Practical steps for implementing a scalable NCD programme Lessons from Abu Dhabi

Health Policy Roundtable, Xi’an, PRC

11:15-11:30, 25 May 2012

Success…

1

Opportunity Plan Results Sustainable results

Opportunity

Situation 2006

•Full range of services for diverse population (2 cities + rural)

•2.4m population

•No/poor data •Outcomes poor relative to spend •Political will to improve

outcomes and quality

•Adequate financial resources

Implication

•Prototype health system •Small enough to make rapid difference

•Improving data should allow quick wins

•Opportunity to shift quality/ outcomes

from low base

•Window of opportunity to focus on outcomes

Impact, transferable

2

Source Health Statistics Analysis

Plan how we got started in Abu Dhabi

(IR-)DRGs fully implemented

in one year (2011)

3

Plan overall data standard is HL7 v3

4

“Smart” HL7 v3 • RIM • XML

Source Health statistics

ID GrossPremium Package Start/Renewal Expiry PolicyHolder Relation

IDs Gross PatientShare Net PaymentAmount

Person

Provider Payer Claim

Financing Encounter

FirstName ContactNumber PassportNumber BirthDate Gender Nationality City

IDs Start StartType Type End EndType Diagnoses

Activity Type Code Quantity Net Clinician

Observation

5

Plan Abu Dhabi data model

Source Health statistics 6

Plan Abu Dhabi data model

Identifiers (Facility, Professional, Patient)

Diagnoses (ICD-9CM, principal/secondary, presenting/discharge)

Activity (CPT-4, ACT(plus) – drug and dose, medical devices)

Observation (LOINC – including mandatory fields, e.g., HbA1c)

Outcomes (discrete)

Plan Full data dictionary and tech specs available at www.shafafiya.org

7

•Dictionary

•Codes

• Standards (15 pages only)

•Governance

• Schemas (4 transactions)

•Prices

Results setup today Simplified

8

Web service Shafafiya.org

(Enterprise service bus)

Licensed Providers

Licensed Providers

Licensed Providers

Licensed Providers

Licensed Providers [n = 1,367]

Licensed Providers

Licensed Providers

Licensed Providers

Licensed Providers

Licensed Payers [n = 38]

KEH

Regulator data warehouse

BI system OLAP cubes

Excel Pivot table

Results selected highlights

9

1. Node centrality of Shafafiya means the Abu Dhabi eHealth system is highly adaptable, e.g., ePrescribing, Electronic Health Records

2. Web-based solution so massively scalable (e.g., 100x volume increase 2011-2012)

3. All Abu Dhabi health data captured on KEH (pharmacy, primary, secondary, tertiary, government and private, citizens and expatriates)

4. >99,99% service uptime (2011)

5. >1 million transactions per day (2012)

6. Initial batch-processes (eClaims and remittances)

7. Now real-time processing of five transaction types (e.g., “PriorAuthorisation” used for eEligibility, eAuthorisation, ePrescribing, ePBM)

8. Migrated to (IR-)DRGs 2011-12

9. Data protection hardwired into systems (“IT as Policy”)

10. Very active Data Standards Panel

11. Data Access Panel

12. Full Data Standards and Architecture open-source [www.shafafiya.org]

Results achieving universal health insurance 2006-2008

Note Some member numbers may be inflated, as in-year cancellations are not excluded

Source Abu Dhabi Payer submissions; Some insurance data not available (AXA, and Al Wathba, Noor Takaful Family, Dubai, Green Crescent, Al Hilal Takaful – PJSC and Methaq Takaful

10

Results data has changed everything… Leading causes of death 2010

Note Causes of death classified according to WHO ICD-10, 2009 data had been revised by the Public Health

Source Death notification data - Emirate of Abu Dhabi, 2010, HAAD-Public Health and Policy

Injury, poisoning and certain

other consequences of external causes

1%

Congenital malformations,

deformations and chromosomal abnormalities

5%Endocrine,

nutritional and metabolic diseases

7%

External causes of morbidity and

mortality19%Neoplasms

16%

Other causes25%

Diseases of the circulatory system

27%

Causes 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001

Diseases of the circulatory system 763 707 697 506 378 424 413 624 778 622

External causes of morbidity and mortality 546 632 464

Injury, poisoning and certain

other consequences of external causes42 57 85

Neoplasms 465 397 360 370 315 294 298 276 289 252

Endocrine, nutritional and metabolic diseases 194 210 79 201 130 133 126 103 73 65

