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 AGBorstelerChaussee53D – 22453 HamburgTel: +49 40 226 211 49 0e-mail: [email protected]
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 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
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
Know-how of regional problems in health careprovision + links to all institutionsandproviders
Know-how in health economy, healthsciences, prevention, controlling- andmanagerialissues
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)
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)
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)
Reductionofmortality .. prolongationoflife
Improvementofthecooperativebasisofprofessions (importantforhelpingpatientsand relatives toreducetheiranxietylevel)
Strengtheningtrustintothehealth care system
Improvementofattractivenessofthehealthprofessionstogetyoungtalentsinterested (war fortalents will raiseproblemswithsmallerworkforceandmoreelderly)
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?
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