Journal de la démence

Abstrait

Caberj Maturity Program: Integrality, Susteinability and Quality in care for the elderly brings financial and economic results

João André Cruz Gomes

The study addresses a health care model of the elderly practiced by a health care provider in the city of Rio de Janeiro, RJ, Brazil, focusing on the age group of the elderly, population segment in which the greatest misconceptions are identified. The current assistance models did not consider the deep transformations observed in the new epidemiological and demographic reality of the country. Considering that the aging process in Brazil is relatively recent, this study presents a proposal for a contemporary care model, recommended by the most important national and international health agencies as the most suitable for better care, focusing on the promotion, prevention of health care and the coordination of care, in order to avoid excesses, waste and fragmentation. The assistance and financial results of this study display very positive figures and indicate the path to be taken by healthcare companies. To present the economic results used from the claims analysis of a chronic management program and its impact on sustainability, from a portfolio of supplementary health clients over the last 4 years. Methodology - Descriptive study, type experience report. Loss data from June 2014 to July 2018 were analyzed. Results - This type of care that favors comprehensive care and prevention through continuous monitoring of the health conditions of members and coordination of care in all instances of care. attention, showed positive results in relation to the reduction of the customer portfolio loss ratio, as we observed in the first year was 108.2%, in the second 85.4%, in the third 82.46% and in the fourth year 70.85%. Conclusions - These results demonstrate that clinical stabilization through continuous follow-up with a care navigator and referral physician contributed to a reduction in consultations with specialists and unnecessary diagnostic tests, consequently leading to greater cost control of the operator.