1. Purchasing primary Care (focus on GP) Amersfoort, 24 May 2005

2. 24th may 2005 Content Primary care General Practioner Market analysis Risks analysis Targets 2005 Quality standards Definition of standards Monitoring of standards

3. 24th may 2005 Primary Care: facts & figures Euro 0,5 mrd, 12000 people providing care, Extremely low size of scale (excl. kraamzorg), No business attitude Focus on innovation, integration primary care and extending Agis position by pro active communication. 4 managers care (2 for GP´s regionally, 1 maternity care en 1 paramedics)

4. 24th may 2005 Marktet analysis (1): facts and figures supply: Nationwide 6.150 GP´s, of which 1.700 (28%) concentrated in areas where Agis is most important buyer Nationwide 600 GP including pharmacy, of which 190 (32%) in Agis area Nationwide 95 medical care centres, of which 47 (50%) are in Agis area, and 4 in major urban areas in construction (Vinex) Nationwide 56 % POH, in primair werkgebied Agis 65 % POH Nationwide 64 GP-posts, of which 7 in primary area of Agis Nationwide 24 Regional Support Units (ROS), of which 4 are in Agis area

5. 24th may 2005 Market analysis (2) Quality: accreditation and registration of GP´s No overview of specialisations of GP-practices Number of complaints regarding GP-activities is limited and focuses mainly on expectations of patients regarding what GP´s should do and the speed the service is available Limited choice for insuree Quality/performance requirements for GP care are being developed

6. 24th may 2005 Market analysis (4) Developments short and long term: Organisation form and contractors will show broader variety. GP medical care will appear in different forms More differentiation of tasks within GP practice (GP delegates the ‘easier’ care tasks to others under his supervision and will concentrate on new, more specialized tasks) Integration acute care (minimal HAP/SEH) Introduction of new health insurance system from 1/1/2006 1/1/2006 new financing system for GP´s and medical care centres (practice plan required to get additional finance) GP will be more conscious of their role as supplier (increasing business attitude) Increasing drives for cost control

7. 24th may 2005 Market analysis (5) Developments on the long and the short term: Shift from supply towards demand driven (from market segmentation to patient groups) Enthousiasm for primary diabetes care, diabetes dbc’s in B-segment Certain type of care will move from ‘care’ to ‘welfare’ (home care arranged for and financed by local governement, people live longer independently) Drive and needs new GP´s differ from GP´s that will retire in the next few years Stronger demand for involvement of insurers in new urban area´s (Vinex neighbourhoods)

8. 24th may 2005 Risk analysis (1) Risks regarding realisation of 2005 targets. GP´s distrust insurers Changes will lead to major resistance of GP´s GP´s advise negatively about Agis towards patients Strikes could lead to extra medical costs Increase of not registered patients by lack of information on practices that could adaccept extra patients (freedom of choice for insuree/patient)

9. 24th may 2005 Risk analysis (2) Insufficient knowledge of the quality of services rendered by GP´s Continuity of service in danger in regions with high percenctage of older GP´s Difficulty in making results of investing money in continuity and quality of care visible to insurees (existing and potential clients)

10. 24th may 2005 Primary goals 2005 Create partnership with GP´s resulting: High contracting ratio in 2005/2006 (Agis norm 95%, CVZ 100%) Succesfull implemantation of new finance and insurance system Keeping costs in control without loosing quality of medical care Translate insuree wishes more explicitly into contract specifications 2006 by Requirments for 2 patient segments Minimal 3 requirments in GP contract are client driven. More promotion of Agis care innovations towards our (potential) clients

11. 24th may 2005 Primary quality aspects Good quality Accessibility Affordability of medical care

12. 24th may 2005 Dimensions of quality Focus on organisation, process or outcome objective or subjective* Patient/insuree driven good medical service: results readily available good coverage/low premium Insurer driven -Value for money -Availability to meet contractual obligations Care providers maintain medical standards * Patients experience

13. 24th may 2005 Definition of quality requirements in basic contract between Agis and GP´s GP obliged to participate in training to keep knowledge up to date to deliver medical care in a effective and professional way in accordance with protocols, standards and norm agreed upon To participate actively in collaboration and disccussion meetings with fellow GP´s in order to maintain and improve GP operations within the total medical care system To deliver care in accordance to the standards which were agreed upon by branche organisations of GP’s and health insurance companies (LHV and ZN) Take notice of the patient rights as formulated by the branche organisations of GP’s and of patients (KNMG and NPCF) Take into account the requirements diagnostic and indication for longlasting fysiotherapy, ceasartherapy e.g.

14. 24th may 2005 Definition of quality requirements in basic contract between Agis and GP´s (2) Obliged to participate in the local pharmatherapeutic meetings Obliged to assure continuity of GP service (illness, leave, e.g) GP remains responsible for the quality of medical service delivered by his replacement Patient files are kept in accordance with the law for privacy protection and kept centrally GP´s office. Majority of medical standards are developed by the professional council often in close co-operation with patient representation councils (NHG, LHV, KNMG)

15. 24th may 2005 Quality reguirements in additonal options (modules) in contract Extra compensation for training Compensation for automatisation of the patient Compensation for electronical invoicing through Vecozo Additional bonus if medical care for people in nursing homes is efficiently organized (limited no. of GP´s) Compensation for costs made to create a HOED (several GP practices in one building)

16. 24th may 2005 ´Zinnig en Zuinig´ focuses on prescription for efficient use of medicins Mirror information on prescription behaviour of GP´s Focus on use of generic medicins Pharmatherapeutic meetings

17. 24th may 2005 Monitoring of quality is hardly developed Feedback on quality of GP practices is limited Letter of complaints by patients Monitoring of continuity of GP-services is contracted out to regional support units and will be yearly reported Quality review program among patients-insurees is being developed Audits and benchmarking of GP practices takes places on basis of invoices

18. 24th may 2005 Our insuree/patient remains our focus