Transcript The 2nd Annual Chronic Care Congress, Cornelius Erbe, DAK

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
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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
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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
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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
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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
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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,
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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
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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
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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
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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
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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
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