Rachelle Kaye, PhD. Bratislava, Slovakia March 6, 2014

The Major Challenge of Healthcare Today Prevention and Management of CHRONIC DISEASE

Calls for mobilization of a comprehensive range of resources promotion and prevention diagnosis and treatment chronic or long-term home care social services Comprehensive and integrated care for the bulk of the assorted health problems in the community is more efficient (The World Health Report 2008: “Primary Health Care – Now More Than Ever”, 47-49

Community-based ( The World Health Report 2008: “Primary Health Care – Now More Than Ever”, p.47-50) People centered primary care Community –Based Multidisciplinary teams

OECD REVIEWS OF HEALTH CARE QUALITY: ISRAEL © OECD 2012 (11)

Israeli Healthcare System Universal compulsory statutory health insurance Financed by earmarked and general taxation Citizens pay a healthcare tax – 4.8% of income 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

Health Funds provide a uniform legally defined basket of services to which every citizen is entitled Every citizen is a member of one of four nationwide health funds Citizens are free to choose and move between health funds Health funds must accept all applicants for membership Health funds are financed by government via age-related capitation payments (90% of total), patient charges and other income (10%) Israeli Health Care System

Ministry of Health Health Funds Clalit 52% Maccabi 25% Meuhedet 14% Leumit 9% Hospitals Acute Care 45 Beds: 14,972 Psychiatric 13 Beds: 3,467 Geriatric 313 Beds: 24,427 Ministry of Finance The Israeli Health Care System

Second largest health fund in Israel. Functions within the framework of the National Health Insurance Law. Provides insurance cover for all services included in the public basket of services Supplies services to its members both via its own facilities and through outside providers.

5,192 physicians (83% self employed) 7,500 Employees 2 M members Owns 62 Pharmacies Contracts 712 Pharmacies 5 Districts, 300 care centers

Maccabi’s Operational Model Free patient choice of physician and other providers Selectively contracts with providers Organization of Primary Care Personal Physician Group Practice The Changing Role of the Nurse Emphasis on Prevention and Health Promotion New Structures and Processes of Managing Chronic Illness Disease Management Integrated Care Increased Community Orientation; Less Hospital Care ICT Support Infrastructure

Integrated Care for Prevention and Management of Chronic Disease Access of Clinicians and Patients to all necessary information Access of Clinicians and Patients to all necessary information Defined responsibility for care coordination Defined responsibility for care coordination Decision support – alerts and reminders Decision support – alerts and reminders Timely Access to services Timely Access to services “Seamless” transition between all points of care “Seamless” transition between all points of care Care that is guided by the “big picture” –holistic view of patient Care that is guided by the “big picture” –holistic view of patient problems and needs problems and needs The patient receives the care he needs, when The patient receives the care he needs, when and where he needs it, and up-to-date and where he needs it, and up-to-date information on his condition is available in real information on his condition is available in real time to the care providers and the patient time to the care providers and the patient

Maccabi’s Computerized Information and Communication System Supports Integrated Care Maccabi Central Electronic Medical RecordCentral Every transaction computerized E-Laboratory E- Prescription E- Consultation Telemedicine Alerts and Reminders Registries Patient Website (PHR)

Telemedicine Services Tele-Diagnosis Tele-radiology Tele- ECG/Holter monitoring Tele-mammography: mobile unit Tele- ophthalmology Tele-dermatology: skin ulcers Tele-Treatment/ Consultation Video Conference – care giver–patient Video Conference- home care Video Conference- service station Service from a Distance(cost, time) Need for 24/7 response

Telemedicine Services Call Centers Multidisciplinary Telecenter for Chronically Ill Patients Maccabi Pharm Nurses Call Center - Triage Smoking Cessation Interpreter Services On line services Website Patient health Record Mobile Phone Applications Service from a Distance (cost, time) Need for 24/7 response

Mobile Physician Portal

Mobile Patients Portal #1 Pregnancy App in the world

Lab Results - Referring doctor - Date

Medication List

As part of the goal to provide a high quality, comprehensive, community based service 24/7 – physically and virtually and to keep its members as far away as possible from the entrance to the hospital Maccabi has established many clinics for secondary specialist care in the community

