Talking business: Integrated Care and its ROI
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Talking business: Integrated Care and its ROI April 2 nd 2014: 50 th Anniversary of RIZIV Special Event on “National Implementation of Integrated Care” in connection with the 14th International Conference on Integrated Care, Bruxelles. Helmut Hildebrandt .

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Talking business: Integrated Care and its ROIApril 2nd2014: 50th Anniversary of RIZIV Special Event on “National Implementation of Integrated Care” in connectionwiththe 14th International Conference on Integrated Care, Bruxelles

Helmut Hildebrandt

OptiMedis AGBorstelerChaussee53D – 22453 HamburgTel: +49 40 226 211 49 0e-mail: h.hildebrandt@optimedis.de

Web: www.optimedis.de

  • Gesundes Kinzigtal GmbH

  • Strickerweg 3d

  • D – 77716 Haslach

  • Tel: +49 7832 – 974 89 0

  • e-mail: h.hildebrandt@gesundes-kinzigtal.de

  • Web: www.gesundes-kinzigtal.de


The Triple Aim* ofGood & ResponsibleHealth Care

Improve the health of the population

Efficient ( ow) per capita costs of care

Enhance the patient care experience

* Berwick DM, Nolan TW, Whittington J. (2008), The triple aim: care, health, and cost. Health Affairs 2008 May/June;27(3): 759-69.

Regional organizedaccountable health care systems (coopnetworks) cantake on responsibilitytoactastheintegrator


Regional organizedaccountable health cares systems (coopnetworks) cantake on responsibility

Regional Care Company

Ownedpartiallybyproviders, hospital, municipality, civilfoundation, seniorsorganisation, sportsclub …. publichealthorganisation

Problem: Providers couldcreateoverloadofservices (highercosts)

Solution / Governance: This RCC is being paid by the insurance for the achieved health outcome in € (related & adjusted to the normal profit ratio) instead for the number of disease/health services


Kinzigtal is in theSouthwestof Germany

Start: 2006 withfourcourageouspartners:AOK Baden-Württemberg and LKK – and Gesundes Kinzigtal GmbH(2/3 shares MQNK e.V. and 1/3 OptiMedis AG)

Concerned Population: 33,000 insureds of AOK andLKK

58% of all the GPs and specialists of the region are partners / altogether around 500 staff from partnering providers in communication loop

Nearly 10,000 patients have already chosen the free membership, getting surplus health care services, coaching and free preventive offers – but staying free in their decision to chose any provider (like in the regular system)

Providers gettheir normal fee plus targetedadd-on feesthrough Gesundes Kinzigtal … around 5-10% surplus … forthoseservices GK wantsthemtodeliver


Gesundes Kinzigtal GmbH: Population-based Integrated Care for a whole Region

Know-how of regional problems in health careprovision + links to all institutionsandproviders

Know-how in health economy, healthsciences, prevention, controlling- andmanagerialissues

ownership:

66,6% MQNK e.V. (Ärztenetz) 33,4% OptiMedis AG

Twoconvincedpartners: A localphysiciannetwork „Ärztenetz MQNK“and a managementcompany „OptiMedis AG“thatstemsfrom a healthsciencebackground

Twopartnerswithpassionandmotivationtoprovetheeffectivenessof a betterorganized regional healthcaresystem in thehandof a dedicated Regional Care System

A companywith a businessmodelthatrewardsinvestments in betterhealth & andbetterfocusedhealthcare … ifitresults in improvedearningsforthepayor (= healthinsurance) = lesscostsofcare (in comparisonwith national standard)


Networking – around 160 partnersand 500 peopleinvolved in thecareprocess


WithFive Key SuccessFactorsforHealthImprovement….


Integration of a networkof SMEs = a businesseffort

Whatarethe „normal“ costs in business ?

