How to make the best use of limited
resources; Keep the cost low, & quality
advent of insurance & third party Administrator concept
“managed care” is Unfolding
the costing system of this “care” has been totally
neglected. In the absence of standardization like “Health
related groups” or diagnostic related groups”, How can the relative
pricing, coupled with optimal quality be ensured ?
“Developing Integrated Care Pathways to achieve benefits
both TPA and the
It is both a
tool and a concept with much to offer.
care pathways are structured multidisciplinary care plans
which detail essential steps in the care of patients with a
specific clinical problem. They have been proposed as a way
of encouraging the translation of national guidelines into
local protocols and their subsequent application to clinical
practice. They are also a mean of improving systematic
collection and abstraction of clinical data for audit and of
promoting change in practice.”
How do Care
pathways translate into benefits at large :
to the TPA
developing a care pathway treatment gets standardized,
So standard cost packages for clinical procedures can be
developed. Extra costs get eliminated because the
pathway is designed with efficient targets eg. Number of
tests required/length of stay etc.
is spend on ascertaining validity of procedures and
Communication frequency with hospital is reduced because
the authorization process gets streamlined.
going through all documentation (amounting to hundreds
of claims a day) only those handful claims need review
which have “Variances” i.e. treatment/tests performed
extra to those approved of on the care pathway.
to the participating Hospital
treatment protocol is pre-printed, it greatly reduces
paperwork and documentation and eliminates variations in
is based on evidence based medicine / guidelines
therefore it ensures best treatment option.
protection cases can be eliminated since risk management
tools are inbuilt in the documentation and legal
requirements are taken care of.
Cost-reduction can be achieved by streaming the process
of treatment from reception to discharge.
care pathway costs are already approved, authorization
process become a very simple task, and the resources,
can be saved.
communication between the multidisciplinary care team
and the patients because of excellence of documentation.
It is a
learning process for the junior doctors because of the
pre-printed treatment guidelines, this also makes
handing over very efficient and effective.
situation"- Two case results
1) (1) BMJ
2004;328:664 (20 March)
follow heart attack guidelines save lives”
There was a 25% lower risk of dying within a year after
discharge if hospitals followed national guidelines and
taught their patients how to follow those standards at home
and in another-for every 10% increase in
adherence, mortality fell by 11”.
and after “congestive heart failure” care pathway
implementation in Canadian- USA Hospitals.
great reduction in workload, efficient & effective practice
with great output.
care pathway is a boon for the hospital because it
streamlines the work, reduces cost, reduces any risk of
consumer litigation and at the same time, makes dealing with
the TPA very simple easy.
It is unique in
being a clinical & a management tool. There are no
compromise in either case.