Project references

The consultancy was undertaken for Medicare Australia. The project scope included the defining, design, pilot testing, evaluation and planning for the roll-out of a new provider payment system based on DRGs. Karol Consulting provided technical assistance related to project management and activity coordination.

The consultancy was undertaken for Medicare Australia and aimed at improving health financing effectiveness and quality of care by developing prospective payment and budgeting mechanisms based on AR-DRGs. Activities included: evaluation of hospital budgeting systems; analysis of provider incentives; review of payment models; activity-based funding design; development of classification and coding standards. Karol Consulting provided technical assistance related to project management and activity coordination.

This project was comprehensive in scope and included: analysis of health and economic data; review of health financing processes; analysis of the roles of the public and private sector; development of proposals for a mandatory and universal health insurance system; design of a basic benefits package; development of a provider payment framework including DRGs; establishment of a national health financing authority; development of the operational principles for the health insurance system; a financing reform implementation plan; the design of a social marketing strategy; and the development of a framework for a health information system.

The objective of the project was to review and modify the existing co-payment policy in Macedonia in order to support the financial sustainability of the basic benefits package and protecting access to services by the vulnerable groups. The project: reviewed the current system of user fees and co-payments and proposed a policy on exemptions from user fees; examined the financial and equity impact of policy scenarios; addressed matters related to compliance and informal payments; and advised on how additional revenues can be generated by the Macedonian Health Insurance Fund.

The consultancy developed management and finance training modules for hospital and primary care managers as part of the national health reform initiative. The training modules covered the following topics: nature of healthcare delivery systems including, responsibilities, organization, administrative practice, and performance evaluation; healthcare financing including budgeting, costing, fiscal control and purchasing; and quality of care including standards, clinical pathways and reporting.

The project implemented an activity-based hospital payment system using the Australian AR-DRGs classifications. The aim of the new payment model was to provide incentives for hospitals to improve their efficiency and quality of care. Project activities included: developing standardised systems of hospital data collection; DRG coding training and feedback to providers; collection and analysis of DRG data; development of an activity-based hospital payment model; advise on the phasing-in of performance payment incentives; developing approaches for DRG costing and financial modelling of hospital payments; development of the Macedonian DRG grouper; and capacity building of the national health insurance fund and hospitals.

The project involved a situational analysis of the DRG implementation process in Croatia that included a review of the status of DRG coding, activity data analysis, and cost data collection. This was followed by an evaluation of current approaches to DRG costing including top–down and bottom–up methods, and recommendations on a costing approach appropriate to Croatia. The main activity was developing DRG cost-weight values and DRG prices. This was undertaken using data from Croatian costing studies, as well as cost information from comparable jurisdictions that used the AR-DRG system. Supplementary activities included: hospital DRG performance benchmarking; recommendations on a national DRG training program; and a DRG Development Action Plan.

The consultancy was undertaken for Medicare Australia and aimed at improving health financing effectiveness and quality of care by developing prospective payment and budgeting mechanisms based on AR-DRGs. Activities included: evaluation of hospital budgeting systems; analysis of provider incentives; review of payment models; activity-based funding design; development of classification and coding standards. Karol Consulting provided technical assistance related to project management and activity coordination.

The consultancy was undertaken for Medicare Australia. The project scope included the defining, design, pilot testing, evaluation and planning for the roll-out of a new provider payment system based on DRGs. Karol Consulting provided technical assistance related to project management and activity coordination.

The objective of the project was to review and modify the existing co-payment policy in Macedonia in order to support the financial sustainability of the basic benefits package and protecting access to services by the vulnerable groups. The project: reviewed the current system of user fees and co-payments and proposed a policy on exemptions from user fees; examined the financial and equity impact of policy scenarios; addressed matters related to compliance and informal payments; and advised on how additional revenues can be generated by the Macedonian Health Insurance Fund.

This project was comprehensive in scope and included: analysis of health and economic data; review of health financing processes; analysis of the roles of the public and private sector; development of proposals for a mandatory and universal health insurance system; design of a basic benefits package; development of a provider payment framework including DRGs; establishment of a national health financing authority; development of the operational principles for the health insurance system; a financing reform implementation plan; the design of a social marketing strategy; and the development of a framework for a health information system.

The consultancy developed management and finance training modules for hospital and primary care managers as part of the national health reform initiative. The training modules covered the following topics: nature of healthcare delivery systems including, responsibilities, organization, administrative practice, and performance evaluation; healthcare financing including budgeting, costing, fiscal control and purchasing; and quality of care including standards, clinical pathways and reporting.

The project involved a situational analysis of the DRG implementation process in Croatia that included a review of the status of DRG coding, activity data analysis, and cost data collection. This was followed by an evaluation of current approaches to DRG costing including top–down and bottom–up methods, and recommendations on a costing approach appropriate to Croatia. The main activity was developing DRG cost-weight values and DRG prices. This was undertaken using data from Croatian costing studies, as well as cost information from comparable jurisdictions that used the AR-DRG system. Supplementary activities included: hospital DRG performance benchmarking; recommendations on a national DRG training program; and a DRG Development Action Plan.

The project implemented an activity-based hospital payment system using the Australian AR-DRGs classifications. The aim of the new payment model was to provide incentives for hospitals to improve their efficiency and quality of care. Project activities included: developing standardised systems of hospital data collection; DRG coding training and feedback to providers; collection and analysis of DRG data; development of an activity-based hospital payment model; advise on the phasing-in of performance payment incentives; developing approaches for DRG costing and financial modelling of hospital payments; development of the Macedonian DRG grouper; and capacity building of the national health insurance fund and hospitals.