Congenital malformations, deformations and

chromosomal abnormalities142 199 120 177 131 156 146 152 199 190

Other 727 715 1'144 867 993 874 943 763 664 845

Total 2'879 2'917 2'949 2'742 2'450 2'446 2'489 2'492 2'617 2'574

600621 503 565 563 574 614

11

Encounters by diagnosis group, % of volume

Note Non-disease conditions include Injuries (ICD-9 codes 800-999)

Source Health Statistics analysis; Cube 2010; categorization based on WHO classification of ICD diagnoses 12

Total Outpatient ER Inpatient

% of Total Encounters 100 92.2 6.3 1.5

Non-disease conditions 21.5 20.3 38.4 24.3

Respiratory infections 14.8 15.0 13.9 4.8

Musculoskeletal diseases 8.2 8.4 6.6 2.6

Digestive diseases 6.5 6.5 6.6 8.3

Endocrine disorders 5.6 5.9 1.5 5.9

Cardiovascular diseases 5.6 5.8 3.1 6.7

Respiratory diseases 5.4 5.4 5.4 5.2

Skin diseases 4.9 5.1 2.6 1.8

Genitourinary diseases 4.7 4.7 3.6 6.5

Diabetes mellitus 4.6 4.8 2.1 3.7

Sense organ diseases 3.9 4.1 2.2 2.9

Oral conditions 3.5 3.7 0.8 0.5

Infectious and parasitic diseases 3.4 3.5 2.3 3.3

Neuropsychiatric conditions 2.1 2.1 1.8 2.7

Nutritional deficiencies 2.0 2.2 0.3 1.9

Maternal and Perinatal conditions 2.0 1.7 2.4 13.0

Cancer 0.6 0.6 0.2 2.9

Injuries 0.5 5.4 1.4

Congenital anomalies 0.3 0.2 1.2

RTA 0.06 0.6 0.4

100 100 100

Results hospital inpatient profile by value

* Share of top 5 Diagnoses groups within providers

Note Non-disease conditions includes injury codes (800-799)

Source Health Statistics analysis; Cube 2010; categorization based on WHO classification of ICD diagnoses 13

Hospital Name Overall Top 5* 1st 2nd 3rd 4th 5th

Tawam 24 Maternal and Perinatal conditions (24%) Non-disease conditions (24%) Cardiovascular diseases (9%) Cancer (9%) Endocrine disorders (5%)

SKMC 9 Cardiovascular diseases (16%) Non-disease conditions (16%) Congenital anomalies (12%) Musculoskeletal diseases (9%) Neuropsychiatric conditions (7%)

Al Noor - Airport Road 8 Cardiovascular diseases (26%) Maternal and Perinatal conditions (21%) Digestive diseases (11%) Respiratory diseases (9%) Non-disease conditions (7%)

Al Corniche 7 Maternal and Perinatal conditions (82%) Non-disease conditions (15%) Genitourinary diseases (2%) Cancer (1%) Infectious and parasitic diseases (%)

Al Ain 6 Maternal and Perinatal conditions Non-disease conditions (14%) Digestive diseases (11%) Neuropsychiatric conditions (9%) Respiratory diseases (7%)

Al Noor 6 Maternal and Perinatal conditions (21%) Digestive diseases (14%) Non-disease conditions (12%) Respiratory diseases (11%) Genitourinary diseases (10%)

Al Mafraq 5 Non-disease conditions (24%) Maternal and Perinatal conditions (18%) Cardiovascular diseases (11%) Sense organ diseases (8%) Digestive diseases (7%)

N M C Specialty 5 Cardiovascular diseases (19%) Digestive diseases (17%) Non-disease conditions (12%) Musculoskeletal diseases (11%) Maternal and Perinatal conditions (10%)

Oasis 4 Maternal and Perinatal conditions (75%) Digestive diseases (6%) Non-disease conditions (6%) Genitourinary diseases (4%) Respiratory infections (3%)

Al Noor - Al Ain 3 Maternal and Perinatal conditions (17%) Digestive diseases (17%) Non-disease conditions (13%) Cardiovascular diseases (12%) Genitourinary diseases (12%)

Madinat Zayed 3 Maternal and Perinatal conditions (25%) Non-disease conditions (17%) Digestive diseases (16%) Cardiovascular diseases (10%) Respiratory infections (8%)

Al Salama 3 Non-disease conditions (33%) Digestive diseases (17%) Respiratory diseases (10%) Musculoskeletal diseases (8%) Respiratory infections (7%)

Life Line 2 Non-disease conditions (20%) Maternal and Perinatal conditions (18%) Digestive diseases (14%) Genitourinary diseases (12%) Musculoskeletal diseases (8%)

