Evidence Based Reimbursement Programme (EBRP)
Daman's goal is to ensure that our patients get the best quality of care from our network providers while ensuring that costs are allocated efficiently. To help achieve this goal, Daman is implementing an Evidence-Based Reimbursement (EBRP) programme to evaluate the performance of network providers as a basis for making adjustments in payment levels. Daman will use a number of metrics to produce a recommended performance-based Payment Factor Adjustment (RPFA) for each provider.
The RPFA will be derived from a combination of the Clinical Performance Score, Structural Performance Score and Financial Performance Score. In phase one of the programme, Daman will be rolling out the metrics to start collecting the baseline data of Measurement year mid 2014-mid 2015 with selected hospitals. Daman has selected a series of metrics designed to evaluate the performance of health care providers. The metrics include:
- Structural Metrics, that reflect the conditions in which providers care for patients, and evaluate the capacity of the provider to deliver contracted health services.
- Clinical Metrics, that show the quality of clinical care the provider is administering. There are two categories within the clinical metrics:
- Process Metrics, that show whether evidence-based practices are followed correctly and evaluate whether a specific action was completed.
- Outcome Metrics, that present the actual results of care and evaluate how well the provider is helping patients achieve good health.
- Financial Metrics that broadly captures indicators of cost and efficiency of health care provision.
Daman will be collecting the structural metric data by observing the providers’ facilities, behaviour, trend, and capabilities. Daman will collect data on the clinical and financial metrics through claims submitted for patient services. A provider’s performance on applicable metrics will determine whether patients are receiving efficient and quality care.
Daman will monitor provider performance on the metrics, and will study their correlation to broader health outcomes, such as patients’ quality of life, long-term health outcomes, and overall cost of care.
Daman will use this analysis to refine the selection and weights of metrics and to provide performance feedback to providers.
Metrics Overview - For each provider, Daman will calculate a score that incorporates the structural, clinical and financial metrics described above, using the EBRP tool. Click here to see the full list of the available metrics.
Daman will be organizing walk in sessions with the providers for questions, suggestions & feedback. For further clarification, please contact your Provider Relations Officer or PRDqueries 02 614 9702 for Providers in Abu Dhabi. You may also email us at firstname.lastname@example.org.