Het Zorgprestatiemodel – The Care Performance Model starting in 2022
The new way all costs made in mental healthcare will be calculated and reimbursed starting in 2022
On January 1, 2022, something will change in mental health care. The Care Performance Model is introduced. This is a new way in which mental health care in the Netherlands is calculated and reimbursed. Focus GGZ sees this as a good development, it is much more transparent for clients, there is a much lower administrative burden for our therapists and we can also add new components to treatments that we see as very valuable, but were not previously reimbursed.
All current treatmentplans in our current system will be administratively closed on December 31st, 2021 and new treatmentplans will be opened on January 1, 2022, according to the Care Performance Model.
Read here what the introduction of the Care Performance Model will mean for you as a client
Why a new model?
The current system in mental health care is not transparent for clients. The way the rate is calculated is very complex. This is often not traceable on the invoice. In addition, an invoice is only sent after the treatment, which is also not usual.
For healthcare providers and therapists, the system is complex and full of time-consuming administrative actions, which are often unnecessary for the effectiveness of the client’s treatment.
How does the Care Performance Model work?
The new model for mental health care is called the Care Performance Model. The name says it all: the foundation of the Care Performance Model consists of the performance surrounding the treatment.
- These performances are recognizable for everyone and they reflect the care actually provided
- The rates are based on who carries out the treatment (e.g. psychologist, health care psychologist or psychiatrist)
- The Care Performance Model is transparent: the performances are clear and well-arranged and are an actual representation of the care you have received
- The prices are in line with the care you have received. Factors such as the profession of the person performing the treatment, the duration of each consultation, the place where the care takes place, all weigh in when determining the price for the care provided
- And there is faster insight into the costs for both the client and healthcare provider. You no longer have to wait until the end of a route, because the performance is no longer linked to a longer running route, but to a day
What will change on the invoice?
On the invoice of Focus GGZ and on the payment specification of the health insurer you can see exactly when and by whom you were treated and for how long. The invoice contains recognizable information that you can easily check. You also get the invoice faster. This way you know earlier which costs have been incurred and how much you have to pay from your deductible. From 1 January 2022, the invoice will also contain the type of care demand.
Your health insurer will receive invoices based on healthcare performance and will therefore reimburse healthcare performance. You can find these healthcare performance in the digital environment of your healthcare insurer.
What performances can be found on the invoice?
On the invoice you can find the performances. At Focus GGZ 3 different care performances are possible:
- Diagnostic consultations: during diagnostics, your therapist examines which problems you are facing;
- Treatment consultation: during treatment you will talk to your therapist with the aim of making your problem manageable;
- Peer consultation: if your therapist considers it necessary for your treatment to consult with an external colleague;
The rate for these services depends on:
- Your therapists profession
- The duration of the consultation.
The rates are set nationally by the Dutch Healthcare Authority.
What is care-demand typing?
Every client is unique. But different clients do have common characteristics. A diagnosis must be made, but says little about how much care someone needs. The type of care-demand is a classification of groups of clients on the basis of the amount and severity of their complaints and problems.
The care-demand typing is done by the supervising therapist. For this, the supervising therapist uses a questionnaire called HoNOS+. This questionnaire is completed by the therapist himself on the basis of the client’s complaints and problems.
Based on the answers to the HONOS+, the supervising therapist determines which type of care-demand best suits your complaints and problems. This provides information about the expected treatment and this must also be stated on the invoice for the treatment.
The type of care-demand is not the same as the treatment plan. The treatment plan indicates which treatment is agreed with you based on your diagnosis and the goals that you agree with the therapist. During the treatment, your therapist will administer the HoNOS+ again during interim evaluations. Based on this, it will be assessed whether the treatment needs to be adjusted and whether the treatment can possibly be terminated. Of course, this is always done in consultation with you.
Would you like to know what the introduction of the Care Performance Model will mean for you as a client?
Read more here…