Al Ahlia 2 Cardiovascular diseases (27%) Digestive diseases (21%) Genitourinary diseases (16%) Non-disease conditions (11%) Maternal and Perinatal conditions (7%)

Al Rahba 2 Respiratory diseases (45%) Maternal and Perinatal conditions (35%) Digestive diseases (5%) Musculoskeletal diseases (4%) Genitourinary diseases (2%)

N M C Specialty - Al Ain 2 Digestive diseases (2%) Musculoskeletal diseases (2%) Non-disease conditions (2%) Genitourinary diseases (2%) Cardiovascular diseases (1%)

Behavioral Sciences Pavilion 1 Digestive diseases (99%) Musculoskeletal diseases (1%) Non-disease conditions (%) Genitourinary diseases (%) Cardiovascular diseases (%)

Emirates French 1 Respiratory diseases (65%) Maternal and Perinatal conditions (12%) Digestive diseases (5%) Cancer (4%) Non-disease conditions (4%)

Emirates International 1 Digestive diseases (24%) Non-disease conditions (16%) Maternal and Perinatal conditions (15%) Cardiovascular diseases (9%) Respiratory diseases (8%)

Gulf Diagnostic Center 1 Respiratory diseases (32%) Genitourinary diseases (17%) Respiratory infections (9%) Digestive diseases (8%) Cardiovascular diseases (6%)

Ghiathy 1 Respiratory infections (24%) Maternal and Perinatal conditions (23%) Digestive diseases (11%) Non-disease conditions (11%) Cardiovascular diseases (9%)

Dar Al Shifaa 1 Respiratory diseases (23%) Digestive diseases (17%) Maternal and Perinatal conditions (14%) Genitourinary diseases (11%) Respiratory infections (8%)

Specialized Medical Care 1 Genitourinary diseases (26%) Respiratory diseases (25%) Maternal and Perinatal conditions (13%) Digestive diseases (8%) Infectious and parasitic diseases (8%)

Marfa Hospital 1 Maternal and Perinatal conditions (41%) Non-disease conditions (16%) Digestive diseases (9%) Respiratory infections (9%) Cardiovascular diseases (6%)

Ruwais 1 Maternal and Perinatal conditions (54%) Digestive diseases (13%) Non-disease conditions (12%) Cardiovascular diseases (6%) Respiratory infections (5%)

Silla 1 Maternal and Perinatal conditions (38%) Cardiovascular diseases (13%) Digestive diseases (12%) Respiratory infections (11%) Non-disease conditions (10%)

Delma 0 Maternal and Perinatal conditions (30%) Digestive diseases (20%) Non-disease conditions (12%) Respiratory infections (9%) Skin diseases (7%)

Al Reef Internaional 0 Musculoskeletal diseases (82%) Genitourinary diseases (6%) Non-disease conditions (5%) Cardiovascular diseases (2%) Digestive diseases (1%)

National 0 Digestive diseases (34%) Genitourinary diseases (12%) Cardiovascular diseases (10%) Respiratory infections (9%) Non-disease conditions (8%)

Results labour productivity

Note Productivity is defined as adjusted episodes per clinician per day. An Episode is any encounter with a consultation. To account for the higher resource need of inpatients, inpatient episodes are multiplied by ratio of the average value (ClaimNet) of an Inpatient Episode versus an Outpatient episode. To reflect clinical complexity inpatient episodes are then adjusted by the difference of case mix index of each individual hospital from Abu Dhabi average. Seha hospitals episodes are underestimated due to certain Seha clinical obligations such as public events medical preparation. Tawam hospital provides rotating staff to Al Wagan which effects both hospitals’ productivity.

Source Cube 2010; HAAD licensing database; Operations Center data for 2009; Health Statistics analysis, Medical Group Management Association Survey

Indicative

14

Productivity Episodes (000)