Maccabi Hashalom Outpatient Clinics

Imaging Clinic in Maccabi Hashalom

Urgent Care Center in Maccabi Hashalom Urgent Care Center in Maccabi Hashalom

Outcomes Improved Efficiency and Quality of Care Tele-ECG -17,000/month – 10 minutes turnaround time Tele-Holter -1,200/month - from 3 weeks to 2 days for diagnosis Teleradiology : Equal Access all over the country Extended hours -7:30-23:30 7 days/week Interpretation – Usually minutes Reduction of 10% in radiologists Savings of over 600,000 Euro/year in cost of film Digital tools increase diagnosis accuracy Improved Clinical Outcomes Better medical practice (DSS and alerts) Improved Patient Compliance Increased Patient Satisfaction

Clinical Outcomes Breast Cancer Screening Blood Pressure Screening

The Best Health Fund Macabbi is perceived as the best Health Fund by far and the difference is statistically significant

Modern-Day Medical Care has moved away from the hospital and into the community away from the clinic to the home of the patient This requires a new concept for modern- day hospitals

Assuta Medical Centers, Israel

General Background Assuta, owned by Maccabi Health Services, is the leading private hospital and the largest surgical center in Israel. Across the nation in 7 different location, Assuta operates four hospitals and three outpatient medical centers.

v Distribution of Facilities Assuta Haifa Assuta Tel Aviv Assuta Ha’shalom Assuta Ra’anana Assuta Rishon Le-Zion Assuta Ashdod Assuta Beer-Sheba Mobile MRI UNIT 2 Mobile Mammography Units

98,000 Surgical procedures Coronary Angiography: 5,020 Heart Surgery: 702 CT Scans: 89,018 MRI: 44,981 PET CT: 10,740 Mammography: 143,899 IVF: 16,045 cycles Nuclear Medicine: 54,549 Oncology treatments: 33,911 Overall Annual Clinical Volume (2013)

Covering the entire spectrum of medical disciplines, Assuta specializes in a broad range of treatments and procedures: Oncology Center Assuta most experienced oncologists provide advanced diagnostic tools and a multi-disciplinary approach with a range of advanced treatment options  Chemotherapy Unit  Radiotherapy Unit  Radiosurgery procedures  Brachitherapy procedures Centers of Excellence

Assuta’s Imaging Centers Assuta has 5 imaging units across Israel equipped with the very latest technologies including:  MRI Institute  PET-CT Institute  Computerized Tomography (CT)  Nuclear Medicine Institues  Interventional radiology units  Ultrasound  Mammography and Women’s Health Centers  X-Ray & Fluoroscopy Centers of Excellence

In Vitro Fertilization Centers Assuta’s IVF Clinic is amongst the top 5 IVF units worldwide in terms of size and success rate. The country’s leading gynecologists and infertility experts treat both male and female infertility, with a range of advanced techniques. Centers of Excellence

Wards, Recovery and ICU

Scheduling Admission Billing Reading Diagnose Dictating Reporting Signature

Anesthesia Digital Vital Signals Documentation

Assuta Ashdod Public Hospital – May 2017 The hospital will accommodate 300 beds (650 in the future). Centers of excellence: ● Heart Disease ● Oncology ● Children ● Women ● Ambulatory and Endoscopic (minimally invasive) Procedures “A Community that has a hospital”

For the first time in 40 years A new public Hospital in Israel is being built, as a result of a new law signed in 2002 and a mega campaign led by the City of Ashdod. Assuta won the tender at 2011 to be the first public hospital financed, built and operated by a private company.

FUNCTIONS Intensive care Emergency room Operating Rooms Maternity Inpatient wards 12

INSTITUTES and CLINICS Pain Unit Gastroenterology Unit Heart Institute Breast Health Genetics Nuclear Medicine Phototherapy Institute Physiotherapy Institute Eye Institute Institute for angiography Imaging Institute Heart Catheterization Clinics

INNOVATIVE VISION To build and run an innovative, most advanced general public hospital, affiliated to a medical school, which provides the community with the highest standards of medical services. The hospital, working closely with the community, will meet both the health and social community's needs. The goal is to form a full integration with the community's medical services, meeting the special needs of the patients and their families, both within the hospital and at home.

ASSUTA ASHDOD

MOMA Multi- Disciplinary Call Center

The Target Population 4000 stable chronic clients 6000 complex chronic clients Stoma& chronic wound Diabetes Oncology patients Home care of stable chronic clients CHF & COPD Levels 2 unstable, 3-4