Patient and Health Care Management in German Health Care

Transcription

1 Patient and Health Care Management in German Health Care Dr. Jens Christian Baas Member of the Board of Management of Techniker Krankenkasse European Health Care Conference, WINEG 20 May 2011, Hamburg Historically, competition among health funds in Germany was purely driven by price Insurant 12 growth 10 BKK R 2 = 0, in % p.a. 6 4 TK 2 GKV 0-2 VdAK DAK AOK -4 Barmer -6 12, ,5 14 Average contribution rate (%) 2 Source: BCG analysis Seite 1

2 Today, funds need to also compete on service quality and health management capabilities TK survey: What are important factors in choosing your health funds? No additional insurance premium. Above average medical services. Access to innovative products and procedures and development of new products. Has highly qualified experts and service staff. Reimbursement of alternative medicine, e.g. homeopathy, acupuncture. Quality checks of doctors and hospitals and regular feedback. Reimbursement of individual prevention programs up to EUR 100 p.a. Local service offices with personal points of contact Medical centres with coordinated, quick access to specialists and short waiting times. Medical networks with quick access to reknown specialists of high reputation. Accessibility 24 hours at 365 days per year. Special program rewarding health-conscious behavior. Saving options by elective health plans and special programs. Elective health plans for individualized health or extended health insurance. Refunding premium to insured. Supplementary insurance. 46,9 39,2 37,5 37,0 33,9 32,8 28,0 26,1 25,4 23,5 22,9 21,3 19,0 17,1 12,1 11,7 3 Source: TK Trend Monitor Health 2010 Health management combines intelligent offers with active patient and doctor involvement. Elements of successful health management by sickness funds Patient empowerment Health offers Doctor's support A successful health management combines innovative, efficient and cross-sectoral services with an active patient empowerment in order to promote patient information, competencies and participation, as well as it actively involves and supports physicians. 4 Seite 2

3 Health management aims at the customers' benefit by improving quality and efficiency of health provision. 5 Health offers increase customer benefit by: Improved access to innovative and qualityassured services Better coordinated by cross-sectoral contracts Coordinated for chronic diseases Improved quality and efficiency of pharmaceutical therapies * TK NetzWerk Psychische Gesundheit TK Regional networks for mental health* Ergotherapy Psychotherapy Primary Sociotherapy Specialist Point of coordination 24h TKconsultants Crisis pensions Ambulatory psychiatric Coordinated ambulatory for mentally ill by cross-sectoral providers Aims to improve health outcomes as well as efficiency by reducing hospital stays Managed elements, e.g. central person of contact, capitation payment, outcome-oriented remuneration A successful health management requires patient management by patient empowerment. Information services centre) Medical advisory centre (TK-Ärztezentrum) Quality assessment tools Hospital guide (TK-Klinikführer) Medical information 24/7 High acceptance and satisfaction of users (2011: 79% of users were content) New: hotline for a second medical opinion 76% of TK insured (2009): Hospital guide is "important / very important" Information and quality assessment tools are completed by offers to support patients' health competencies, e.g. shared decision making. 6 Source: Trend Monitor 2009; n=1.003, numbers in % Seite 3

4 Patient empowerment includes to know the patients' needs by giving them a voice. In order to know the patient better, TK conducts regular surveys among the insured. In a customers' advisory committee (Kundenbeirat) TK-insured bring in their wishes to further improve their sickness fund. The scientific institute of TK (WINEG) conducts health services research. very imporant Extensive counseling sessions Close cooperation between hospitals and physicians/ between physicians of different specialites Quick access to reknown specialists Short waiting times, quick appointments for surgery Physician/hospital meets special quality standards Avoiding unnecessary double examinations Use of new diagnostic procedures Start of rehab measures at the day of discharge from hospital Use of new therapeutical techniques Surgeant coordinates all treatments and measures Ambulatory surgery with option for overnight stay One-stop medical treatment because the attending physician carries out the surgery as well Hospital accomodation in 2-beds-rooms important less important not important Which aspects do the insured prioritize in case of a serious or chronic illness? 7 Source: Trend Monitor 2009; n=1.003, numbers in % Health management largely depends on the active involvement of medical providers. Today: predominantly indirect relation to doctors via the patient Information services for doctors TK Arzneimittelreport (drug report) Evidence-based manuals for the use of doctors, e.g. doctors' manual on depression TK Arztberatung (doctors' advice) Contractual agreements in selective contracts incentivize high- quality and cost-efficient treatment Pay-for-performance Integrate evidence-based guidelines Future focus: increasingly direct involvement of doctors Provide active support of doctors Co-manage patients as 'extended arm of the doctor' Control doctors' cost-efficiency of therapy Give administrative support Provide trainings for doctors Take administrative load of doctors to reinforce their focus on medical supply 8 Seite 4

5 Conclusion Health management in Germany is already carried out with wide acceptance and the patients benefit of an increasing consumer orientation. Yet there are various pitfalls: The German HC system does not provide the necessary financial options to fund innovative HC management models. There is a wide lack of measurable quality targets for health provision. Much remains to be done More patient orientation is needed, esp. better transparency regarding the quality of medical services. The focus has to expand from pure service orientation to measurable quality management. The future success of health management will depend on the perceived quality of by the customers, as well as the financial efficiency of the services in the long run. Therefore, a reliable competitive frame is needed. 9 Thank you for your attention! Who is the one with the insurance package "human kindness"? Seite 5