Gesundes Kinzigtal GmbH An overview Gesundes Kinzigtal from agreement to realization Christian Melle, Project Leader Health Care and Research Department

Gesundes Kinzigtal GmbH

An overview Gesundes Kinzigtal from agreement to

realization

Christian Melle, Project Leader Health Care and Research Department

Helmut Hildebrandt – Chairman of the Board OptiMedis AG & CEO Gesundes Kinzigtal Ltd


The total population of the Ortenaukreis included the western and central Kinzigtal region has 410.000 inhabitants. – the service area of the Gesundes Kinzigtal has 71.000

Characterized by its agricultural environment (especially wine and fruit growing) and its rural spirit

Because of the mild climate the region is very attractive for tourism.

And sports like hiking and moutainbiking for example.

Manufactural and medium sized industrial sector is very well established and builds the core of the economical strength in this region (unemployment rate is less than 4% and one of the lowest ones in Germany).

Introduction


2015: Status Quo of Gesundes Kinzigtal

Kinzigtal is a valley formed by the river

Kinzig flowing to the rhine (Baden-

Württemberg)

Inhabitants: 71,000

Shared Savings Contract for all inhabitants

insured by AOK and LKK: 31,000

Total cost of the relevant insurants ~ 75 Mio €

Management Company with a variety of

different professions organizes care across

all sectors (14 FTE)

3


Our fragmented healthcare systems are

engineered for “repair” but not for “maintenance”

and not at all for “prevention” and “innovation”.


Can’t we do better?

Innovating the health system to be more efficient

and to produce health.


A new business model: Shared Health Savings Contracts

In “Shared Health Savings Contracts” we generate

an economical benefit for purchasers for a defined

population through wise investments, prevention

and optimized care.

Gesundes Kinzigtal GmbH 7

Challenges in the future of Kinzigtal

Triple Aim - better health, better health care and lower health care costs © Hildebrandt 2012, in Anlehnung an Berwick DM, Nolan TW, Whittington J. (2008), The triple aim: care, health, and cost. Health Affairs 2008 May/June;27(3): 759-69.

„Triple Aim“

Health care must be reconsidered

Entwicklung der Bevölkerung

2012 2015 2020%-Entwicklung

2020 zu 2012

Berghaupten 2419 2414 2395 99%

Biberach 3366 3336 3292 98%

Fischerbach 1690 1672 1646 97%

Gengenbach 10810 10605 10263 95%

Gutach 2217 2191 2158 97%

Haslach 6911 6847 6729 97%

Hausach 5772 5723 5635 98%

Hofstetten 1735 1749 1752 101%

Hornberg 4290 4231 4128 96%

Mühlenbach 1690 1692 1684 100%

Nordrach 2009 1983 1936 96%

Oberharmersbach 2538 2515 2498 98%

Ohlsbach 3194 3162 3123 98%

Oberwolfach 2758 2739 2716 98%

Steinach 4003 4010 4032 101%

Wolfach 5746 5670 5516 96%

Zell a.H. 7983 7902 7760 97%Summe 71143 70456 69283 97%

1. Demografic change 2. urbanisation

Population

Enhance the patient

care experience

Efficient per capita costs of

care

Improve the health status of

the population


We improve health care in three dimensions:

Based on the Triple Aim principles of Donald M. Berwick

Donald M. Berwick (et al.) (2008). Health Affairs, vol. 27 no. 3, 759-769


Many years of experience with Gesundes Kinzigtal and the scientific evaluation shows that it works.


Gesundes Kinzigtal produces value in three Dimensions:

Participants die 1.4

years later (78.9 vs

77.5 control)

98.9 % of

enrollees who

set an objective

agreement with their

physician would recommend

becoming a member to their

friends or relatives

5.613 Mio €

surplus

improvement

for the two sickness

funds in the Kinzigtal

region in 2013 against

75 Mio € norm costs


4.65 Mio € Delta in Year 8 for 31,355 insurees of AOK

Shared between AOK and Gesundes Kinzigtal Ltd


Quality of life and professional

satisfaction of providers: 15 % increase in

income for partnering physicians per case + higher

satisfaction through better cooperation (with other

providers and patients + viceversa).

Community building and securing health

care for the region: Local municipalities are

calling on Gesundes Kinzigtal to secure the supply

of health care and the staff for physician and

nursing practices.

Healthy workforce: Companies are calling on

Gesundes Kinzigtal to get support for health

promotion management and activities around

health at the workplace.

It even produces value in three further dimensions:


Accountability = the Driver

Financially: If Gesundes Kinzigtal Ltd. does not improve the

delta between the relative health care costs for the

33,000 insured people in Kinzigtal … then it does

not get any money.

Ethically: If Gesundes Kinzigtal Ltd. does not improve the

responsiveness of the local health care provision

and improve the health of the population and would

not generate a value for them… people would not

join & Kinzigtal would not be successful (because

all 33,000 have freedom of choice between many

providers) … and physicians and other health

professionals would leave the model


How do we do that?