Lookingintothe „production“ of Integrated Care …. => comparabletotheintegrationofthesupplychainofotherbusinesses

Aligningtheincentives / ICT-integration / aligningandconvincingthe SMEs working in theprovisionof care whoarecompetitors … => comparableto „clustermanagement“ projectsofnewtechnologies

Activatingthepatientstousethefull potential oftheirresources in reducingcosts …. => comparabletomassmediacampaigning like HIV-campaigns / comparabletousingconsumersown time insteadofemployees (bankingbusiness)


LookingintoCosts / Finances

Kinzigtal – 33 000 insuredpeople => 74 000 000 € total costsof care per year

Investment = Costsforaligning / administration / campaigning / analyzing => 2 200 000 € per year (meanoverfiveyears)

Results = GainforHealthInsurances / Sickness Funds => brutto: 5 000 000 € per year (meanoverfiveyears)=> netto: 2 300 000 € per year (meanoverfiveyears) (after sharingtheresultwith Gesundes Kinzigtal GmbH and after taking off theowntransactioncosts … estimated)


Intangible „Welfare“ Benefits

Reductionofmortality .. prolongationoflife

Improvementofthehealthstatusofthepopulation

Improvementofthecooperativebasisofprofessions (importantforhelpingpatientsand relatives toreducetheiranxietylevel)

Strengtheningtrustintothehealth care system

Improvementofattractivenessofthehealthprofessionstogetyoungtalentsinterested (war fortalents will raiseproblemswithsmallerworkforceandmoreelderly)


Governanceand Investments

Need tointerestmultidisciplinarynetworks in improvinghealthstatusandinvestintohealth … not just fortheshortrun but forthelongrun

Need for a regional interested (social) entrepreneurcapabletoinvestintothetransitionfromacute care oftodayinto a chronic care andpersoncentered care ofthefuture => comparabletothe ACO-organisations in the US / Kaiser Permanente

Start-Up Investment … whopaysandwhoearnsthe ROI afterwards?


Wearelookingforwardtoyourcomments & cooperation

Helmut Hildebrandt, Vorstand,

OptiMedis AG, Borsteler Chaussee 53, D – 22453 Hamburg

Tel: +49 40 226 211 49 0

e-mail: h.hildebrandt@optimedis.de

www.optimedis.de

See video + website

www.gesundes-kinzigtal.de


SomeLiterature – extra website on evaluation in german/englishwww.ekiv.org

Hermann C, Hildebrandt H, Richter-Reichhelm M, Schwartz FW, Witzenrath W. Das Modell „Gesundes Kinzigtal“. Managementgesellschaft organisiert Integrierte Versorgung einer definierten Population auf Basis eines Einsparcontractings [The „Gesundes Kinzigtal“ model: A managementcompanyorganises a population-basedintegratedcaresystem on thebaseof a shared-savingsapproach]. Gesundheits- und Sozialpolitik 2006;(5-6):11-29. [in German].

Hildebrandt H, Hermann C, Knittel R, Richter-Reichhelm M, Siegel A, Witzenrath W. S Gesundes Kinzigtal Integrated Care: improving population health by a shared health gain approach and a shared savings contract. International Journal of Integrated Care [serial online] Vol. 10, 23 June 2010 Available from: www.ijic.org

Hildebrandt H, Schulte T, Stunder B. Triple Aim in Germany: Improving population health, integrating health care and reducing costs of care in the Kinzigtal-region – lessons for the UK? Journal of Integrated Care, Vol. 20 Iss: 4, pp.205 - 222 (2012). Emerald Group Publ. DOI: 10.1108/14769011211255249

Siegel A, Köster I, Schubert I, StösselU. Utilization Dynamics of an Integrated Care System in Germany: Morbidity, Age, and Sex Distribution of Gesundes Kinzigtal Integrated Care´s Membership in 2006-2008. In (Janssen C, Swart E, Lengerke T v. Ed) Health Care Utilization in Germany. Springer 2014 DOI 10.1007/978-1-4614-9191-0 pp.321-335


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