Implementation of an Acute, Unscheduled Care Network for an Integrated Payer & Provider System in Chile: Alternative Sites for Increased Access and Cost Control


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Access to high quality acute care in Chile is limited to the population able to pay for private insurance or out-of-pocket. This variable performance leads to disparities in outcomes and preventable morbidity and mortality. A conceptual model for acute unscheduled care in Chile, that consists of four domains: Social and Individual Determinants of Health, Care Decision Making, Care Delivery and Outcomes, is presented as a description and analysis to identify essential factors that contribute to injury or illness, setting choice, care transitions, quality and value. To discuss focused areas for improvement, crowdsourced ideas about ways to improve acute unscheduled care in Chile were synthesized into 17 solution areas. Using a Delphi approach, solution areas were then ranked by feasibility and importance and discussed by 6 individuals with key roles in the Chilean acute unscheduled system, to divide them into high, mid, and low priority solutions. The process yielded a prioritized list of solutions which could serve as a roadmap to improve acute, unscheduled care. A plan to grant access to care and control spending for a population enrolled in a health plan with a 20 year history of overutilization of resources in the urgent care setting was elaborated leveraging on the background mentioned above and implemented following implementation science and change leadership methodologies, showing success for the first time.



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