Hospital Do

cto

r

Nu

rse

Inp

atie

nt

Ou

tpat

ien

t

Tota

l,

We

igh

ted

Al Ahalia 12.0 14.2 3.4 350.3 402.9

Al Wagan 10.9 3.2 .6 38.7 47.6

Oasis 10.1 4.0 6.0 105.7 188.8

Al Noor 9.4 6.8 8.5 414.0 533.3

Al Salama 9.3 7.1 2.8 154.1 190.9

Al Noor - Airport Road 9.1 5.2 7.0 294.7 408.6

Al Noor - Al Ain 8.9 5.3 4.8 261.1 327.2

Specialized Medical Care 8.6 11.2 1.2 56.1 69.3

Dar Al Shifaa 8.6 7.7 1.0 98.9 110.1

Al Ain 8.6 2.1 12.6 377.7 579.8

SKMC 8.0 2.3 17.7 580.3 1,021.3

National 7.7 4.5 .3 55.8 59.1

Emirates International 7.1 12.6 1.7 91.7 110.7

Life Line 6.6 5.1 2.7 151.6 189.4

Ghayathi 6.5 2.9 .8 40.8 52.0

N M C Specialty - Al Ain 6.4 3.1 1.6 122.8 147.4

Al Rahba 6.4 2.1 7.7 132.5 247.8

Gulf Diagnostic Center 6.3 8.0 .9 140.7 152.2

Delma 6.2 3.0 .3 20.8 24.9

N M C Specialty 5.9 3.1 4.4 238.8 310.1

Tawam 5.7 2.1 23.7 492.8 932.3

Al Corniche 5.7 1.6 12.3 76.7 257.8

Al Raha 5.6 8.2 .4 34.9 39.1

Al Sil la 5.2 2.1 .5 24.8 30.5

Al Mafraq 5.2 2.3 18.8 329.2 664.7

Al Mirfa 4.5 1.6 .4 24.5 29.4

Madinat Zayed 4.3 2.1 3.4 111.6 160.0

Emirates French 4.2 4.2 .9 28.4 41.2

Al Reef Internaional 4.0 3.0 .1 21.4 23.1

Al Rewaise 1.6 0.8 .3 10.8 14.6

Total/Average 6.4 2.9 146.7 4,882.1 7,366.3

Tawam

Al Mafraq

SKMC

Al Ain

Al Corniche

Al Rahba

Madinat Zayed

Ghayathi

Al Mirfa

Al Silla

Al Wagan

Delma

Al Noor

Oasis

N M C Specialty

Al Noor - Al Ain

Al Ahalia

Al Noor - Airport Road Al Salama

Life Line

Dar Al Shifaa

Emirates International

Emirates FrenchAl Reef Internaional

Gulf Diagnostic Center

Al Raha

Specialized Medical Care

N M C Specialty - Al Ain

National

Al Rewaise

Seha

Other

Epis

od

es

pe

r d

oct

or

pe

r d

ay

Episodes per nurse per day

6.4

2.9

Notes Diabetics is number of members who had an encounter with diagnosis of diabetes. Well controlled diabetes is a measure of diabetics whose latest HbA1c<7%. Moderate and well controlled diabetics is those whose latest HbA1c<7.5%.Poorly controlled diabetics is those whose latest HbA1c>9%. Related care indicators apply to diabetics only and indicate ≥1 test per member per annum. Rates shown are rates within breakdown category. Indicator definitions are available at https://www.shafafiya.org

Source KEH Episodes with Encounter start date 1 January – 31 December 2011 as at 21 February 2012 15

Results quality data is improving continuously

General

Diabetes

Results Abu Dhabi health system financing

16 Source HAAD external consultants

Financial Flows2010 Policy All Scenario

AED millions 1 Demand

Individuals

416.5

6.1 2,491.9

Insurance Thiqa

2,681.0 + 2,491.9

1,512.0 2.9

235.6 340.0

151.0 259.1 0.3

Thiqa Admin HAAD

235.6 340.0

Status Quo

Public providers

6,961.2

9,275.7

5,298.2

DoFEmployers

2,674.8

2,215.3

2,674.8

913.22,474.4

910.0

Private providers Foreign providers

High

Source Health Statistics Analysis

We planned sustainability from the start

Regulator • Transform regulatory ‘operations’

• Shift information asymmetry

• Cut admin staff and consumables

• Free 2.5 hours/day doctors time

• Automate and outsource claims

• Outgrow competition

Provider

Payer

Free software adds momentum

17

Outline of Weqaya Programme

The Approach Screen >90% adult Emiratis screened (>190,000) Plan Clinical Standards, website/call centre Act Clinical care, targeted lifestyle behaviour change (diet, physical exercise, tobacco) Levels of Intervention Population Nutrition (trans-fats, food labeling)

Physical activity (gyms, AD UPC) Tobacco control

Group Workplace

Schools Communities Families

Individual Clinical care

Encourage: Weqaya reports Enable: Website/call centre

Internet Mobile network

Aged Care Facilities

Community Service &

In Home Patient Care

Integration with Hospital Services

Long Term Illness & Care

Field Health

Services

NGN – MPLS Cloud

Insurance Co’s

Connecting through “the cloud”

Health impact to date Impact of Weqaya screening and follow-up on diabetes control

