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CAYHEALTH Initiative

Health Services in the Cayman Islands. Government- H S A The Private Sector. Physician/1000 pop=4Nurses/1000 pop = 7. Support Services available on Island. CTs, MRI, digital mammograms3D-ultrasound, echocardiographyGI endoscopy, cystoscopyChemotherapyHospice and in-home nursingPharmacies

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CAYHEALTH Initiative

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    1. CAYHEALTH Initiative Cayman Islands Government Health Services Authority

    3. Support Services available on Island CTs, MRI, digital mammograms 3D-ultrasound, echocardiography GI endoscopy, cystoscopy Chemotherapy Hospice and in-home nursing Pharmacies -well-stocked

    4. The Government Health Services Authority (H.S.A.) Reports to the Government through the Ministry of Health Is an Authority vs a Department Self Regulated – own HR Department Responsible for own financing Staff: 750 Nurses 250 Physicians 58 GP: Specialists 1: 4 Dentists 8

    5. The H S A –cont. 125-bed Cayman Islands Hospital on Grand Cayman 18-bed Faith Hospital on Cayman Brac Primary Healthcare & Public Health Services Distric Health Clinics - 5 in Grand Cayman 1 DHC in Little Cayman Dental and Ophthalmology Services are provided on site at the Health Service Complex in Little Cayman

    7. Specialist Services Pediatrics, internal medicine dermatology gynecology & obstetrics public health, psychology, psychiatry neurology, nephrology cardiology radiology, pathology anesthesiology surgery, orthopedics, reconstructive surgery ophthalmology, otolaryngology, period ontology maxillofacial surgery, and urology

    8. Access to Health Care - current

    9. Access to Care (presently costly and not patient centered) Client may access care through multiple Primary care Physicians Through a specialist Through the Specialist and Primary Care Physician Through the Hospital via the A&E Department Hence a New Initiative in Health Care CAYHEALTH

    10. What is CayHealth? CayHealth is a new initiative between the Ministry of Health and Ministry of Community Affairs and Housing (through Dept of Child and Family Services) to provide personalized, quality Healthcare services.

    11. What is CAYHealth? Prgramme to provide patients with access to a preferred general practitioner who will be their primary physician. This primary physician teams with the patient to improve their access to healthcare, coordinate any specialist referrals (local and overseas), and direct health screening intervention and education programs

    12. What is CAYHealth? Patients will have the benefit of accessing care at the health centre in the district in which they reside Schedule all appointments with their personal general practitioner and the health care team at that Health Centre.

    13. What Does CayHealth Offer? Access to preferred primary care physician Access to care in the districts of residence Access to medication at the District Health Centre Access to Health education & healthy lifestyle programs

    14. Improved Access to Preferred Primary Care Physician Continuity of care for chronic conditions Coordinated referrals to specialists Evidence based chronic disease management Use of Quality care metrics

    15. Access to care in the districts District Doctors’ Clinics Monday to Friday 8:30 a.m. – 4:30 p.m. Saturdays at some clinic locations

    16. Access to Medication at the District Health Centre Pharmacy opened during doctors’ clinic days Urgent medication through nurses Enhancement of pharmacy services as needed

    17. Improved Access to Pharmacy Services

    18. Improved Access to Health Education & Healthy Lifestyle Programs Lifestyle health and fitness programs undertaken by the Public Health Department Diabetic education classes Other health education and health promotion activities undertaken by the Public Health Department or coordinated with other agencies

    19. The Referral Process The personal physician will determine the necessity for specialist referral Patients will receive their appointment times before they leave the clinic Such referral orders will be specially designated as Cayhealth.-Priority Access The Specialist will relegate care of those stable patients back to the GP’s

    20. Outpatient referrals cont’d Currently appointments require visits or telephone calls to Georgetown Hospital Appointments Office--Problematic Cay Health patients have appointments made at the clinic before leaving for home There are four referral priorities STAT- To Emergency Dept. Within seven days-Urgent Within four weeks, or Within three months

    21. CAYHealth Model

    22. Initial Target Population Initiate the strategy with persons managed by the DCFS

    23. Why this group? It is already a well-defined patient group ~1100 We have data and metrics to facilitate their management High-risk healthcare conditions are common in this population group – diabetes, hypertension, dialysis etc.

