Minister Speaks To ABIC About Health Strategy

February 21, 2018

Earlier today, Minister of Health Kim Wilson spoke to members of the Association of Bermuda International Companies [ABIC] about the Bermuda Health Strategy and the health-related elements in the recent Budget.

Minister Wilson said, “The Ministry of Health is one of the largest Ministries in the Government. Our mandate is very significant and we oversee a sector that represents 11.4% of the Island’s GDP.

“You will have heard by now of the great news that Health benefitted from increases in the most recent budget. These are largely to reinstate the Government subsidy for patient care at the hospital. But it also includes $1.8 million to begin to recover public health services that had been left unfunded for several years.

“In particular, what I’m most excited about is the funding to re-open 10 beds at the Sylvia Richardson Care Facility. I cannot tell you how much the country needs this long term care capacity, particularly as we know the strains put on acute care beds at KEMH by long stay patients.

“But today I’m speaking about the Bermuda Health Strategy.

“Some of you may have been asking, “what will happen to the Health Strategy under the new Government?” … I’m pleased to tell you that we are progressing full steam ahead with it.

“One of the first things I looked into when taking over the Ministry was the status of the National Health Plan. And I realized very swiftly that the Bermuda Health Strategy is, effectively, the same strategic plan for reforming the health system.

“Although some time was lost in between the two, many good things have advanced, and we are now picking up momentum to press ahead with the more challenging reforms needed to contain health costs and ensure coverage is affordable to all.

“You will recall that the Bermuda Health Strategy outlines the priorities to reform our health system. It’s vision is that of the Ministry of Health: “Healthy people in healthy communities” – because that is what it’s all about.

“Its mission is “to provide affordable and sustainable healthcare for all Bermuda residents”. This encompasses the spirit intended by this Government: to achieve Universal health coverage. That is our goal, and we have every intention of achieving it.

“The Health Strategy is founded on three core values: Quality, Equity and Sustainability. I want to tell you about the things that have been achieved to date and, more importantly, what we plan to do next.

“Starting with the core value of ‘Equity’, achievements in this regard the following examples:

“The Health Insurance Department introduced two significant benefit innovations to deliver better care to patients who often end up on a revolving door at the hospital. Namely, the Personal Home Care Benefit and Enhanced Care Pilot. In addition, BHB established the Patient Centred Medical Home for the un- and under-insured. I will talk about these more in a moment.

“We are also working hard to contain premiums, which has been helped by the previous reduction in BHB fees for long stay, dialysis and diagnostic imaging. As painful as these fee reductions have been for providers, ultimately they translate to premium reductions, which is vital to improve accessibility.

“We are currently converting BHB fees to the relative value method to ensure rational, standardized fees which, in the long term, will better enable us to contain health costs.

“Now on to the ‘Quality’ core value.

“Good quality care reduces health costs because it avoids over-treatment and prevents the need for costly interventions. Some of the achievements in this regard include the following:

“The Health Insurance Department is experimenting with a different way to pay healthcare providers so they are rewarded for good outcomes. The Enhanced Care Pilot pays providers a set monthly fee to manage a patients’ chronic conditions, plus a bonus at the end if their health outcomes are met.

“The Health Council has developed a Unique Patient Identifier, based on Social Insurance numbers, as the foundational element to an electronic health system. The UPI is currently being piloted with Department of Health health centres, the developing chronic disease registry, and three private providers.

“In addition, the Pan American Health Organization [PAHO] conducted an assessment of Bermuda’s infrastructure for an integrated electronic health information system. Their report and recommendations should be with us soon.

“The Residential Care Homes Act was amended in December to bring dramatically improved standards to rest homes. We are currently consulting on a draft Code of Practice, which will clarify standards and expectations for everyone.

“Further, as part of the Long Term Care Action Plan, the Health Insurance Department collaborated with BHB in developing a Long Term Care Assessment tool. This has now been implemented at KEMH and is being piloted with several care homes. The purpose is to ensure appropriate assessment of seniors’ needs prior to admission so that the right care level can be delivered, anywhere in the system.

“In addition, we are implementing long-needed updates to our mental health legislation to improve the quality of care for persons in need. You will have heard of the open consultation taking place now, and I invite you to review the proposals and give feedback if this issue is important to you.

“Improvements have also been made to the oversight of healthcare professionals, and we are looking at further enhancements to make sure health professional boards are appropriately supported to regulate their own professions.

“Ultimately, if we want better quality, we will need health professionals to be better accountable to their regulatory bodies, like the Bermuda Medical Council. I note, however, that there are 24 separate professional regulatory bodies, so this initiative is a significant undertaking.

“As I said, these are just examples to give a flavour of progress to date.

“Next is Sustainability

“It is well established that some of the primary drivers of health costs in Bermuda are chronic disease, the ageing of our population, and utilization of expensive treatment options, in particular emergency room and hospital beds. A great deal of work is underway to improve things in this regard.

“First is the Department of Health’s Obesity and Diabetes Framework, which was a Throne Speech initiative under this Government to tackle the scourge of chronic non-communicable diseases like diabetes and heart disease.

“I’m sure you heard about the framework when we held the “Commit to Change Symposium” in January – we got great coverage for this and it got a lot of people talking. This framework was developed with wide community consultation and engagement and it is our best hope at “halting the rise in obesity and diabetes” in this country.

“Next is the Sugar Tax, which you will have all heard about by now. This initiative was in our platform and our Throne Speech, and it has developed quickly presenting an exciting opportunity to send the strongest message to the community that this Government is serious about tackling obesity and chronic diseases. The consultation finishes at the end of this month, and we will move fast thereafter to implement a new regime in June this year.

“And, in addition, there are the innovations in healthcare benefits which we are piloting to try to reduce healthcare costs by delivering better chronic disease management and driving care out of the hospital, to the community, where it rightly belongs.

“The Enhanced Care Pilot [ECP] is provided by the Health Insurance Department for eligible under-insured or uninsured persons with specific chronic diseases: obesity or overweight, hypertension, diabetes, asthma/COPD, and coronary vascular disease [hyperlipidemia].

“The ECP benefit includes comprehensive case management, community doctor’s visits, medications without co-pays and transport assistance where needed. The intent is to change the chronic disease care model by improving chronic disease management. There are 190 patients enrolled with good levels of patient satisfaction and early indication of improved outcomes, such as weight loss and reduced medication needs.

“The benefit is funded out of the Mutual Reinsurance Fund and targets high-cost patients to reduce hospitalization. The programme is being evaluated for effectiveness to determine its long term viability.

“The Patient Centred Medical Home is a sister-service to the Enhanced Care Pilot, which is provided by BHB directly for patients with more complex needs without a community physician. The benefit is funded by BHB for most patients, but the ECP covers eligible clients.

“The benefit is for eligible patients with a GP referral and/or identified as ‘superusers’ of emergency services. It covers comprehensive care, including visits from a primary care team for chronic disease management.

“Lastly, the Personal Home Care Benefit offered by HIP and FutureCare covers skilled and unskilled assistance with personal care and/or dementia care at home for eligible policy holders. It includes home care, nursing and day care services. The benefit has exceedingly high levels of patient satisfaction and strong indication of cost effectiveness.

“The benefit is highly cost-effective as its average monthly cost is $1,850 per participant, compared to $4,000 to $5,000 for a care home, $20,000 for a long-stay bed at BHB and over $40,000 for an overflow bed at KEMH.

“This benefit has also stimulated positive workforce opportunities as the caregiving sector has expanded and demand for the Bermuda College nursing associate programme has increased. Given its popularity, cost effectiveness and early promise, the Ministry is looking at how this benefit can be extended to the full insured population.

“As you can see, a lot of movement has been taking place under the auspices of the Health Strategy, and I’m proud that the seeds we planted with the National Health Plan is what led to all of every one of these initiatives.

“However, we are still short of the major prize: universal health coverage. Where are we with that?

“Actuarial work has been completed pricing a whole new basic benefit package developed under the National Health Plan, and presenting options to reform our health financing in order to achieve universal coverage.

“We are looking for a new basic package that can include preventive as well as curative and specialist services. We are considering primary care, diagnostic tests, prescription drugs, long term care and overseas care, in addition to local hospitalization, of course. And we are looking at the options available to pay for it.

“Financing option models were proposed by the Finance and Reimbursement Task Group together with our actuaries, and we are gearing up to share more on these proposals. Nut in a nutshell we need to change the model to a more streamlined way to finance healthcare than what we have currently.

“This is the work that I’m most excited about for the coming year. I’m pushing my teams because I want these reforms in place for 2019, and we have no time to waste.

“To wrap up, that summarizes the achievements to date under the Health Strategy, the priorities underway and the next steps coming soon.

“I want to end by saying how pleased I am to have secured the health portfolio. I believe in this so much and I want to make change happen.

“I’m not going to lie: it has not been easy. Few people know the magnitude of the health portfolio – or the deficits it is suffering with respect to funding, staffing and long term care capacity.

“Nevertheless, I remain steadfast and committed to seeing the financing reforms through, and I hope you will follow our progress.”

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  1. shrew says:

    National Health = Income Tax