Integration of

health care & social care

clinical wisdom & scientific

competence (health sciences)

targeted prevention & mobile

innovation

electronic data exchange &

analysis of Big Data for improvement

community organizing & health promotion

health care & public health

Hard and ever ongoing working in a continuous quality improvement cycle

Organization /Management

Physicians/ Medical

Professions

Psychosocial Interventions / Public

Health

Research & Development /

Innovations

Citizens & Patients


The aims are reached by different prevention- and healthcare programs

Primary prevention

Lectures

Smoke cessation

Courses

Healthcare programs

Heart failure

Metabolic syndrom

Back pain

Mental Crisis Intervent

Depression

etc.

More subjects

Support of young GPs

Quality indicators

Electronic health record

Research projects

etc.

16

Health professionals support the idea of integrated care



Developing a health care program consists of 5 steps

Indication related and structured care

programs organised through a central

management authority ensure the optimal

care of the patient

Bottom up approach wanted (patient level

etc.)

A comprehensive development process is

necessary to obtain a care program

Cost-benefit analisis

Approval of medical advisory board

17

Project-impulse

Data research/ analisis

Project- order

Conceptual design

Testing stage


• Active multi-specialty support for patients through disease management

• HK-progr.: Psychotherapy acute / depression

• Selfhelp+ self management training for chronic patients (in preparation … Stanford SDSM)

Just one example of the interventions around diabetes

High

cost

patients

Rising risk patients progressing

Insured in risk

Healthy insured – before getting into risk

20%

40%

35%

5%

• HK-progr.: Healthy weight (adipositas)

• HK-Progr.: blood pressure okay

• Developing jointly health goals

• Cooperating with sports clubs

• Unspecified.training in health literacy

(for patients and pracitices)

• Health Festivals + health promotion

within kindergartens, schools,

companies

• Supporting the existing preventive

offers of health insurances

• Health coaching

• Attention on polymedication – regular training

• HK-progr: Physicains plus nursing (improving Interaction)


PMV, a department of University of Cologne, is our external scientific

evaluation agency

Just diabetes: We succeed in reducing hospitalisations


Outcome: fractures in patients with knownosteoporosis

Percentage of osteop.patients with fracture

Controls


…it´s not all about data - other important factors to gain success in integrated care

Build confidence between

stakeholders

excellent public relations and

frequent contact to citizens

Standard IT-infrastructure in

physicians´practice

21


For the best quality of healthcare a network across the boundaries of professions and institutions was set up in the last seven years

22

Sportclubs and

Studios

Municipalities

Sickness FundsCompanies

Schools


Long-term perspective of the model ensures incentives for the right care

Strengthen the financial independence:

• Long-term contracts enable the freedom of decision within the model

• Attract additional sickness funds to benefit also from the health effects for their

insured persons

• Development of new business fields which are independently financed (e.g.)

• World of Health “Gesundheitswelt”

• Occupational Health Management: financed by enterprises

• Health academy and Health Courses: financed by participation fees

• Additional project related funds from third parties

23


Long-term contract as an incentive for sustainable health investments and prerequisite for a meaningful

evaluation

Regional approach for trustfully cooperation of all shareholders involved

Data availabilityfor sustainable controlling

Eye-level approachfor a good cooperation between management, health professionals, and patients

Lessons Learned: The „Triple Aim“ can be reached – requirements for success

Co-Ownership of the local physician networkas an additional incentive for initiative and engagement

The quality challenge can be fulfilled: we improve health, quality AND reduce costs at the same time!


Regional care company as “integrator” + partly

ownership through local providers

Investment for the first three years

(until earnings are big enough for ROI)

Going / thinking beyond healthcare +

entrepreneurial health sciences spirit

Emotional quality between providers,

professions, management and

patients

Comprehensive implementation of

technology: ICT & data-driven management

approach

“Coopetition” = cooperation and

competition through transparency and

benchmarking

Balanced payment system oriented

towards achieving the Triple Aim

Innovative culture and friendly interactions

“open source” mindset

10 years contract with sickness fund

to refinance investment

What makes our regional integrated care model unique?


The Time has Come: what can we do to support similar initiatives abroad? - I

OptiMedis collaborates with partners in an “open source”

environment

• 6 more regions in Germany within the next two years and

• 2 other countries besides Germany with each 3 regions, e.g. in

• the Netherlands (OptiMedis-NL

already founded)

• Switzerland

• Interest as well in UK, Belgium, Austria

+ Australia

Ready for replication: Quality indicators,

evaluation protocols, program outlines,

incentive systems, guidebook, data

warehouse, reporting system …


Let‘s get in contact

Web: www.optimedis.comwww.gesundes-kinzigtal.com

Newsletter: www.optimedis.com/newsletter

Helmut Hildebrandt

[email protected]

OptiMedis AG

Borsteler Chaussee 53

22453 Hamburg

Phone +49 40 226221490

Mobile +49 172 4215165

Christian MelleEisenbahnstr. 17 77756 [email protected]

http://www.optimedis.com/

http://www.gesundes-kinzigtal.com/

http://www.optimedis.com/newsletter

mailto:[email protected]

http://de.linkedin.com/pub/helmut-hildebrandt/44/796/b47

https://www.xing.com/profile/Helmut_Hildebrandt2

http://integratedcarefoundation.org/

http://www.bmcev.de/

Documents

Gesundes Kinzigtal GmbH An overview Gesundes Kinzigtal from agreement to realization Christian Melle, Project Leader Health Care and Research Department