Integrated Care. Helmut Hildebrandt

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1 Virtual Study Tour to Germany Integrated Care Helmut Hildebrandt Helmut Hildebrandt, CEO, OptiMedis AG & CEO Gesundes Kinzigtal GmbH Borsteler Chaussee 53, D Hamburg Tel: , Fax:

2 What is the right kind of care today? Demographic situation ti... More people getting older Lifestyle-related diseases proceed Many diseases are to some extent associated e.g. comorbidity of depression and diabetes... Less people are accepting traditional medical authoritarian style but call for participation p in decisions

3 New economic consideration for payors = sickness funds / health insurances In Germany health policy makers of all parties believe in competition as incentive for creating innovation and to keep costs down competition between sickness funds as well as between providers Sickness funds cover about 90% of the population = regulated market / 10% are covered by health insurance plans = private market The sickness funds in the regulated market have the same premium (this goes to a national agency and is distributed to the funds after a risk adjusted scheme that uses morbidity trees to develop a fair payment to the funds) but vary whether they have to ask for a separately paid surplus premium

4 New economic consideration for payors = sickness funds / health insurances Sickness funds compete about surplus premiums, services and offers to the patients and about selection (healthy vs sick) They have to ask: What are the strongest interventions in increasing health status and keeping costs down? Who is offering a comprehensive and sustainable solution serving my population? With what kind of reimbursement scheme do I attract the right spirit... not too much interventions ti but not too few as well... tackling the right people... using the newest technology but with as few costs as possible?

5 Integrated Care in Germany Discussioni of Managed Care in the US / first projects / development of physician networks 2000 German Health Care Reform Act introducing Integrated Care as selective contracting possibilities to sickness funds and providers or groups of p. or companies connected with providers 2004 New law allowing for start-up-financing until end of Pharmaeutical Companies may contract with sickness funds as well

6 The future of health care provision / German HC Advisory Board

7 Managed volume / Market of Integrated Care in Germany today Around 12 billion managed volume in Integrated Care contracts t and other Selective Contracts * * * 1 billion paid by sickness funds to IHO directly * * Quelle: Eigene Berechnungen von OptiMedis auf der Basis der KV45-Daten der GKV, eigene Schätzungen bzgl. HzV-Verträge

8 Health Market in the Future: Important Players: Integrated Health Care Systems Trad. way: The health care system is characterized by fragmented provision of care from different sectors, each under different economic constraints, and not oriented towards patient benefit but towards the provider s economic interest. This results in multiple issues regarding information and care management, leading to redundant services and interventions with no economic incentive for providers for efficient management of the care delivery process. Phys Hosp Reha. Nursing Prescr. The new way: Reengineering the chain of care through integrated health care systems, which contract with sickness funds and also with care providers. Contractor/Network management company A Contr./NMC B Contr./NMC C

9 The solution: Population-based Integrated Care sharing the health gain Oi Origins i of the concept: Managed Care in US and Switzerland... ICDS = Integrated Care Delivery Systems Disease Management age e & Predictive e Modelling Salutogenesis... Health sciences Organisational psychology Consumerism Ian Duncan, FSA MAAA, DMAA

10 Gesundes Kinzigtal GmbH: Population-based Integrated Care for a whole Region Two convinced partners: A local physician network Ärztenetz MQNK and a management company OptiMedis AG that stems from a health science background means two partners with passion and motivation to prove the effectiveness of a better organized regional health care system in the hand of a dedicated Integrated Delivery System. Ärztliche Erfahrung zu den Versorgungsproblemen vor Ort und Kontakte zu den anderen regionalen Leistungserbringern Gesundheitsökonomisches Wissen, Prävention, Controlling- und Managementkompetenz, Investitionsfähigkeit Gesellschaftsanteile: 66,6% MQNK e.v. (Ärztenetz) 33,4% OptiMedis AG 10

11 OptiMedis manages ICDS-Systems in various regions in Germany Interessenten: evtl. Rendsburg, Dithmarschen, Steinburg Interessenten in Berlin Interessenten: Lingen (Ems), Medi OWL - Bilfld Bielefeld Interessenten: ANR - Arztnotruf Lahn-Dill Kooperationspartner: QuE (Nürnberg-Nord) und UGOM (Amberg) Interessenten: GENESA (Saarlouis), Ärztenetz Südwest (Rheinland-Pfalz), Ärztenetz Neuwied Most advanced Interessenten: GesundheitsNetz Süd (8 Netze) Interessenten in München

