>> According to Steffen Bohm, managing director of the Berlin consulting company Agenon, which is itself a consortium partner in two innovation fund projects (IdA and IGIB StimMT), the transition to standard care requires a little more than the purely informal one that is usually practiced in many projects Cooperation. In order to actually achieve comprehensive and therefore more sophisticated innovations, “structured, binding forms of comprehensive cooperation and working groups” would be needed. But so far there is SGB V
only three standard care formats that meet the requirement for structured and obligatory forms of cross-sector cooperation and division of labor:
• Outpatient specialist medical care (ASV, § 116b SGB V)
• Outpatient treatment in inpatient care facilities (§ 119b SGB V)
• Specialized outpatient palliative care (SAPV, §§ 37b and 132d SGB V)
The G-BA provides the ASV with a relatively complex application process and high demands on structural quality, which is why the establishment of ASV projects has so far fallen far short of expectations. In addition, an ASV-specific calculation system should also be developed, which – according to Bohm – is still pending.
As with the ASV, according to Bohm, separate fee schedule items must also be created for some IF projects if they are to be transferred to standard care.
But that will take time, Bohm draws a comparison with the ASV, which has been anchored in the law for more than ten years: “That gives a bit of an impression of how long it takes until more sophisticated solutions find their way through the authorities In the end, we actually arrived at the care.” Politicians could also create new legal requirements for cooperative forms of care, analogous to the existing formats of standard care - such as Sections 116b, 132d, 119b SGB V. In addition, depending on the project approach, additional specifications would have to be introduced, such as G-BA guidelines, framework agreements at the federal level or appendices to federal shell contracts. Separate application and approval procedures as well as subsequent remuneration regulations and other contractual agreements are also conceivable. However, based on the experience available so far, time-consuming preliminary specifications as part of complex agreement processes, long start-up phases in implementation and limited achievement of the intended care goals can be expected. Hence Bohm's advice: "You should consider whether you can describe procedures or paths here where it doesn't take years and years until a care approach that is considered sensible actually reaches the level of care."
It would also be recommended that results from cooperation management be taken into account more than before in IF projects. According to Bohm's findings, successful collaborations “first and foremost require the actors to have an interest and desire in this regard,” which is commonly referred to as intrinsic motivation. But you won't get this if you simply write a new number into the EBM and thus create a new remuneration option. “People who are supposed to cooperate with each other across institutions, some with complex illnesses, must also have this desire in some form,” Bohm knows from his work in consortia funded by the IF.
For Dr. Wolfgang Riedel, co-author of the Prognos report on the interim evaluation of the IF, first and foremost has to answer the question of what can and should be transferred to standard care. The Prognos researcher is certain that it will often not be the case that a “project is transferred one-to-one into the collective agreement” or into the “multiplication of selective agreements”. In his opinion, there will be a summary of results from various projects whose potential for standard care has been recognized. That is why it is necessary to look at and bring together many partial results from projects and, if in doubt, to combine them into something new that can then be transferred into standard care. There could be very different implementation options here, for example in the form of a change to the federal framework agreement, a new assessment figure within the fee schedule, a change to the G-BA guidelines or even in the form of legal
initiatives. Riedel: “There are always different procedural paths that you have to take in order to transfer individual results into standard care.”
Much of this (or at least some) seems to be unknown to politicians, especially the Federal Ministry of Health. Friederike Botzenhardt, Head of the Innovation Fund Department, Digital Health Future Region at the BMG, stated that when developing the draft of the Digital Care Act, it was intended not only to make the funding “even more targeted,” but also “to focus on approaches that are particularly relevant to care " to transport. But also “to develop a proposal for how successfully tested effective approaches can be transferred into standard care”.
The law stipulates that the Innovation Committee must take action three months after receipt of the final report and make a recommendation - positive or negative - for transfer to standard care. According to Botzenhardt, this recommendation for the transfer must contain a concrete proposal as to how the transfer should take place and which organization is responsible for it. Since there are various projects with a wide variety of components, it may be that G-BA guidelines need to be changed, EBM numbers introduced or the financing catalog expanded.
“But it may also be that something has not yet been provided for in SGB V and the recommendation will then be that the legislature should please make an adjustment to SGB V or another piece of legislation,” explained the BMG department head. The Innovation Committee, which will be able to make use of self-appointed experts in the future, is expected to present a rough classification, while the respective detailed elaboration will in turn be the responsibility of the responsible self-government bodies or the legislature. <<

by: Martin Klein (freelance journalist) and MVF editor-in-chief Peter Stegmaier

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