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How payers could meet the challenges – A German approach Dr. Cornelius Erbe, DAK, Germany OPEN DAYS European Week of Regions and Cities Brussels, October 7, 2008 1 Our figures. Our facts. One of Germany's largest statutory health insurances Experts in health care since 1774 Over 6 million customers Nationwide network of 750 branches Around 14,500 competent and friendly staff Annual expenditure [2007]: EUR 13.8 billion in health insurance EUR 1.4 billion nursing insurance Test winner – many awards for quality of treatment and service 2 In Germany, growing problem from demographic change and increasing medical cost for chronic patients PROBLEM Effect on Growing proportion of older and chronically ill Germans Costs for patients suffering from chronic diseases are on average twice as high as for those without chronic diseases Costs associated with chronic diseases rise as a function of co-morbidity on average more than threefold compared to those without chronic illness Transfer of morbidity-related risks from care providers to German Statutory Health Insurances (SHI) in 2009 Decreasing transparency of SHI-specific care options for members and service providers Introduction of Health Fund/possible supplementary premium requires offering special rates, e.g. for chronic patients Costs Quality & customer satisfaction Source: Sachverständigenrat für die Konzertierte Aktion im Gesundheitswesen III p208/209 3 Which objectives do we want to achieve with regard to managing chronic patients? CUSTOMER SATISFACTION Accompaniment and guidance of the insured QUALITY Improvement of compliance/basis for COST CONTROL through the health care system across sector boundaries Development of an understanding of the insured taking into account his/her overall environment (co-morbidity, social environment, etc.) Offer of superior service quality participation of the patients Transparency concerning customized treatment options Improvement in quality of life DAK OBJECTIVES Prevention of co-morbidity and thereby overproportional cost increases Prevention/avoidance of hospitalization Long-term condition management performed according to specified guidelines 4 Providing qualified support for chronic patients will help us to achieve our objectives Objective of support RESULT Support motivates the insured to engage in a healthy lifestyle Stabilization of the disease, prevention of co-morbidity and avoidance of further demand for care services Increased cooperation of the patient improves the doctor-patient relationship Cooperation of the insured in his/her therapy and acceptance of personal responsibility Level of information held by the insured gives him/her a more active role as a patient Indirect motivation of the GP and other service providers to optimize care Providing support to the chronic patient leads directly or indirectly, via the service provider, to the achievement of our objectives 5 This is the DAK approach: frequency and type of support depend on the severity of the illness Telephonic High Risk Care Management Few Patients Highest Risk Most Intense Intervention Intensive one-to-one nurse/patient care management for the highest-risk, 3 most complex of the population Highly trained Care Managers well informed about community resources Social and family-wide intervention; caring for the caregiver As risk for hospitalization is reduced, patients are transferred to Level 2 Telephonic Disease Management Care management for all diseases and co-morbidities Nurse team intervention model with care managers with optional remote 2 patient monitoring Adherence to standards of care, medications, promotion of behavior change, lifestyle modification and self management skills Doctor-directed care plan integration Risk reduction leads to transferal to Level 1 Supported Self-Care Many Patients Lower Risk Less Intense Intervention 1 LEVEL Ongoing relevant and personalized patient mailings Web-based patient wellness portal Healthways in-bound health coach line and assessment tools Optional self care solutions and programs Source: Healthways 6 Pilot in Bavaria and Baden-Wuerttemberg: Over 200,000 candidates included, approx. 40,000 already enrolled Enrollment process 25,000 100% 90% 80% 19,000 70% 60% 50% 40% 30% 20% 10% week 1 week 27 First Contact Motivation Call Consent Start of program Results Contact by Letter Flyer Consent form First telephone contact: Informing the candidates about the advantages of participation in the program Welcome call Gathering Information Classification with Embrace® Approx. 40,000 Waiting for incoming consent forms of the candidates In the case of no response, second motivation call The program can start only with candidates' consent! (predictive modeling) Classifying the patients by their individual support level candidates enrolled • In Bavaria 22,600 • In BadenWuerttemberg 17,400 7 In addition to the economic assessment an independent evaluation is undertaken Key data Challenges Additional acquisition of 5,000 extra Approx. 10% sample Collected in pilot region Chosen at random Assessment of quality of life using the EuroQol instrument Basis for analysis: Cost of ambulatory care, hospital care, pharmaceutical spendings, etc. participants Problem to win over members of the control group Coordinating the design of the survey with the scientific institute Side effects compromise statutory RSAV-DMP Contractor Prestigious institute of health economics at a well known German faculty of medical science 8 Lessons learned: Five key success factors Health care policy and legal framework need to be supportive Adaptation of the program to the specific cultural context is crucial Integration of all stakeholders (patients, GPs, politicians, authorities, professional associations, etc.) needs attention (and time!) Public reaction is not always positive but don't give up too early Don't lose sight of your customers' needs and interests 9 We look forward to creating a win-win situation for our members, the doctors and our company DAK Increase of quality of life Increase of loyalty of our members Reduction of longterm complications Improvement of our brand image Experience of a superior medical service Avoidance of overproportional cost increases DOCTORS Improvement of doctor-patient relationship win win PATIENTS Increased cooperation of the patients Reduction of administrative work compared to DMPs 10