* Engagement with care defined as one or more HbA1c tests during period

Source KEH; Data cubes analysis

Key points

• One early indicator of impact is diabetes control (% HbA1c)

• National diabetic patients passing through Weqaya (C1) have substantially better control of diabetes than those not passing through Weqaya (C2/C3)

• Consistency of care is also far higher between facilities for diabetes than for management of other chronic disease

20

Our shared challenge…

Hannibal of Carthage, military commander

21

I know half my spending on advertising is wasted…

…the problem is I don’t know

which half

© Health Authority – Abu Dhabi (2010)

State Transition Matrix: Male, Age 66

22 Source Verisk, Strategy analysis

HCC1 HCC185

HCC

185

Probability = 0

Probability = 0.4

© Health Authority – Abu Dhabi (2010)

Treatment patterns

23

Co

nd

itio

n

Treatment

Relative Frequency

Hi Lo

Current status

Hannibal of Carthage, military commander

24

• Shafafiya and KEH data dictionary and source code available on Shafafiya.org

• Discussions ongoing regarding replication of key elements of Abu Dhabi model in 1. Dubai 2. Other UAE Emirates 3. Turkey 4. Seven SE Asian countries 5. Five African countries 6. UK (pilot, Birmingham)

Our philosophy

Hannibal of Carthage, military commander

25

If you want to go fast, go alone

If you want to go far, go together…

• Strong interest in Abu Dhabi in sharing data with others for data portability, performance benchmarking, shared learning, and shared innovation (particularly in tackling non-communicable diseases)

• Happy to provide support, particularly where there is potential for transnational sharing of data and innovation

Practical steps for implementing a scalable NCD programme Lessons from Abu Dhabi

Health Policy Roundtable, Xi’an, PRC

11:15-11:30, 25 May 2012

Source Gaps: 2011 survey of 575 clinicians; 2012 Interviews with Medical Directors; Planning analysis; Episodes: KEH; Physicians and Facilities: Licensing database; Waiting times: 2011 TPA analysis Note Growth compares 2009 to 2010

Results live capacity map As at 31 January 2012

C9

Capacity Balance

Critical capacity gap

Severe capacity gap

No capacity gap

% private/public capacity

Growth - public private

Growth - public

Waiting times

High

Intermediate

Low

Shorter than 2010

Longer than 2010

Specialty Gaps Physicians % P

riva

te

Growth Facilities % P

riva

te

Growth

Intensive & Critical care medicine 38 -1 9 2

Emergency medicine 90 -27 16 1 5-10 n/a

Neonatology 13 -5 7 30 1

Cardiology 71 -9 22 5 60 1

Psychiatry 49 18 16 3 60 1

Obstetrics & Gynecology 262 40 82 15 30-60 2

Pediatrics 369 61 87 3 5-10 1

Oncology 32 9 -2 60 2

General surgery 235 45 66 10 20-30 1

Pediatric surgery 17 -5 9 1 60 2

Internal Medicine 350 156 86 22

Physical medicine & Rehabilitation 16 2 13 2 n/a 1

Allergy & Immunology 3 1 3 1 60 1

Cardio-thoracic surgery 23 -1 11 1

Orthopedics 137 17 48 11 30 1

Family medicine 129 22 41 7 20-30 2

Radiology 145 30 55 9 30-60 1

Neurology 43 -3 18 1 60 2

Anesthesiology 226 49 38 4

Preventive medicine 2 1 n/a n/a

Ophthalmology 124 18 54 2 30 2

Infectious diseases 7 -5 6 -2

Dentistry 805 87 324 19 60-120 2-3

Urology 77 7 36 3 30-60 1

General medicine 1814 328 260 28 30-60 N/A

Pulmonology 14 -3 11 30-60 1

Pathology 146 34 79 12

Nephrology 22 -10 9 -3 60 1-2

Endocrinology 30 -2 11 -2 60 2

Dermatology 139 18 84 11 20-30 1

Gastroenterology 22 -7 12 -2 30 2-3

Alternative therapies 2 2 10-20 1

Oral & Maxillofacial surgery 48 3 39 3 60 2

Rheumatology 12 -3 11 1 60 2

Otolaryngology (ENT) 135 20 59 8 30 2

Total 5,647 875 1634 174

Walk-in (minutes)

Appointment(days)

Gaps

Source Population: SCAD, 2010 Estimate, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis. C11

