WTW 基于價值的醫療支付模式.pdf

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1、Value-Based Payment Models in Healthcare26 August 2024Getting Patients,Providers and Payers onto the Same SideCharlene LeeHealth Leader,APAC 2024 WTW.Proprietary and confidential.For WTW and WTW client use only.SINGAPORE ACTUARIAL CONFERENCE 2 2024 WTW.Proprietary and confidential.For WTW and WTW cl

2、ient use only.SINGAPORE ACTUARIAL CONFERENCE 202426-29 August 2024CostsOutcomesCareSafeEfficientAccessibleAffordableSustainablePersonalH3 2024 WTW.Proprietary and confidential.For WTW and WTW client use only.SINGAPORE ACTUARIAL CONFERENCE 202426-29 August 2024CostsOutcomesCareis being deliveredare b

3、eing chargedbut w/o direct link 4 2024 WTW.Proprietary and confidential.For WTW and WTW client use only.SINGAPORE ACTUARIAL CONFERENCE 202426-29 August 2024CostsOutcomesCareValue-Based P5 2024 WTW.Proprietary and confidential.For WTW and WTW client use only.Value/valju/noun the importance,worth,or u

4、sefulness of something.Oxford English DictionarySINGAPORE ACTUARIAL CONFERENCE 202426-29 August 6 2024 WTW.Proprietary and confidential.For WTW and WTW client use only.Value/valju/noun the importance,worth,or usefulness of something.Oxford English DictionarySINGAPORE ACTUARIAL CONFERENCE 202426-29 A

5、ugust 7 2024 WTW.Proprietary and confidential.For WTW and WTW client use only.Value/valju/noun the importance,worth,or usefulness of something.Oxford English DictionarySINGAPORE ACTUARIAL CONFERENCE 202426-29 August 2024Health/hl/noun a state of complete physical,mental and social well-being and not

6、 merely the absence of disease or infirmity.World Health O8 2024 WTW.Proprietary and confidential.For WTW and WTW client use only.Value/valju/noun the importance,worth,or usefulness of something.Oxford English DictionarySINGAPORE ACTUARIAL CONFERENCE 202426-29 August 2024Health/hl/noun a state of co

7、mplete physical,mental and social well-being and not merely the absence of disease or infirmity.World Health OrganizationHealthCareto help me achieve/hlk/noun the organized provision of medical care to individuals or a community.Oxford English D9 2024 WTW.Proprietary and confidential.For WTW and WTW

8、 client use only.Value/valju/noun the importance,worth,or usefulness of something.Oxford English DictionarySINGAPORE ACTUARIAL CONFERENCE 202426-29 August 2024Health/hl/noun a state of complete physical,mental and social well-being and not merely the absence of disease or infirmity.World Health Orga

9、nizationCareto help me achieve/hlk/noun the organized provision of medical care to individuals or a community.Oxford English Dictionaryin the context ofthe usefulnessof medical services providedto help individuals/communities achievephysical,mental and social well-10 2024 WTW.Proprietary and confide

10、ntial.For WTW and WTW client use only.ValueSINGAPORE ACTUARIAL CONFERENCE 202426-29 August 2024HealthCarein the context of=OutcomesC11 2024 WTW.Proprietary and confidential.For WTW and WTW client use only.SINGAPORE ACTUARIAL CONFERENCE 202426-29 August 2024CostsOutcomesCareBased PaymentsValue-12 202

11、4 WTW.Proprietary and confidential.For WTW and WTW client use only.SINGAPORE ACTUARIAL CONFERENCE 202426-29 August 2024A&EAdmission/SurgeryOutpatientFollow-upFullyDischarged$/visit$/day x LOSSurgery$Drugs$/visitTotal ChargesReadmission$/day x LOSCostsOutcomesCareHUH?to patient/payerScenario 13 2024

12、WTW.Proprietary and confidential.For WTW and WTW client use only.SINGAPORE ACTUARIAL CONFERENCE 202426-29 August 2024CostsOutcomesCareA&EAdmission/SurgeryOutpatientFollow-upFullyDischarged$/visit$/day x 5d 3dSurgery$Drugs$/visitTotal Chargesto patient/payerdoctordoctorScenario 14 2024 WTW.Proprietar

