Integrated care calls for integrated payment
PhD dissertation by Apostolos Tsiachristas
Disease management programs (DMPs) and innovative payment schemes are potentially powerful instruments to stimulate the delivery of integrated care and influence health care expenditure. This is what Apostolos Tsiachristas concludes in his PhD research about the impact of these instruments. Tsiachristas defends his PhD dissertation on Friday 20 March 2015 at the Erasmus University Rotterdam.
Chronic diseases are a major threat to population health and sustainability of health care systems as well as a challenge to economies worldwide. Integrated care, delivered in the form of DMPs, is a promising concept to tackle this threat. DMPs are frequently supported by innovative payment schemes, which provide health care providers with financial incentives to implement integrated care.
Tsiachristas investigated in his PhD dissertation titled ‘Payment and Economic Evaluation of Integrated Care’ the impact of innovative payment schemes, the variability in costs of DMPs, and the cost-effectiveness of DMPs for cardiovascular risk management (CVRM), COPD, and diabetes.
Reduction in the growth of health care expenditures
Pay-for-performance, pay-for-coordination, and all-inclusive payments provide intended and unintended incentives. A combination of these payment schemes may overcome the unintended financial incentives of each individual scheme. Compared to countries that they did not implement innovative payment schemes, the annual growth of hospital and administrative expenditure was reduced in countries that have implemented pay-for-performance while, the annual growth of outpatient expenditure was reduced by the introduction of all-inclusive payment schemes.
Variability in costs
There is great variability in the health care utilization costs of patients participating in DMPs. These costs are higher in patients that are older, have multi-morbidity (especially when cardiovascular disease is included), and have low quality of life. Patients in COPD DMPs have higher health care utilization costs than patients included in CVRM and diabetes DMPs. There is also wide variation in the development and implementation costs of DMPs. This is driven primarily by the duration of the development phase and the staff needed to develop and implement a DMP. The development and implementation costs of DMPs may be reduced by exploiting existing economies of scale and economies of scope.
More comprehensive more effective
DMPs improve lifestyle indicators such as physical activity and reduced smoking in the short term. However, effects in terms of Quality Adjusted Life Years (QALYs) are insignificant. DMPs that are more comprehensive have the potential to be effective or cost-effective compared to less comprehensive DMPs.