Population Facilities Clinicians Ratios 2030 Plan growth Hospitals Clinics

Region District Gap now Type Tota

l

% N

atio

nal

Nat

ion

als

Tota

l

Ho

spit

als

Cli

nic

s &

Ce

ntr

es

Ne

arb

y

ho

spit

al

Do

cto

rs

Nu

rse

s

De

nti

sts

Oth

er

Fac

ilit

ies

/10

00

0

Do

cto

rs

/10

00

Nu

rse

s

/10

00

Population Growth

ne

ed

un

de

r w

ay

ne

ed

un

de

r w

ay

Am

bu

lan

ce

sta

tio

n

20

30

Po

pu

lati

on

Abu Dhabi Desert Villages Rural 35,489 #NAME? 7,844 None 74,511 1 1L 1 110,000

Al Falah Rural 5,019 #NAME? 1,109 None 94,981 1 1M 1 1 100,000

Ghantoot District Rural 3,088 #NAME? 682 None 96,912 1 1M 1 100,000

Abu Dhabi Island Urban 391,040 #NAME? 86,429 229 13 182 2,529 3,878 430 1,284 5.0 6.5 9.9 33,960 425,000

CBD/Financial Centre Urban 217,602 #NAME? 48,095 124 5 86 1,131 1,663 241 539 4.2 5.2 7.6 (27,602) 1M 190,000

Musaffah Urban 176,035 #NAME? 38,908 36 31 161 194 21 68 1.8 0.9 1.1 (76,035) 3 100,000

Bani Yas Rural 58,872 #NAME? 13,012 43 37 162 106 57 73 6.3 2.8 1.8 11,128 4 1M 1 70,000

Al Shahama Rural 47,142 #NAME? 10,419 10 10 45 47 14 24 2.1 1.0 1.0 62,858 1 1 1 110,000

Shamkhah Rural 19,737 #NAME? 4,362 None 1 110,263 1 1 1 130,000

Al Rahba Rural 19,084 #NAME? 4,218 1 1 132 325 5 89 0.5 6.9 17.0 90,916 1 110,000

New Port City Rural 14,629 #NAME? 3,233 None 1 135,371 1 1L 1 150,000

Capital District South Urban 11,523 #NAME? 2,547 None 1 43,477 1 1L 1 55,000

Bain Al Jesrain Urban 9,588 #NAME? 2,119 3 3 33 42 10 17 3.1 3.4 4.4 15,412 1 1M 1 25,000

Khalifa City A Urban 6,626 #NAME? 1,464 11 1 10 78 74 17 75 16.6 11.8 11.2 63,374 1 6 1 70,000

Grand Mosque District Urban 6,551 #NAME? 1,448 None 1 113,449 1 1 1M 120,000

Inner Islands Urban 3,494 #NAME? 772 1 2 4 2.9 0.6 1.1 16,506 1M 1 20,000

Capital District North Urban 2,955 #NAME? 653 2 1 1 426 792 36 302 6.8 144.2 268.1 67,045 1 3 70,000

Al Mina Urban 1,333 #NAME? 295 7 4 87 103 25 62 30.0 65.2 77.2 98,667 1L 100,000

Al Raha Urban 1,031 #NAME? 228 2 1 1 41 42 9 12 19.4 39.8 40.8 118,969 1 1L 1 120,000

Yas Island Urban 967 #NAME? 214 None 99,033 1l 1 100,000

Mohamed Bin Zayed City Urban 409 #NAME? 90 2 2 1 2 4 2 2.4 4.9 49,591 4 1L 1 1 50,000

Saadiyat Urban 152 #NAME? 34 None 119,848 2L 1 120,000

Airport District Urban 122 #NAME? 27 6 4 8 11 5 11 65.5 90.1 49,878 1L 1 50,000

Lulu Island Urban 93 #NAME? 21 None 19,907 1M 1 20,000

Capital District Urban - #NAME? - None 240,000 2 1L 1 240,000

Mohamed Bin Zayed Centre Urban - #NAME? - None 80,000 1 80,000

South Hudayriat Island Rural - #NAME? - None 100,000 1 1L 100,000

Marina Village Urban - #NAME? - 3 2 1 3 6 5,000 1S 5,000

Al Suwwah Urban - #NAME? - None 30,000 1 1 30,000

Al Reem Urban - #NAME? - None 200,000 2L 1 200,000

Al Ain Umm Ghaffa Rural 9,250 #NAME? 2,884 None 2,650 1S 1 11,900

Nahel Rural 5,430 #NAME? 1,693 None 4,570 1S 1 10,000

Industrial City Rural 51,004 #NAME? 15,899 8 5 14 5 1 5 1.0 0.3 0.1 28,736 1 79,740