12 Salutogenesis = approaches improving the patient physician p (hc worker) interaction Coaching the patient, t shared decision i making, empowering the patient and his or her relatives and shifting emphasis on prevention, health promotion and disease management Health related goals being jointly defined between patient and doctor and monitoring adherence over time Empowering and training the physician (hc worker) via feedback, video analysis of his or her interactions ti with the patients t Developing and using innovative technology like telemedicine, ambient assisted living, prevention and diagnostics as well as programmes for health and disease management Living quality management in the entire group

13 Sharing the health gain (contribution margin) over the next ten years Sickness Funds AOK + LKK Baden- Württemberg Managing the System - taking risk Providers - without risk

14 Investing into Health Gain Financial Invest Fees to the providers & costs of programmes and admin Know-how Invest Know-how of the local physicians towards therapeutical potentials Know-how of the management and OptiMedis AG (and intensive use of universities) Evidence Based Medicine + Prevention Rebates and incentives, contracting with pharmaceuticals Added Contribution Margin (related to prior intervention) Contribution margin (revenue to costs...morbidity, sex and age adjusted) Share of sickness funds Share of Gesundes Kinzigtal

15 Networking around 100 partners and 300 people involved in the care process... April 2011 Partners No. Enrolled Insurees of AOK and LKK Providers with Family doctors, specialists, psychotherapists... around 52 partnership 50% of those working in the area contracts Staff in the provider offices ca. 180 Hospitals...around 85% of all cases 6 Physiotherapists (project on osteoporosis) 5 Nursing homes 11 Ambulatory nursing agencies 4 Further partners in cooperation Pharmacies... around 70% of all p. 16 Physiotherapists, other therapists 5 Fitness-Centers... ca. 80% 6 Vl Voluntary associations, sports clubs, social clubs 23 15

16 Programmes on Prevention, Health Promotion and Disease Management just a few of them Nov Programmes Partic. Heart Failure cohort 1: Call Center + Telemedicine i / cohort 71 2: Chronic Care Model monitoring through physician assistants Adipositas: early intervention to prevent the metabolic 155 syndrom and diabetes Smoking Cessation Kinzigtal: Ärztl. intensiv begleitete 156 Raucherentwöhnung mit multimodalem Programm AGIL Aktive Health Promotion with the Elderly: Training sessions in groups regarding nutrition, exercises, social issues, medication and wellbeing Crisis intervention with psychotherapists: Family doctors have access for patients to psychotherapists on the spot Osteoporosis: Prevention of fractures in a modular setting using exercises, nutrition, medication and monitoring Case Management: Patients t with complex social problems or 122 addiction may be supported by phys. & case worker

17 Programmes on Prevention, Health Promotion and Disease Management some more Jan 2011 Disease Management programmes + other interventions Disease- Management Programmes Diab. mell Card. 295 Breast C 15 Asthma 112 COPD 169 Gesamt Healthy Kinzigtal moving Voucher scheme to support active membership in sport and gym clubs (as well dancing, singing, golf, tennis, soccer...) = 15 EUR and rebates for membership in fitness-centers/ gyms Preventive medical checkup U10 and U11 and amblyopie: Gesundes Kinzigtal pays the expenses for the enrolled kids 484 Aqua-Fitness for enrolled insurees Specific nutrition counselling Programmes for Health Promotion at the Workplace Programmes to improve medical support in nursing homes participants Patient University = Medical Education oriented towards development of self management competency (health literacy) incl. prevention of falls

18 Patient University = Medical Education to name just a few Organized in cooperation o with the adult education center e Kinzigtal Osteoporosis... (Dr. Feyrer, Dr. Edlich) Arthrosis... (Dr. Feyrer, Dr. Edlich) Snoring... (Dr. Kuhlicke) tick-borne diseases...(dr. W. Stunder) Asthma and allergies Scin cancer... ( Dr. Haagen) Vaccination for children... (Dr. Steinhausen) Pulmonary diseases and gym Eye affections and diseases with the elderly... (Dr. Binder) Stress disorders... (Dipl.-Psych. Kind) Allergies... (Dr. Daxer) Migraine... (Dr. M. Keßler) Asthma and infektious dieseases Asthma with children and youth...(dr. Dengel)

