German Health Care Policy - Implications for the Management of Innovation

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1 German Health Care Policy - Implications for the Management of Innovation Dr. Norbert Klusen CEO of Techniker Krankenkasse, Germany American & German Healthcare Forum 2010, University of Minnesota Minneapolis, 27 April 2010

2 Funding of Innovation in German Statutory Health Insurance Statutory Health Insurance (SHI): 166 insurance funds provides health care for 85,1% of German population p original basis for health care provision: Collective bargaining (Partly) Good access SHI pays for the "medically necessary" Access to innovation: Inpatient: General access, if not excluded Drugs: Immediate access after market authorization Outpatient: Access after approval by GBA Financial i challenges Cost rise rise of SHI expenses continously above rise of assessable income of members Late Reforms Central Health Fund restricts insurers' financial autonomy Risk-adjustment scheme Selective contracting Facing pharmaceutical innovation 2 Source: TK

3 Financial Gap of Statutory Health Insurance (SHI) Growing financial gap throughout the last years 140 GDP per resident SHI expenditures per capita (member) Assessable income per capita (member) expenditures exceed revenues Index 1995 = Source: BMG, Statistisches Bundesamt, GKV-Schätzerkreis, TK

4 Immediate access to new medical procedures and drugs has TOP-priority for the insured In the case of changing your insurance, what would be a MUST with your future insurance? (mark top 5 critera) Qualified service staff Above-average range of benefits Access to innovative medical procedures and drugs, supporting development of innovation Provision of alternative medicine Extensive preventive medical services Makes quality of care transparent to customers Access to networks of doctors Provision of interdisciplinary healthcare centres Wide network of local service-points Accessability 24 h / 365 days Saving options, e.g. optional tariffs 45,5% 45,4% 44,6% 43,7% 43,4% 41,5% 35,1% 31,4% 28,5% 24,7% 22,2% Partial repayment of premiums 15,3% 4 Source: TK-Servicebarometer 2009 (criteria declared by interviewees in %)

5 Need for the Management of Innovation by TK Several Fields of Managing Innovation & management of innovation Innovation Medical innovation Social innovation Medical products/ procedures Drugs e.g. integrated care, service innovation, behavioral innovation Provide quick access to good innovation at minimized risks Manage costs in order to sustain funding of highh quality health care Add social innovation to product innovation 5 Source: TK; Pfaff 2009

6 Access of Innovation to the Collective Contractual System Outpatient Care: Lengthy Processes, Benefit often Unclear Institute for Quality and Efficiency in Health Care here: Non-drug interventions Completed evaluations 21 Specific request Recommendations Interventions with reported positive benefit 7 Federal Joint Committee (GBA) Approx Start consultations IQWiG Final report PET/CT for Lymphatic cancer: benefit not assessable* Expected reports for other indications Unclear results and long evaluation ation times often due to missing research data 6 Source: WINEG 2010; IQWiG * Decision by GBA still pending

7 Management of Medical Innovation by TK Provision of Innovative Concepts via Selective Contracts TK provides product innovation and social innovation Example: PET/CT for breast cancer* PET/CT-examination for insured with diagnosed cancer Selective contracts with quality-assured medical centres Cost advantage: 695$ p.c.** Added social innovation, e.g. social counseling Second opinion before back operations Integrated care contract for lung transplantations Service innovation, e.g. Medical Hotline Clinic Guide TK-award for innovative ideas 2010: Improve access to innovation Generate scientific data to evaluate benefits / risks Economic benefit "Ideas for the Future" 7 Sources: TK * other indications: lymphatic cancer, bowel cancer ** compared to conventional diagnostic procedures (Sloka et al. 2007)

8 TK provides Innovative Services in Many Different Fields Long Tradition as Innovator Innovative services MRT-managed focussed treatment of uterus-myoma Interdisciplinary treatment for back pain patients with outcome-oriented remuneration Health care network for psychological indications with capitation payment Early detection of cancer TK Health Coach promotes healthy behavior and improves curing process TK Online-dialogue supporting patients' skills for shared decision making Elective health plans responding to clients' needs 8 Source: TK Innovative offers are accompanied by the TK-owned scientific institute t

9 Management of Costly New Drugs Cost Management in Relation to Benefit of New Products Rise of drug expenses (2008: +5,3%) Drugs Average SHI continously above SHI expenses 150 expenses Status quo Rising share of patent drugs (cost rise 2008: +19,3%) only 41% of new drugs (2008) considered to be genuine innovations = ,7 148,1 What is needed Quick access to genuine innovation has to be maintained Rapid evaluations of newly approved drugs regarding their benefit Pricing for new drugs according to their benefit (innovation / Metoo) Selective contracts for innovative drugs, including social innovations (e.g. patient participation processes) SHI Required: more freedom for insurers to realize cost-savings savings for products without added benefit in order to finance genuine innovation Sources: TK-calculations; BMG (2009, 2007, 2003); Arzneiverordnungsreport 2009

10 TK - For a Safe, High Quality and Sustainable Care Innovation Management for an Optimized Health Care For a successful management of innovation we need a reliable financial i basis to finance costly new products and procedures as well as the accompanying research. effective screening, management and evaluation processes to promote promising new products. a combination of product and social innovation, e.g. service innovation, according to the needs of the patients. 10

11 Thank you for your attention