Al Salamat/Al Yaher Urban 39,237 #NAME? 12,231 1 1 1 3 1 6 0.3 0.1 0.0 34,763 1 1 1 1 74,000

Al Dhahra Rural 5,182 #NAME? 1,615 None 818 1S 6,000

Abu Krayyah Rural 4,293 #NAME? 1,338 None 707 1S 5,000

Al Saad Rural 4,002 #NAME? 1,247 None 998 1S 5,000

Al Araad Rural 3,962 #NAME? 1,235 None 38 1S 4,000

Abu Samra Rural 2,030 #NAME? 633 None 470 2,500

Al Ain City Urban 358,472 #NAME? 111,744 186 7 148 1,733 2,864 318 968 4.3 4.8 8.0 348,828 3 8 2M 2 707,300

Al Quaa Rural 13,076 #NAME? 4,076 1 1 8 13 1 3 0.8 0.6 1.0 9,924 1M 1 23,000

Al Wagan Rural 12,400 #NAME? 3,865 1 1 17 29 1 4 0.8 1.4 2.3 17,600 1S 1 30,000

Al Hayer Rural 12,002 #NAME? 3,741 3 3 25 34 4 3 2.5 2.1 2.8 19,998 1M 1 1 32,000

Al Dhaher Rural 11,121 #NAME? 3,467 1 1 13 20 3 4 0.9 1.2 1.8 3,229 1M 1 14,350

Remah Rural 8,556 #NAME? 2,667 1 1 6 9 2 1.2 0.7 1.1 944 1S 9,500

Sweihan Rural 8,235 #NAME? 2,567 1 1 8 11 1 1 1.2 1.0 1.3 31,765 1L 1 1 40,000

Al Khazna Rural 7,682 #NAME? 2,395 2 2 4 13 1 2.6 0.5 1.7 1,318 1S 9,000

Mezyad Rural 6,696 #NAME? 2,087 None 1 1,704 1S 8,400

Al Shwaib Rural 3,407 #NAME? 1,062 1 1 3 4 2.9 0.9 1.2 2,093 1S 5,500

Al Fagah Rural 2,183 #NAME? 681 1 1 3 3 4.6 1.4 1.4 1,317 3,500

Western Liwa Rural 41,256 #NAME? 5,803 5 1 1 8 17 5 32 0.5 0.2 0.4 23,744 1L 1 65,000

Madinat Zayed Rural 59,821 #NAME? 8,414 16 2 11 175 256 23 107 2.2 2.9 4.3 (19,821) 1 1L 1 40,000

Ruwais Rural 33,005 #NAME? 4,642 4 1 3 50 100 7 14 1.2 1.5 3.0 96,995 1 1L 1 130,000

Mirfa Rural 30,942 #NAME? 4,352 4 1 3 32 61 3 17 1.3 1.0 2.0 44,058 1L 1 75,000

Ghayathi Rural 16,502 #NAME? 2,321 6 1 5 38 63 5 18 3.6 2.3 3.8 (1,502) 1 15,000

Sila'a Rural 10,314 #NAME? 1,451 1 1 22 39 2 10 1.0 2.1 3.8 59,686 1L 1 70,000

Delma Island Rural 10,314 #NAME? 1,451 1 1 23 25 2 10 1.0 2.2 2.4 (314) 1 10,000

Capacity Gap

Severe

Moderate

None

Supply

Underserved

Potential

over supply

Gaps

Duplications

Results live capacity by location

Notes Performance is not shown for all categories of healthcare professionals or healthcare facilities. Rates shown are rates within breakdown category.

DM Clinician Category encounter numbers based on activity count ratios during sample period.

Indicator definitions are available at www.haad.ae/Datadictionary.

Source KEH Episodes with Encounter start date 1 January – 31 December 2010 as at 10 May 2011.

Drug/Diagnosis/CPT alerts: KEH, Greenrain (Sample of 3,057,800 encounters with transaction dates 1 - 30 September 2010), Dimensions Healthcare (Ingenix and CMP Medica) sample of 6,778,887 encounters with activity start dates 1 March - 10 September 2010. 29

Results clinical performance

Consultant Specialist GP Hospital Center Polyclinic Clinic Public Private

Episodes w Common Cold w Antibiotics 34 % 35 % 34 % 34 % 36 % 24 % 50 % 28 % 22 % 39 %