    24. CayHealth Population statistics Total number of population = 1021 Total number registered with H.S.A. = 800 The total number of encounters in the last year = 7158 (9 per person) Cost $9,755,808 The total number of encounters to specialist clinics = 535 (1 per person) ($101,244)

    25. Population statistics Number with diabetes (diagnosed, or with HbA1C >7) = 339 (42%) Of those with diabetes, the average glycosylated hemoglobin recorded = 7.56 Number with hypertension diagnosed = 543 (68%)

    26. Desired Outcomes of CAYHealth Improve Access to all services Improve appointment availability in the specialist clinics to decrease wait time for patients who need specialty care Deliver more affordable health care by standardizing internationally accepted Best Practices and Evidence Based Medicine Decrease Chronic Disease Burden

    27. Evidence-based Management With a specified list of patients, the physician is better able to monitor condition management Point-of-care software support is also being made available to give physicians information on best-practice options while the patient is being seen

    28. CayHealth and healthcare delivery This is a programme to improve clinical outcomes by improving access to care, health and well-being. focus on quality and outcomes through evidence based medicine

    29. Advantages of CAYHEALTH Will facilitate more personalized care. Help to improve chronic medical conditions and consistency of care. Patients preferred general practitioner will provide quality medical care, and maintain their medical records. Promote evidence based chronic disease management. Use of Quality care metrics

    30. Who Benefits from CAYHealth? Initially the program is being offered to DCFS clients who receive healthcare benefits through the Health Services Authority Future plans would extend this plan to the rest of the Government Insured and ultimately to the entire population

    31. Chronic Diseases Reducing the Chronic Diseases burden on the CIHSA will be a major benefit of this program

    32. Chronic Diseases Leading causes of death and disability worldwide Disease rates are accelerating globally Currently account for almost 60% of all deaths and 43% of the global burden of disease By 2020 their contribution is expected to rise to 73% of all deaths and 60% of the global burden of disease

    33. Chronic Diseases Top four: cardiovascular diseases (CVD), cancer, chronic obstructive pulmonary disease and type 2 diabetes Action to prevent these major chronic diseases should focus on controlling these and other key risk factors in a well-integrated manner.

    34. Chronic Diseases Example: Diabetes in Cayman Total Outpatient Diabetes visits between January 2009 and Sept 2010: 6986 Total Inpatient Diabetes admissions between January 2009 and Sept 2010: 105 3224 (45%) of these persons are >65 years old.

    35. Access to Health education & healthy lifestyle programs Lifestyle health and fitness programs undertaken by the Public Health Department Diabetic education classes Other health education and health promotion activities undertaken by the Public Health Department or coordinated with other agencies

    36. Funding CAYHEALTH Capitation? Fee for Service?

    37. Capitation Healthcare service providers (physicians) are paid a set amount for each enrolled person assigned to that physician or group of physicians, whether or not that person seeks care, per period of time The amount of remuneration is based on the average expected health care utilization of that patient (more for patients with significant medical history). Other factors considered include age, race, sex, type of employment, and geographical location, as these factors typically influence

    38. Funding- Advantages Capitation Providers tend to focus on Preventive Care as they will be more financial reward in keeping a person from becoming ill than to treat them once they have become ill Providers shift away from performing expensive, newly developed, and/or less effective treatment options that may have only a marginally higher success rate than alternatives.

    39. Fee-for-Service( FFS) In Health Care- FFS occurs when health care providers receive a fee for each service such as an office visit, test, procedure, or other health care service. Fee-for-service plans typically allow patients to obtain care from doctors or hospitals their choosing,[ In return for this flexibility they may pay higher copayments or deductibles. Patients frequently pay providers directly for services, then submit claims to their insurance company for reimbursement

    40. Funding CAYHealth Best suited to a Capitated model as opposed to the fee-for-service model currently in use Numerous studies show that healthcare costs are better managed and contained by capitating the fee Health care providers are economically motivated towards Evidence Based Medicine and improved outcomes

    41. Implementation The patient count and distribution by District was completed in collaboration with DCFS, CINICO and HIC letter and programme information were sent to patients Patients were aligned to physicians/nurses. Promotion through letters, CDs and H.S.A staff encounters. Patients care plan. – A work in progress

    42. Stakeholder Presentations/Communications Ministry of Health & Ministry of Community Affairs & Housing Cabinet & MLAs CINICO, DCFS Staff & Social Workers H.S.A Senior management H.S.A Section Managers H.S.A Physicians H.S.A Staff

    43. Media Briefing To inform the media about the CayHealth Create community awareness of the initiative Provide information to residents about the benefits of CayHealth

    44. Media Briefing cont’d Chamber of Commerce Civil Service - To provide information to members about the benefits of CayHealth Community Awareness Meetings organized through CDs District meetings sponsored by MLAs

    45. Evaluation Of CayHealth Initiation of the project – September 1, 2010 Evaluation July 2011 Metrics of Outcome measures are now being finalized to use as program output indicators

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