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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OptiMedis AG Borsteler Chaussee 53 D – 22453 Hamburg Tel: +49 40 226 211 49 0 e-mail: [email protected] Web: www.optimedis.de

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Optimedis ag borsteler chaussee 53 d 22453 hamburg tel 49 40 226 211 49 0 e mail h hildebrandt optimedis de web www optimedis de

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: [email protected]

Web: www.optimedis.de

  • Gesundes Kinzigtal GmbH

  • Strickerweg 3d

  • D – 77716 Haslach

  • Tel: +49 7832 – 974 89 0

  • e-mail: [email protected]

  • Web: www.gesundes-kinzigtal.de


The triple aim of good responsible health care

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 organized accountable health cares systems coop networks can take on responsibility

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 the southwest of germany

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

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 partners and 500 people involved in the care process

Networking – around 160 partnersand 500 peopleinvolved in thecareprocess


With f ive key success factors for health improvement

WithFive Key SuccessFactorsforHealthImprovement….


Integration of a network of smes a business effort

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)


Looking into costs finances

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 w elfare b enefits

Intangible „Welfare“ Benefits

Reductionofmortality .. prolongationoflife

Improvementofthehealthstatusofthepopulation

Improvementofthecooperativebasisofprofessions (importantforhelpingpatientsand relatives toreducetheiranxietylevel)

Strengtheningtrustintothehealth care system

Improvementofattractivenessofthehealthprofessionstogetyoungtalentsinterested (war fortalents will raiseproblemswithsmallerworkforceandmoreelderly)


Governance and investments

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?


We are looking forward to your comments cooperation

Wearelookingforwardtoyourcomments & cooperation

Helmut Hildebrandt, Vorstand,

OptiMedis AG, Borsteler Chaussee 53, D – 22453 Hamburg

Tel: +49 40 226 211 49 0

e-mail: [email protected]

www.optimedis.de

See video + website

www.gesundes-kinzigtal.de


Some literature extra website on evaluation in german english www ekiv org

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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