via own facilities and outside providers Our Office
Maccabi Statistics 2 M members
Owns 56 Pharmacies Contracts 700 Pharmacies
10,000 Employees
5 Districts , 140 Branches
1.8 billion € Budget :
5000 physicians (85% self employed)
13 Hospitals- Assuta
The Cornerstone- Clinical Information System Every transaction with the patient is computerized Shared EMR and Central Medical Record E-Laboratory
Hospital Medical Visits
Diagnoses
E- Prescription E- Consultation Alerts and Reminders
Pathology Tests
Central Medical Record
Treatment
Physician Portal ( web & mobile) Patient Website ( also mobile) Telemedicine
Imaging Tests
Medicines & Drugs Lab Results
Designed for the healthcare professionals ( GP, Specialist, nurse, physiotherapist)
and the patient Enables remote disease management and integrated care Monitors, identify and alerts on abnormal conditions and guides the caregiver Integrated with the EHR Includes decision support tool Provides Standardization tool for treatment with embedded clinical protocols Assistive tool for the Healthcare provider Provide guidelines and decision support tool for the HC professional in his daily work Serve as the basis for interaction between the Healthcare professional and the patient Enable tracking treatment problems\actions
MOMA Multi-Disciplinary Call Center
The Rationale Rising national healthcare costs
Recurrent/unnecessary referrals to ER
Lack of treatment uniformity
Low compliance rate
Limited accessibility and availability
Growing shortage of professional practitioners
Advanced technology call center-why? New approach to management of large population with complex chronic conditions and co-morbidity
Better accessibility to medical advice for broad range of population
Patient involvement in decision making for improved health outcomes
Effectively coordinated medical treatment and health services: • Cost effective • Productivity effective
The Target Population 6000
complex chronic clients Home care of stable chronic clients CHF & COPD Levels 2 unstable, 3-4
To provide support network to assist primary physicians
To monitor and provide care for diverse client groups with chronic conditions
To coordinate and integrate care with community-based services
To preserve/enhance clients’ physical and mental quality of life, performance scores, compliance rates, and satisfaction
To reduce the demand for healthcare services
To empower clients and caregivers that support the care process
Program Structure Community-based units: Primary medicine, specialized medicine, outpatient units, emergency center, athome care center, medical services, community-based care wards
10,000
Complex clients At-home care
COPD/ CHF
Diabetes
Stoma
Maccabi Nonstop
Hard-to-heal Wounds
Cardiac Rehabilitation
The uniqueness
1 2 3 4 5
Regular, personalized monitoring by nurse specialist
Full collaboration with PCP and Transparent medical record
Online identification of exacerbations of the client’s disease
Multi-disciplinary team real time advice
Involvement of relevant community-based resources in real time
Primary physician Secondary physician Multidisciplinary team
