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You are here: Home / Anderson On Health Insurance / Improvements and payment models

Improvements and payment models

by David Anderson|  November 22, 20136:59 am| 11 Comments

This post is in: Anderson On Health Insurance

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From one of my favorite new blogs, Not Running a Hospital on a staffing change in a hospital in Toronto that has shown significant clinical and cost improvements:

 While I had heard about the concept of a patient navigator before today, including at my own former hospital, the navigator service was usually designed to help people of different cultural backgrounds maneuver through the complicated labyrinth of the tertiary care system. At Mt. Sinai, they have taken the concept to its logical conclusion, providing patient navigators for all general internal medicine, surgical oncology, and inflammatory bowel disease patients….

When a patient arrives on the floor from the emergency department, Heather is already on the case, handling a multitude of tasks that previously would have taken time away from nurses or other clinical staff. Heather’s academic training? Fine arts!

This program is supported by philanthropy, as the payment regime from the province of Ontario does not include funding for this kind of service. It is so effective, though, in terms of patient satisfaction and clinical improvement, that the hospital is working on a way to provide sustainable funding.

Ontario Health Insurance Program (OHIP) is a single payer system which primarily uses a fee for service model. A provider does service X and receives so many loonies for that service.  Providers get paid for the services they rendered and not the services that they did not render.  It also means it is an extreme challenge to get paid for services provided by someone without initials after their name.  The incentives don’t line up for the hospital in a fee for service model to make sure their patients know what is going on, know what is expected and needed from them and know where to find follow-up information.

Models where there are fixed fees attached to either a diagnosis or a population change this incentive.  The incentive is to find some way for the patient to manage their own health through their own understanding of requirements and expectations.  A navigator allows the higher skilled and more expensive nurses and doctors to provide high value care instead of setting up follow-up appointments at the rehab center or scheduling a PCP visit in three weeks as well as transportation to the office.

 

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11Comments

  1. 1.

    Soonergrunt

    November 22, 2013 at 7:33 am

    Well, that would definitely be a cost saver for patients, insurers, and facilities.
    Doubtless we won’t see it here anytime soon, and Medicaid/Medicare will be forbidden to utilize it, I’m sure.

  2. 2.

    Richard Mayhew

    November 22, 2013 at 7:39 am

    @Soonergrunt: Actually these types of positions are fairly common in Accountable Care Organizations, integrated payer-provider models (Kaiser, Geissenger etc) and some of the better organized HMOs

  3. 3.

    dr. bloor

    November 22, 2013 at 7:48 am

    What, specifically, are the navigators doing that releases docs and nurses for more clinical care? It seems like they’d be freeing up more time for bachelor’s level social workers, discharge planners and ward clerks than for anyone else.

    We’re also never going to agree on the underlying motive for the “fixed fee” model. It’s a way for insurance companies to shift risk and fix their costs, nothing more, nothing less.

  4. 4.

    RSR

    November 22, 2013 at 8:29 am

    A hospital or some other healthcare facility is running a radio ad here in the Philly region that touts their patient navigators. We hadn’t really heard the phrase before, and I know my wife was skeptical about it. But if it allows the medical staff to spend more time with patients and less time filling out forms and clicking checkboxes, and it helps alleviate stress and confusion for patients then it sounds like a good thing.

  5. 5.

    Svensker

    November 22, 2013 at 9:06 am

    From the blog post, I’m not quite sure exactly what a navigator does. However, Mt. Sinai is an amazing hospital. Top notch staff, incredibly pleasant rooms, attentive aides and nurses, every amenity possible. If you have to go to a hospital in Toronto, you try to go to Mt. Sinai if you have a choice. If they think “navigating” improves the patient experience at Sinai then it must be really good.

  6. 6.

    Ferdzy

    November 22, 2013 at 9:32 am

    Ironically, as an Ontarian, the only time I’ve run into a patient navigator, was in Turkey. (The navigator was also a translator, not surprisingly.) From the patients point of view they were useful because they were able to tell us how long things would take, what would happen next, where we were going, and in the end even walked down to the pharmacy with us, since we had no idea where it was and directions wouldn’t help much given our lack of the language.

    Just having someone official sitting there with us making some small talk made the whole thing far less stressful and provided continuity as we moved from nurse to scan technician to doctor. It turned out they weren’t much use on the paperwork front, and the paperwork was pretty exasperating, especially since I am used to going for medical care and seeing no other paperwork than the charts.

    I recently read about another Ontario project, in the town of Deep River, that is apparently saving a lot of money on emergency calls from seniors. It’s pretty simple; paramedics visit them before they call, and on a regular basis.

    http://www.cbc.ca/news/seniors-911-calls-cut-in-half-by-weekly-paramedics-visits-1.2286800

  7. 7.

    piratedan

    November 22, 2013 at 9:45 am

    @Svensker: instead of a nurse doing administrative duties, they have a unit clerk type doing all of the appointment coordination, interdepartmental correspondence and coordination. So instead of handling those tasks, nurses can actually spend more time monitoring the patient and administering care. Means that the navigator follows through with patient, is a familiar face for the same types of issues and questions that deal with the paperwork and insurance and the administrative needs of the hospital.

  8. 8.

    pharniel

    November 22, 2013 at 9:58 am

    The RTC part of the article looks like Lean/TPS applied to health care.

  9. 9.

    HelloRochester

    November 22, 2013 at 10:26 am

    I missed the part of the article where they describe the death panels?

  10. 10.

    Crusty Dem

    November 22, 2013 at 10:30 am

    Ahh, my old boss (technically boss^4-ish). Did you catch his whine about paying more for his health insurance (I’ve actually linked to him in your posts before)?

    He does have some very solid opinions on hospital function. His rants against surgical robots, gamma knives, and proton beam therapies (while not as ranty as I’d like) are very enjoyable. Though it is worth noting that during his term at BIDMC, he purchased surgical robots and gamma knives, blaming it on the necessity of keeping up with the Mass Generals, etc…

  11. 11.

    BruceFromOhio

    November 22, 2013 at 1:58 pm

    A provider does service X and receives so many loonies for that service.

    Just a thought, might want to point out that this transaction yields Canadian dollars for the service provider, and not copies of Michele Bachmann.

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