Healthcare Management by Volker Eric Amelung

Author:Volker Eric Amelung
Language: eng
Format: epub
ISBN: 9783662595688
Publisher: Springer Berlin Heidelberg

Assessment

The evaluation focuses on the Geisinger Health System in the United States, which admittedly is an example of a particularly well-functioning model. As a vertically and horizontally integrated healthcare and insurance system, the Geisinger Health System includes the provision of a wide spectrum of services as well as their financing. Geisinger has compensated coronary artery bypass operations with bundled payments since 2006 through its ProvenCare program. Beyond the operation and related hospital stay, the compensation includes all preoperative measures as well as postoperative follow-up treatment for up to 90 days. The amount of the basic compensation is calculated according to evidence-based guidelines. A surcharge is added to this which, based on empirical values, is calculated from half of the average compensation for complications. Therefore, the payment still assumes that it is possible to cut the complication rate in half. For quality purposes, the medical staff agreed upon 40 evidence-based procedures that must be performed on each patient (Rosenthal 2008; Mechanic and Altman 2009). After the first year of introduction, the evaluations actually reported an increase in quality as well as a reduction of the treatment costs through ProvenCare. After completion of the first year, 100% of the patients had received the full set of 40 recommended quality service components. Their length of stay sank by 16% and there was a simultaneous 10% decline in readmissions rates. This led to 5.2% lower hospital charges (Casale et al. 2007). A 44% decline in readmission rates within 18 months has also been reported. Due to these very positive results, Geisinger expanded its recipe for success to treat additional diseases (Mechanic and Altman 2009). However, it should still be emphasised that according to expert opinion the success of ProvenCare is due to the unique structure of Geisinger to a large extent. This includes the high degree of integration, which also incorporates the financing of services, as well as their equipment with a highly efficient, computerised information and documentation system (Lee 2007). In addition to the coronary artery bypass operations, Geisinger has added other diagnoses-based procedures to ProvenCare as well as treatment for chronic conditions (OECD 2016).

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