Routine dental extraction w complication 1 % 0 % 1 % 1 % 1 % 1 % 1 % 1 % 1 % 1 %

Episodes Obese w Lifestyle or Drugs 5 % 22 % 3 % 2 % 5 % 12 % 8 % 10 % 1 %

Episodes [GR]/Encounters [DM] w potentially

severe or life threatening drug-drug interactions

GR

DM

0.42%

0.17%1.44%

0.17%

0.61%

0.18%

0.19%

0.11%

0.60%

0.20%

0.19

%

0.09

0.00%

0.15%

0.00%

0.80%

0.82%

0.08%

0.34%

0.23%

Encounters w absolute drug-disease

interactions

DM 0.73 % 1.00% 0.74% 0.55% 0.84% 0.51% 1.20% 1.61% 0.46% 0.91%

Episodes w duplicate generic drug prescribed GR 16 % 27% 14% 19% 22% 20% 0.20% 0.17% 19% 17%

Encounters w diagnosis error alerts DM 1.52 % 1.16% 1.87% 1.08% 1.78% 1.26

%

0.89% 0.65% 0.54% 2.50%

Encounters w inappropriate CPT alerts DM 51 % 63% 51% 41% 66% 30% 21% 47% 44% 49%

© Health Authority Abu Dhabi 2009 30

Pay for Quality and Pay for Health

• Based on compliance with evidence-based care pathways and clinical quality indicators

• Mechanism set-out in Standard Contract (between Healthcare Facilities and Health Insurers)

• Expectation it will affect base payment by <10%

• “Compliance with high quality care receives a bonus”

Pay for Quality

Pay for Health

• Based on individual health status

• Health initially defined as 10-year risk of cardiovascular event (heart attack or stroke)

• Contract between individual and Disease Management Programme

• AED1,000 per 1% reduction in risk to maximum of AED5,000 (5%)

• “No health improvement – no money”

© Health Authority Abu Dhabi 2009 31

Diabetes 35,000

Pre-diabetes 55,000

Other CVD risk factors 45,000

No current CVD risk factors 55,000

3 DMPs each with multiple services Se

rvic

e 1

Serv

ice

2

Serv

ice

3

Serv

ice

1

Serv

ice

2

Serv

ice

3

Serv

ice

1

Serv

ice

2

Serv

ice

3

“Community” of 9-12 services

experimenting with different messaging

and channel mix

DMP 2 DMP 3 DMP 1

Shared data platform means HAAD can audit effectiveness real-time

DMP RoI is locked-in by design

DMP saves two Dirhams for each Dirham spent (in addition to driving innovation and saving

more than 3,000 Emirati lives)

32

Complication

Baseline 10 year

CVD risk

Annual cost of

complication

(US$)

Annual cost of CVD

in AD (AED)

Contingent annual

fiscal liability of

CVD complications

per average

Emirati

CVD risk if the

patient enrolls

in DMP

Contingent annual

fiscal liability of

CVD complications

per average

Emirati

Annual cost

saving per

patient

Cardiovascular diseases

(MI, CVA, CCF)20% $ 69,911 256,573AED AED 51,315 19% AED 48,749 AED 2,566

In-year savings based on 1% risk reduction (AED1,000) for average Emirati with diabetes

Results coding allows us to work differently

•Understanding what is happening, without relying exclusively on interviews/word of mouth Strategy

Health System Financing

Health System Compliance

Health Regulation

Health Regulation

•Alter incentives •Introduce Pay for Quality and Pay for Health

•Monitor ongoing health status with Weqaya

•Audit clinical practice/outcomes, not inputs/buildings

•Shift weight of licensure to recognising what clinicians are actually doing

33

Solution architecture offers free basic services combined with maximum innovation

•Exposes an index of web services and applications •Hosts core web services, developed by HAAD for free, including

upload, download, and access to KEH*

* Access to KEH data is being developed by Netcetera as part of the Weqaya contract

Shafafiya.org

KEH •KEH keeps a copy of all transactions exchanged on shafafiya.org

to create an electronic health record •KEH provides data access (multiple uses)

Applications

•Applications provide a user interface and are based on the consumption of web services exposed on shafafiya.org

•Free market for applications and web services, which includes HAAD’s weqaya.ae as well as 3rd party applications such as eClaimExpress.com, JeT and Greenrain Connect

Applications Applications

© Health Authority – Abu Dhabi (2010)

Redefining Health Care Elizabeth Olmsted Teisberg and Michael Porter, 2006

35

• Seminal book on health care

• Key topic is defining value in healthcare and then value-based competition on results

• More data = More analytical power + Benchmarking

It is your life we are after…

36

Healthy

Cold

Cataract

Diabetes

Appendicitis

Duration Quality

Disease Treatment

Qu

alit

y

Age

Ideal Life

Impact of

Impact on Life: