Service: Enhanced Care Management - Prediction model for hospitalisation/assistance

Responsible organisation: Estonian Health Insurance Fund (Central-Government)

In 2015, the Estonian Health Insurance Fund started cooperating with the World Bank to develop and pilot a risk-based management model that would help increase the integration of health services. With risk-based management, GPs can identify patients with multiple chronic diseases on their list for whom additional prevention, counseling and monitoring would be most beneficial to their health and quality of life. If these patients are neglected by the GP teams, this can lead to serious problems, including unnecessary deterioration in health, which not only causes health damage but also unnecessary costs to the healthcare system (avoidable hospitalizations, duplication of examinations, etc.).The created solution finds the best algorithm for predicting which patients with selected diagnoses are likely to be hospitalized. In the solution, the EHIF database of medical bills first finds certain conditions / diagnoses to be included in the algorithm.

Additional information

Source Open Innovation Regione Lombardia
Web site https://www.haigekassa.ee/sites/default/files/uuringud_aruanded/1.7.%20Report%20pf%20ECM%20Pilot%20Evaluation.pdf
Start/end date 2016 -
Still active?

Related cases