Universität München Fakultät für Informatik Lehrstuhl für Wirtschaftsinformatik (i17) Sebastian Dünnebeil Helmut Krcmar

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1 Universität München Fakultät für Informatik Lehrstuhl für Wirtschaftsinformatik (i17) Sebastian Dünnebeil Helmut Krcmar

2 Market Engineering for Electronic Health Services Technische Universität München Chair for Information Systems Sebastian Dünnebeil Ali Sunyaev Jan Marco Leimeister Helmut Krcmar HICSS, Maui January 7 th, 2012

3 Agenda Motivation Telemonitoring of Chronic Heart Failure The Market Engineering Methodology Socioeconomic, Technical and Legal Environment The Transaction Object of the Market Microstructure, Infrastructure and Business Structure Conclusions

4 Motivation - e-health Applications can: Save Lives (Lappé et al. 2004, Helms et al. 2007, Kempf/Schulz 2008) Reduce Costs and Increase Efficiency (Bernnat et al. 2006, Whitten et al. 2001, Shekele et al. 2006) Increase Quality of Life and Quality of Health Services (Stroetmann et al. 2006, Kosock 2009, Becker et al. 2008) However, e-health applications are hardly adopted in OECD Countries. (DesRoches et al. 2008, European Union 2007, European Union 2010)

5 Example: Chronic Heart Failure (CHF) Heart failure is one of the most widespread chronic diseases in Germany. (Neumann et al. 2009) Decompensation of CHF, caused by heart attack or pneumonia, leads to fluid retention and uncontrolled hypertension. (Krum/Abraham, 2009) CHF caused the highest number of hospitalizations, reported to be caused a single disease. (Neumann et al. 2009) 60% of all CHF related costs were caused by hospital stays.

6 Implications of CHF in Germany In ,000 patients with a diagnosis of CHF lived in Germany. The treatment cost in 2006 summed up to 2.9 billion. About 1.1% of all national health expenses. (Neumann et al. 2009) An annual financial benefit of at least 3,000 per patient can be achieved using telemonitoring. (Helms et al. 2007) 1/3 of the total average cost of approximately 9,000 per year. How to design a market in order to support the prevention of CHF by telemonitoring?

7 Methodology - Market Engineering Market Results (allocation and prices) Behavior of the market participants Transaction Services (Market Structure) Infrastructure Microstructure Businessstructure Transaction Object Socioeconomic, Technical and legal environment Market Quality (Interpretation of the results, considering the environment) Market Engineering Framework according to (Weinhardt et al., 2003) Desired market result is the best possible monitoring of CHF. Avoidance of hospitalization, lack of work and expenses caused by CHF. Savings resulting from prevention of CHF should be distributed to the stakeholders as incentives. Satisfying market results are achieved, when telemonitoring solutions report equal results in the field as in clinical studies.

8 Socioeconomic Environment The Ingolstadt Region 500 Physicians Research Cooperation Insurants Inhabitants Patients suffering CHF. 360 Patients are insurants of the Audi BKK. Market Volume of approximately 1 Mio.

9 The Technical Environment Healthcare Telematics HPC/EHC Web- Service Central Telemedicine Services Applications Medical Applications Added-Value Applications Connektor Local Services Web- Service Healthcare Telematics Value-Added Services

10 Legal Environment German Public Health Fund Equally financed by employees, employers and a tax subsidy. Treatment and medication are part of a fixed service portfolio. Telemonitoring is not yet part of that portfolio. Health insurances can conclude a contract with physicians and their representing organizations to provide integrated care services. 140a of the 5 th book of the code of social law (SGB5) Bundesrepublik Deutschland, Sozialgesetzbuch (SGB) Fünftes Buch, Gesetzliche Krankenversicherung (2011)

11 The Transaction Objects of the Market Registration once a year Health Insurance Participant Patient Max Max Mustermann Mustermann Date Datum /01/2011 Weight 92 kg Gewicht 92 kg Heart Herzfrequenz Rate 60 Schläge/Min. 60 bpm Blood Pressure (Sys) Blutdruck (Sys) mmhg mmhg Blood Blutdruck Pressure (Dia) (Dia) 87 mmhg 87 mmhg Max. 31 Data sets monthly Physician Max Max Mustermann Mustermann (Q1 (Q1 2011) 2011) Max Mustermann n One Report per Quarter Service Provider 750 Patients (Q1/2011) Compliance Ø 87 % Hozpitalization 347 Days Lack of Work 473 Days CHF-Treatment 5742 EBM Max. 750 Datasets per Quarter 50 Herzfrequenz (S/Min) Gewicht (KG) Blutdruck (Dias, mmhg) Blutdruck (Sys, mmhg) Compliance Compliance 92% 92% Hozpitalization Hospitalisierung 2 2 Days Tage Lack Arbeitsausfälle of Work 33 Days Tage CHF-Treatment HI-Behandlungen EBM EBM Recommendation developed by the Heart Failure Association of the European Society of Cardiology (2010)

12 The Microstructure Who does what and to whom?

13 Infrastructure - Patients Application WII - Balance Board ehc eid (encryption) (signature) Web- Service Telemonitoring Service AusweisApp 2.0

14 Infrastructure - Monitoring Interfaces for Physicians Overview Patient Details

15 Infrastructure Allowance Overview for Physicians

16 The Business Structure- Initial Period t0 CHF Annual Cost: 9,000 per patient Utilization of Telemonitoring Potential Savings: 3,000 Revenue for Providers: 735 Incentive for Caregivers : 900 Incentive Ratio 2/3 1/3 Incentive for Patients : 365 Potential Net Savings: %

17 The Business Structure - Savings in tn The business structure reflects the payments and fees to achieve the desired outcomes. The financial flow is an adverse flow of the transaction objects. Savings achieved in the previous period (t n-1 ) are distributed to the stakeholders in the current period (t n ). The annual spending for CHF result from the total treatment costs in ambulatory care and hospital cases caused by CHF. Saving t n = CostCHF to CostCHF tn

18 Allowance for Physicians Allowance is paid each quarter and reaches up to 30% of the achieved saving (gain sharing). Reflects the sum of all savings achieved for their patients. In case of high physician and patient compliance (> 80%), the compliance factor is agreed to be 1. Possible quarterly amount of 225 per patient ( 900 per year) n i=1 gain sharing i compliancefactor i saving payment division i = 3 =1 0,

19 Conclusion The German health system has currently no regular market model for e-health. The paper illustrated how health insurances and physician networks can create a market for e-health services, to harvest the benefits identified in clinical studies. In case of CHF existing studies indicate that potential fund savings are sufficient to finance a new market just by the increase in treatment efficiency. Successful e-health pilot applications can be moved to the regular allowance portfolio of the health insurance.

20 Thank you very much! Further Questions? Sebastian Dünnebeil Fakultät für Informatik Technische Universität München