13、y and confidential.For WTW and WTW client use only.SINGAPORE ACTUARIAL CONFERENCE 202426-29 August 2024A&EAdmission/SurgeryOutpatientFollow-upFullyDischarged$/bundleReadmissionTotal ChargesCostsOutcomesCareto patient/15 2024 WTW.Proprietary and confidential.For WTW and WTW client use only.SINGAPORE

14、ACTUARIAL CONFERENCE 202426-29 August 2024Cost to patient/payer(ie charges)based on completion of care journey,not volume.Patient receives optimal,efficient care to achieve health goals.CostsOutcomesCareRewarded for improving care efficiency without compromising 16 2024 WTW.Proprietary and confident

15、ial.For WTW and WTW client use only.SINGAPORE ACTUARIAL CONFERENCE 202426-29 August 2024DiabetesdiagnosisNodisability$/blood test$/screeningTotal Charges10y annualscreening$/consultNoamputationCostsOutcomesCareto patient/payerScenario CostsOutcomesCareto patient/payer17 2024 WTW.Proprietary and conf

16、idential.For WTW and WTW client use only.SINGAPORE ACTUARIAL CONFERENCE 202426-29 August 2024Diabetesdiagnosis Pr(Nodisability)$/blood testFixed$/yearTotal Charges Pr(Annualscreening)$/consult Pr(Noamputation)Scenario 18 2024 WTW.Proprietary and confidential.For WTW and WTW client use only.SINGAPORE

17、 ACTUARIAL CONFERENCE 202426-29 August 2024Cost to patient/payer(ie charges)encourages good care seeking behaviour.Patient receives optimal care to prevent adverse health events.CostsOutcomesCareCosts to provider for routine care more stable,covered by subscription 19 2024 WTW.Proprietary and confid

18、ential.For WTW and WTW client use only.SINGAPORE ACTUARIAL CONFERENCE 202426-29 August 2024Value-Based Payments#3:Capitation(in the context of its implementation in Singapore)$/personAssignedpopulation“Master”ProviderPreventivePrimarySpecialistTertiaryetcfor all individuals within assigned 20 2024 W

19、TW.Proprietary and confidential.For WTW and WTW client use only.SINGAPORE ACTUARIAL CONFERENCE 202426-29 August 2024(health insurance)$/personInsuredpopulationInsurerSelected OPTertiarySelected Otherfor all individuals within insured populationValue-Based Payments#3:CapitationNot for #1 BundlesPayme

20、nt Model#2 SubscriptionClear start&end in care journeyWhen to use?To encourage care seekingBundle definitionsMulti-provider care journeysComplexitiesIncorporating into current offeringsCare management partnershipsBundles include readmissionsOnly effective ifInterventions are evidence-basedStability

21、in claim cost per eventManage portfolio profitabilityFor payersPrevent large future claimAcknowledged as health partnerRewarded for care efficiency&qualityFor providersGreater care adherence ratesQuality,efficiency,affordable careFor patientsPrevent adverse complications21 2024 WTW.Proprietary and c

22、onfidential.For WTW and WTW client use only.SINGAPORE ACTUARIAL CONFERENCE 202426-29 August 22 2024 WTW.Proprietary and confidential.For WTW and WTW client use only.SINGAPORE ACTUARIAL CONFERENCE 202426-29 August 2024CostsOutcomesCareBased PaymentsValue-ProviderPayerP23 2024 WTW.Proprietary and conf

23、idential.For WTW and WTW client use only.This presentation has been prepared by WTW for general information purposes only and does not constitute professional advice.The information,opinions and illustrations contained are derived from various sources and have not all necessarily been independently

24、verified by WTW.The presentation is not intended to guide or determine any specific individual situation,and persons should consult qualified professionals for appropriate professional advice before taking any specific actions.Neither the presenter,nor the presenters employer,shall have any responsi

25、bility or liability to any person or entity with respect to damages alleged to have been caused directly or indirectly by the content of this presentation.If you require professional advice or require any further information,please contact your usual WTW representative.D24 2024 WTW.Proprietary and confidential.For WTW and WTW client use only.Thank you!Charlene.L|+65 9649 1624