Meningkatkan Mutu Pelayanan

dan Efisiensi Rumah Sakit

KUNTJORO AP
DANIEL BUDI WIBOWO
SEMINAR “Membuat tarif INA-CBG’s Cukup”
YOGYAKARTA, 8 NOPEMBER 2017
Healthcare Megatrends 2016 – 2020 ; Manatt.com, 2015
Customers take charge
• Consumers pay more and make
more care decisions, using social
media/apps to acquire
price/network data.
• More micro-marketing, more
links to social media/ wearables,
managing dynamic network
information.
More value
• Providers take risk for
population/patient/product
outcomes, requiring new care
models and contracts.
• More risk sharing, regulating
risk-based payments, managing
narrow networks, linking
to/from pharma.
Healthcare everywhere
• Care monitoring and delivery
move out of traditional settings,
shifting the locus of / focus on
patient loyalty.
• Managing multiple data flows,
engaging non-traditional sites of
care, assuring privacy and
security.
Mega Health Systems
• Providers and payers consolidate
to manage costs and enhance
pricing power, fighting for the
Care Management space.
• Focus starts to shift away from
system-formation to system-
optimization.
Centrality of the states.
• States become more active regulators and purchasers, creating
marketplace mosaics and more “experiments.”
• Aligning payment models across payers, managing waivers, navigating
multiple regulators.
Value through data
• Data on health status &
effectiveness become widely
available, changing practice and
payment patterns.
• Reconciling clinical and claims
data, establishing governance
structure, preparing for breaches
Predict – Prevent - Personalize
• Bigger datasets yield insights,
informing personalized care and
challenging price-setting and
patient privacy.
• Central vs. local analytics,
connecting prescription and
medical, developing new
pathways, patient targeting
strategies.
Employers recalibrate.
• Employers’ role continues to
erode, while exchange plans
sharpen focus on multi-year
patient loyalty.
• Engaging employees, negotiating
plan/network parameters,
managing coalitions and retirees
.
The new Aging
• Digital natives’ and baby
boomers’ interests coalesce,
forcing focus on new ‘late-
life/end-of-life’ care models.
• Aligning across medical and
LTSS, addressing workforce
shortages, linking to self-
monitoring tools
Healthcare goes Global
• Visibility into global prices and care models improves, requiring providers
to justify value and pricing.
• Managing trans-national price differences, linking local after-care to out-of-
country procedures, licensing.
• Social determinants accepted as major cost driver, leading to increased
focus on service integration.
• Building strong local relationships, aligning payment/ reimbursement,
addressing regulatory barriers .
Global Hospital Trend

Profit
Capping
Value
based
Less
service
person
Use of
Artificial
Digitalized
intelligence
Hospital.
 Balancing – JKN Stakes Holder

PROVIDER THIRD
PARTY
PAYOR
BPJS-K
GOVERNMENT
INDONESIAN
Hospital
Challenges
in JKN Era

PATIENTS
 Effectiveness : Relates to providing care processes and
achieving outcomes as supported by scientific evidence.

Efficiency : Relates to maximizing the quality of a comparable

unit of health care delivered or unit of health benefit achieved
for a given unit of health care resources used.

Equity : Relates to providing health care of equal quality to

those who may differ in personal characteristics other than
Quality Domains their clinical condition or preferences for care.
(Institute of Medicine -
IOM Domains) Patient centeredness : Relates to meeting patients' needs and
preferences and providing education and support.

Safety : Relates to actual or potential bodily harm.

Timeliness : Relates to obtaining needed care while minimizing

delays.
WHAT MAKES A “PERFECT” HOSPITAL ?
• Staying Healthy. Getting help to
avoid illness and remain well.
• Getting Better. Getting help to
recover from an illness or injury.
• Living with Illness or Disability.
Getting help with managing an
ongoing, chronic condition or dealing
with a disability that affects function.
• Coping with the End of Life. Getting
help to deal with a terminal illness.
CanMEDS,2014
Principles of Hospital Quality
1. Patient Centered Care on every stage of service;
2. Stress on patient safety as primary duty of all clinical staff, set up 6
major safety targets;
3. Stress on problem oriented medical quality;
4. Continuous improvement of hospital management based on
management tools and big data evidence;
5. Create hospital culture of valued base service, safety, morale,
learning and innovation.
Problem oriented, insist on evidence, tracing, continuous improvement and SOP
Value in hospital care.

the core issue in the delivery of hospital Value = Health Outcomes

care today is the value of hospital Cost of delivering
care delivered the outcomes
Where does efficiency comes from ?

Hospital Operation Resources

Operation
Process Development Human
Capacity Purchasing and Resource and
Supply strategy Technology and
Strategy. remuneration
Strategy improvement
Strategy strategy
 Impact of miss capacity Operating Theatre

Lost of Revenue
Less 1 OT USD 5.1 milion USD per OT/year (estimated)

Over invest CAPEX 2.75 juta USD per OT and

Over 1 OT
maintenance cost.

IHF – UIA Collaboration project: reducing

hospital operating cost through better design
IHLM - 2017
danielpantiwilasa@gmail.com