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Effectiveness and cost-effectiveness of care management programs for the indications Alzheimer's disease and multiple sclerosis - Results of an empirical survey of the German statutory health insurance. Sonja Ivancevic Lennart Weegen, M.A. Lasse Korff, M.A. Dr. Anke Walendzik

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Effectiveness and cost effectiveness of care management programs for the indications

Effectiveness and cost-effectiveness of

care management programs for the indications

Alzheimer's disease and multiple sclerosis -

Results of an empirical survey of the German statutory health insurance

Sonja Ivancevic

Lennart Weegen, M.A.

Lasse Korff, M.A.

Dr. Anke Walendzik

Prof. Jürgen Wasem

Dr. Sarah Mostardt

Institute for Health Care Management and Research


Research project

Research project

Institute for Health Care Management and Research


R esearch project

Research project

  • Developing efficient managed care programs for the chronically ill – ethic, economic, legal and social aspects

  • Aim

    • analysis of possibilities and conditions for efficient care management programs

    • identification of potential limits

  • Selected indications:

    • Alzheimer‘s disease (AD)

    • Multiple sclerosis (MS)

Institute for Health Care Management and Research


R esearch project1

Research project

  • Sub-project:

    • inventory of health economic evaluations concerning care management programs for Multiple sclerosis and Alzheimer´s disease

    • identification of effective and cost-effective aspects of existing care management programs for developing new efficient care programs

    • methodological approach:

      • systematic review

      • surveyof the German statutory health insurance

Institute for Health Care Management and Research


Survey of the german statutory health insurance methodological approach

survey of the German statutory health insurance – methodological approach

Institute for Health Care Management and Research


M ethodological approach 1 2

Methodologicalapproach 1/2

  • Empirical qualitative survey

    • standardized questionnaire

    • subjects:

      • existence of care management programs for both indications

      • evaluations regarding their effectiveness and/or cost-effectiveness

  • Sample:

    • 40 largest of the totality of 144 statutory health insurances

    • selected by the number of insured population

    • selection contains 90% of statutory insured population

Institute for Health Care Management and Research


Respondent statutory health insurances

Respondentstatutoryhealthinsurances

  • BKK Verkehrsbau Union

  • BKK vor Ort

  • Daimler Betriebskrankenkasse

  • DAK-Gesundheit

  • Deutsche BKK

  • HEK - Hanseatische Krankenkasse

  • hkk

  • IKK Brandenburg und Berlin

  • IKK classic

  • IKK gesund plus

  • IKK Nord

  • IKK Südwest

  • KKH-Allianz (Ersatzkasse)

  • Knappschaft Bahn See (KBS)

  • Mhplus Betriebskrankenkasse

  • Novitas BKK

  • Pronova BKK

  • Schwenninger Betriebskrankenkasse

  • Siemens-Betriebskrankenkasse (SBK)

  • Techniker Krankenkasse (TK)

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AOK Baden-Württemberg

AOK Bayern

AOK Bremen/Bremerhaven

AOK Hessen

AOK Niedersachsen

AOK Nordost

AOK Nordwest Direktion Dortmund

AOK Nordwest Landesdirektion Kiel

AOK Plus

AOK Rheinland/Hamburg

AOK Rheinland-Pfalz/Saarland

AOK Sachsen-Anhalt

Audi BKK

Bahn-BKK

Barmer GEK

Betriebskrankenkasse Mobil Oil

BIG direkt gesund

BKK Essanelle

BKK Gildemeister Seidensticker

BKK Pfalz


Effectiveness and cost effectiveness of care management programs for the indications

Methodologicalapproach 2/2

  • Postal questionnaire

  • Survey period:

    • november 2012

  • Follow-up

    • resend of 20 questionnaires in january 2013

  • Telephone enquiry

    • february-march 2013

Institute for Health Care Management and Research


Results of the survey

Resultsofthesurvey

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Survey participation

Survey participation

More than 90% ofstatutoryinsuredpopulation

response rate

65%

numberofinsurants ca. 53 Mio. (76%)

Institute for Health Care Management and Research


Number of existing managed care programs for multiple sclerosis and alzheimer s disease

Number of existing managed care programs for Multiple Sclerosis and Alzheimer‘s disease

Institute for Health Care Management and Research


Effectiveness and cost effectiveness of care management programs for the indications

„InterdisciplinaryHealth-Care Model forPatientswith Multiple Sclerosis in North Rhine“ Nelles et al. 2010

  • 2-Year Follow-Up (pre-post comparison)

  • sample: 319 patients

  • results:

    *p<0,05

    ¹ statedaretheaccountingsofpatientswithat least onevisitoftheinstitution in the last 12 months.ARR= absolute riskreduction; RRR= relative riskreduktion

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Discussion and conclusions

Discussion and conclusions

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Discussion

Discussion

  • For both indications currently available evaluations do not allow a qualified assessment of the effectiveness of care managemnt programs

  • Low number of published evaluations:

    • sensitive data, only for internal use

  • Possible causes for the failure of evaluation:

    • internal controlling is considered as sufficient

    • disproportionately high effort

  • Managed care programs in development

    • evaluation occurs with delay

  • No involvement in evaluations of contractual partners or no information about results

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Discussion1

Discussion

  • Limited incentives for the statutory health insurance in developing care management programs for Alzheimer’s disease

    • excluded from Morbi-RSA

    • low costs of illness for the health insurance

    • most costs apportioned to informal carers and care insurance

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Annual costs of illness for alzheimer s disease in germany leicht et al 2011

Annual costs of illness for Alzheimer’s disease in GermanyLeicht et al. 2011

statutory health insurance services23%

source: Leicht et al. (2011) Net cost of Dementia by disease stage

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Discussion2

Discussion

  • Care management programs for Multiple sclerosis imply more incentives for the statutory health insurance

    • more potentials in cost-reduction

      • high hospitalisation rate

      • ambulant treatment of episodes possible

      • considered in Morbi-RSA

  • Usually longer interval between initial diagnosis and care dependency

    • long period of cost responsibility of health care insurance

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Conclusions

Conclusions

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Ambiguity about effectiveness of care management programs for MS and AD

To ensure the goal-orientation and avoid misallocations the measurement of success is necessary

Evaluation of effectiveness and cost-effectiveness for developing new care programs required

Need for more transparency to enable orientation on best-practice


Effectiveness and cost effectiveness of care management programs for the indications

Effectiveness and cost-effectiveness of

care management programs for the indications

Alzheimer's disease and multiple sclerosis -

Results of an empirical survey of the German statutory health insurance

  • Thanksforyourkindattention!

Contact: Sonja Ivancevic

Institute for Health Care Management and Research

University Duisburg-Essen

phone: +49-(0)201-183-6835

Mail: [email protected]

http://www.uni-due.de/medizinmanagement

Institute for Health Care Management and Research


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