The consultancy advised the Government of Macedonia on health reform policy issues including: the content of the basic benefits package; co-payment schedule; and the role of voluntary health insurance in the health financing framework. Activities included: production of financial estimates of for the benefits package and prospective co-payment income; advising on the options for the introduction of voluntary health insurance and the content of insurance packages; and review of the health insurance law and advice on amendments.

The project aim was to assist the Croatian Institute for Emergency Medical Services in the development of a strategy and standards for EMS in both pre-hospital and hospital settings. Project activities and recommendations included: a review of the current systems; review of international EMS standards and best practice; advice on EMS standards appropriate for Croatia; advice; on methods to rationalise the current system of EMS delivery, including the geographic re-distribution of EMS centres; and advice on reforms of the EMS operational systems and new EMS staffing arrangements. The final deliverable was an EMS reform implementation plan that included a time-frame for EMS reforms.

The project objective was to implement a hospital DRG payment system that would create incentives for efficiency improvements. The project was divided into four phases and included the following activities:

• Development of a change management and a communication strategy
• Review of previous activities related to the reform of the hospital payment system
• Review of the current IT capacities in acute hospitals
• Translation of AR-DRG documentation
• Development of an AR-DRG grouper and related software for case data collection and analysis
• Conduct of training in DRG system operations and case coding, for all national hospitals and Health Insurance Funds
• Undertaking of a DRG pilot across all acute level hospitals including DRG data collection and analysis
• Analysis of the results of the pilot and conduct of financial modelling for payment purposes
• Preparation of an Action Plan for the national roll-out of the AR-DRG based payments system including recommendations for performance-based contracting and health service pricing.

This project was undertaken in a joint venture with Digitel komunikacije. The goal was to assist the Ministry of Health in strengthening its communication messaging and in developing and implementing a nation-wide public awareness campaign to support Croatian health care reform. Project activities included: conduct of public opinion surveys; planning and launch of the public awareness campaign; organisation of stakeholder forums; and briefings for journalists.

The activity was part of Montenegro’s hospital reform initiative and involved: implementation of the AR-DRG patient classification system; AR-DRG training in case coding and data analysis; design of a hospital financing strategy for activity-based funding; design of a new hospital contracting system to include performance measurement using DRGs; and development of an Action Plan for the further development of DRG capacity and full implementation of the DRG system.

Development and on-going support for software that assists hospital staff to accurately code case data for grouping purposes. The software provides direct and easy access to relevant classifications in local language for use in the coding of principal and secondary diagnoses, as well as interventions.

The project involves both, an intensive training program aimed at improving the quality of DRG coding in three hospitals, and a monthly case by case review of DRG data to identify any shortcoming in coding accuracy. Reporting includes a commentary on the quality of coding practice, identification of miscoding events and recommendations on specific coding issues that require attention.

The aim of the consultancy for two hospitals was to improve the quality of DRG coding in order that hospitals accurately record their actual inpatient activity levels for payment. Activities included an intensive training program aimed at improving the quality of DRG coding, and a monthly review of hospitals’ DRG data to identify shortcoming in the quality of coding.

The consultancy involved the review of hospital operations and funding and included training on the features of the DRG funding model and its requisite processes. Recommendations were made on opportunities to increase hospital funding and methods by which the DRG payment model can be used to optimise revenue.

The project objective was to undertake a large pilot involving 100 hospitals to demonstrate the feasibility of implementing the DRG based payment system in Ukraine. The project involved the following activities:

The objective of the assignment was to develop a provider payment and contracting mechanisms for primary care. The issues that were addressed in the course of model design included supporting equity of access, coordination of funding methods, payment based on performance including quality of care, and referral systems.

Technical assistance aimed at improving the hospital financing system through introduction of case-based funding. The scope of the activity included: assessment of case management information system; developing case grouping criteria; undertaking a cost-accounting analysis; adoption of case-group weights and base rate; designing forms of contract between hospitals and funders; assessing training needs for the implementation of case payment; and collection and analysis of inpatient case data.

This activity extended activity-based funding for non-impatient services. The project included the development of new classifications and the grouping of care categories that are similar in resource use for both outpatient and emergency care services for use in an activity-based payment system.

The analysis of hospital activity was undertaken to pave the way for the introduction of the DRG based payment model. Activities included a comparative analysis of inpatient caseloads of three hospitals and made use of available data to calculate their relative efficiencies. Other activities undertaken included advising on the implementation of performance-based contracting, analysis of the hospitals’ income streams, development of inpatient budgets, and planning the implementation of the activity-based payment model.

This consultancy developed a strategic plan and pathway for advancing the implementation of the DRG system. The aim was to make use of DRG data to accurately measure hospital activity, and introduce incentives for efficiency gains. The report provided the framework for future developmental activities and identified priority interventions.

The System of Health Accounts is the standard international methodology that reports on both, national health funding and expenditure. The project developed TB and HIV Sub-accounts for assist in the monitoring of financing flows used in the prevention and treatment of these important infectious diseases. A key data source used for the activity was the national DRG activity data set.

The project objective is to review options for the contracting-out of non-clinical services (NCS) by public hospitals. Key activities included:

• Identification of relevant legal and operational issues associated with the potential the contracting–out of NCS Determining the services suitable for possible outsourcing or spin-off, focusing on laundry, cleaning, and food services
• Review of the potential advantages and risks of the various contracting-out options
• Estimation of the potential cost savings of outsourcing NCS
• Development of model contracts and service performance specifications for outsourcing NCS
• Design of an Action Plan for the implementation of NCS reforms

The project was undertaken for the Andrija Stampar School of Public Health and supported the building of national healthcare management capacity. Karol Consulting had responsibility for the healthcare contracting component and provided the following services: a training needs analysis to identify current skills and attitudes as well as priority needs; a training methodology and program; training content and reading materials for 10 training modules; delivery of interactive training sessions that included theory, case studies and exercises.