19 Health management is organizing it means to gather and share informations Internet Portal for sports, gym and other club activities for our physicians and their staff and our members Gesundes Kinzigtal GmbH

20 20 OptiMedis AG Gesundes Kinzigtal GmbH...and organizing campaigns and rallys... smoke free restaurants

21 ... and developing a joint documentation = electronic medical record over all physician practices... Der Arzt trägt die Patientendaten wie bisher in sein PVS- Programm* ein (aber gleiche Kürzel) * Turbomed, S3, Medistar Jede Nacht werden die GDK-Daten auf alle Kommunikationsserver, wo der Patient schon mal seine Karte gegeben hatte, synchronisiert Dort sind sie verschlüsselt und nicht einsehbar Patient gibt der Praxismitarbeiterin seine Karte = Schlüssel. Praxis-MA gibt Karte in Lesegerät. Verschlüsselte Information ist geöffnet 21 OptiMedis AG Gesundes Kinzigtal GmbH

22 ... and data analyses + Benchmarkreports... Gesundes Kinzigtal i GmbH gets all cost, claims, diagnosis data of the sickness funds for all the insured in this region (pseudonymous data) Beispiel: Depressionen Fallzahlen, Gesamtkosten nach Sektoren gesicherte Arztdiagnose: F32 F34 F34 * 2.Q.07 1.Q.08 Anzahl der Fälle in % Arzneimittel ,8% Krankenhaus ,8% Arzt ,0% Arbeitsunfähigkeit / Krankengeld ,8% Kur ,8% sonstige Kosten ,8% Gesamt % * F32. Depressive Episode, F33. Rezidivierende depressive Störung, F34. Anhaltende affektive Störungen Analyses of diseases and of their development over time... to be able to learn and renavigate our efforts Additionally we are able to inform our physicians about the effexts of their treatments... Example: How many of your chronic patients have had a hospital stay in this year? 22

23 In short: With higher Quality we achieve a higher Contribution Margin Targeted and really tangible care management and organization of integrated health care Optimized health and disease management of those parts of the population that are under risk New insurees via an attractive offer - with freedom to choice Improving the contribution margin of the sickness fund

24 Surprisingly positive Improvement of the Contribution Margin for the sickness funds... already within the first two-three years!! 6% We standardized the contribu- 4,82% 5% tion margin prior to the intervention for the whole 4% 3,38% population, whether part of the 3% 2,08% invention or not = Reference 2% Only the surplus delta defines the success = in % 4,82 Attention: The result refers to the contribution margin for a) all around insurees (but only enrolled insurees at the end of 2008) b) 2008 was only the 3rd year and the project was until 7/07 still in its inital phase. 1% 0% 120 EUR 100 EUR 80 EUR 60 EUR 40 EUR 20 EUR - EUR 2.HJ HJ2007 HJ HJ HJ HJ HJ

25 Strong reduction in the deficits for Insurees with Osteoporosis* Rd Reduction rate 2005 to 2008: -78,50% Deckungsbeitrag pro Versichertenjahre *Diagnosen: M80., M81. exkl. Verdachtsdiagnosen

26 Promising improvement of contribution margins for insurees in nursing homes Deckungsbeitrag pro Versichertenjahre

27 Some results of the scientific evaluation We spent about million on Evaluation Process + Outcome Evaluation Here are some results of the Evaluation on deficits as well as over supply of care (Unter-, Über- und Fehlversorgung) from the pmvforschungsgruppe, Universität zu Köln

28 scientific evaluation: higher ratio of use of generic drugs

29 scientific evaluation: Less use of benzodiazepine drugs

30 scientific evaluation: lower ratio of fractions incurring by patients with osteoporosis

31 We are looking forward to your comments Invitation: We are looking for further partners in cooperation Please contact Helmut Hildebrandt, Vorstand, OptiMedis AG, Borsteler Chaussee 53, D Hamburg Tel:

32 Some Literature extra website on evaluation german/english Hildebrandt dt et al: (2010): Gesundes Kinzigtal i Integrated t Care: improving population health by a shared health gain approach and a shared savings contract. International Journal of Integrated Care Vol. 10, 23 June Hermann C. et al. (2006): Das Modell Gesundes Kinzigtal. Managementgesellschaft organisiert Integrierte Versorgung einer definierten Population auf Basis eines Einsparcontractings. Gesundheits- und Sozialpolitik 5-6, S

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