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

The Israeli Public Health Care System

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

Maccabi Healthcare Services

Our

Office

Maccabi Statistics

10,000 Employees 5000 physicians (85% self employed)

13 Hospitals- Assuta Owns 56 Pharmacies Contracts 700 Pharmacies

2 M members

1.8 billion € Budget :

5 Districts , 140 Branches

The Cornerstone- Clinical Information System

Every transaction with the patient is computerized

Shared EMR and Central Medical Record

E-Laboratory

E- Prescription

E- Consultation

Alerts and Reminders

Physician Portal ( web & mobile)

Patient Website ( also mobile)

Telemedicine

Central Medical Record

Hospital

Diagnoses

Treatment

Medicines & Drugs

Lab Results

Imaging Tests

Pathology Tests

Medical Visits

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

Lack of treatment

uniformity

Limited accessibility

and availability

Recurrent/unnecessary

referrals to ER

Low

compliance rate

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

4000 stable chronic

clients

6000 complex

chronic clients

Remote cardiac Rehabilitation

Stoma& chronic wound

Diabetes

Home care of stable chronic clients

CHF & COPD Levels 2 unstable,

3-4

Goals

Organisation level To provide support network to assist

primary physicians

To coordinate and integrate care with

community-based services

To reduce the demand for healthcare

services

Client level To monitor and provide care for diverse

client groups with chronic conditions

To preserve/enhance clients’ physical and

mental quality of life, performance scores,

compliance rates, and satisfaction

To empower clients and caregivers that

support the care process

10,000 Maccabi

Nonstop

Community-based units:

Primary medicine, specialized medicine,

outpatient units, emergency center, at-

home care center, medical services,

community-based care wards

Program Structure

At-home care Complex clients -

COPD/ CHF Diabetes Stoma

Hard-to-heal

Wounds

Cardiac

Rehabilitation

The uniqueness

Regular, personalized monitoring by nurse specialist 1 Full collaboration with PCP and Transparent medical record 2

Online identification of exacerbations of the client’s disease 3 Multi-disciplinary team real time advice 4

Involvement of relevant community-based resources in real time 5

Primary physician

Secondary physician

Multi-disciplinary

team

At-home care units

Maccabi Nonstop Call

Center

Emergency medicine centers / services

Primary clinic/ personal physician

Multi-

Disciplinary

Center

Technology

Call center

The Client

Technology

Advanced Technology

Robotic survey

Task management

system

Clinical protocols

Video calls

Call center system

Success measures

Hospital reports

Reduction in

hospital / ER

referrals

Shorter hospital

stays

Performance questionnaire

Improved client

performance

measures

PHQ9

SF 12

Improved QOL

measures

(physical and

mental)

Medication purchase report

Improved

treatment

compliance

measures

Satisfaction survey

Satisfaction

Financial assessment (cost-benefit analysis)

Controlling Hba1c

9.5

9.0

8.5

8.0

7.5

10.0

Discharge Moma Prior Moma

Member

Reached Treatment Target

Other

Flu vaccination

0

10

20

30

40

50

60

70

80

90

Maccabi Population

Fragile Wounds

Stoma Home Care

Diabetes COPD

CHF

63.8

83 80

69.2

80.3 81.8

85.1 83.4

Summary

Advanced technologies play a significant role

in chronic disease management in primary care

Remote disease management call centers create

new and unique nurse specialty field

Moma call center acts as an intersection of health

services for best clients & organization outcomes