15-year family doctor contract with AOK Baden-Württemberg
23.05.2023 18:03
The family doctor-centered care (HZV) from AOK Baden-Württemberg has clear advantages for patients compared to standard care (RV). This is the conclusion reached by scientists from the Goethe University Frankfurt (Main) and the University Hospital Heidelberg. Projections for the years 2011 to 2020 show that over 11,000 serious complications were avoided among 119,000 diabetics. Among other things, around 350 cases of new blindness and around 2,250 strokes were avoided. Overall, the 1.78 million AOK insured people cared for by 5,400 doctors in the HZV receive demonstrably more intensive and better coordinated care.
In 2020 alone, there were two million more family doctor contacts and 1.9 million fewer uncoordinated specialist contacts without referral. Better quality of care has been achieved at lower costs for years. As part of the evaluation results presented in Berlin today (May 15th), the contractual partners emphasize the consistent further development of the HZV and the associated specialist doctor contracts.
The signing of the contract on May 8, 2008 for the first HZV contract nationwide was the blueprint for many other contracts. And in outpatient care it represents the competitive move into a world of selective contracts without the involvement of the statutory health insurance associations (KV). The full supply contract of AOK Baden-Württemberg continues to set qualitative standards today - not least because the HZV allows significantly more degrees of freedom to independently organize regional supply. Dr. Werner Baumgärtner, CEO of MEDI Baden-Württemberg and MEDI GENO Deutschland explains: “Our family doctor and specialist contracts were, are and remain the better alternative to standard health care and call center medicine. The magic formula is controlling patient care. This is only possible with selective contracts on a full care basis. The HZV contract was designed to be expandable right from the start, both for general practitioner treatment and for better outpatient care through a more structured interaction between general practitioners and specialists.”
However, the collective agreement is still too convenient for many health insurance companies. According to the contractual partners' experiences, the statutory HZV health insurance requirement, which prescribes the offer of HZV, is not sufficient. So that significantly more patients nationwide can benefit from the proven advantages, they are demanding that full care contracts must be explicitly supported by federal policymakers through start-up financing and bonuses.
Many enrolled insured people are convinced of the advantages of the HZV, according to the CEO of AOK Baden-Württemberg, Johannes Bauernfeind: “Overall, we are very satisfied with the development of the HZV. It is well received by our participating insured persons. The coordinated care provided by the family doctor is the most important reason for participation for 9 out of 10 insured people.” Regular surveys show that around 90 percent of participants recommend the HZV and more than 90 percent are very satisfied with the care offered. “The annual costs per patient are around 40 euros lower than for a comparable insured person receiving standard care,” continues Bauernfeind. However, the prerequisite for successful care structures like the HZV is stable cash finances. This could only be achieved if the efficiency advantages of selective contracts remain where they are achieved.
“People with chronic illnesses in particular benefit from HZV,” says Prof. Dr. Ferdinand M. Gerlach, Director of the Institute for General Medicine at the Goethe University Frankfurt/Main, summarized the current evaluation results: “For example, in diabetics we see significantly fewer serious complications and even a longer life expectancy.” Part of the reason for this is probably the around 20 percent higher participation in disease management programs (DMP), which is specifically encouraged in the HZV. Care will become more structured and continuous, which is particularly important for chronic illnesses. In addition, there are mutually reinforcing control measures, such as the quality circles for guideline-compliant pharmacotherapy established in the HZV or the strengthened role of family doctors as guides through the care landscape in the HZV. “It is also noteworthy that the quality gap between HZV and standard care is opening up more in favor of HZV from year to year. And this also applies under the difficult conditions of the pandemic,” adds Gerlach. In the current evaluation, impressive results were achieved with 422,000 older insured people (aged 65 and over) in the HZV group compared to the RV: The projections in the first pandemic year 2020 showed over 35,000 more influenza vaccinations, around 6,500 fewer prescriptions of potentially inappropriate medication and Approximately 195 hospital stays avoided due to hip fractures.
Prof. Dr. Joachim Szecsenyi, Senior Professor and long-time Medical Director of the Department of General Medicine and Health Care Research at Heidelberg University Hospital emphasizes: “HZV patients demonstrably receive more intensive and better coordinated care with permanently higher continuity of care. HZV practices with a care assistant in the family doctor’s practice (VERAH) perform even better.” Since the beginning, the HZV has particularly focused on ensuring that the entire team is involved in the care. In the HZV contract of the AOK Baden-Württemberg, the further qualification of MFA to VERAH in the practice team has been supported and paid for since the beginning. More than 2,300 VERAH now relieve the burden on doctors. Another point that was examined is the care provided by more and more employed doctors. When the HZV started in 2008, there were around 12,500 employed doctors in the outpatient sector; the number has now quadrupled. “That’s why we investigated the question of whether and how the quality of care differs between HZV practices with and without employees,” says Szecsenyi. “The analysis of important indicators such as avoidable hospital admissions showed that patients in HZV practices with employed doctors receive just as good care as in HZV practices without them.”
These results are of great importance for the contractual partners as they underpin central strategic development strands. Prof. Dr. Nicola Buhlinger-Göpfarth, chairwoman of the Baden-Württemberg Association of General Practitioners, emphasizes: “The general practitioner’s practice must remain the central place of care. With the HZV innovation engine, we are focusing intensively on the expansion of delegation and the development of family doctor-centered care.” In addition to general practitioners, MFA and VERAH, the core team of a team practice should also include other academic, non-medical health professionals. These primarily include academic VERAH and Physician Assistants. From July, the contractual partners will support their training with 300 scholarships of 5,000 euros each and, upon completion, also pay these skilled workers. An important and timely step towards family doctor-centered care should also be taken by registering patients for HZV in practices instead of with individual doctors. “Such expanded HZV practices are more efficient, more flexible and more attractive for employees. And they can care for significantly more patients. This is an extremely important contribution to being able to continue to offer high-quality primary care nationwide in the future,” says Buhlinger-Göpfarth.
One focus of further development is measures in HZV practices to deal with the diverse effects of climate change on health. Heat waves that will occur more frequently in the future pose a particular health risk, especially for older and chronically ill people. These groups make up over 60 percent of HZV participants. The contractual partners aim to strengthen the health and climate competence of risk groups in a structured manner through their respective treatment practices. “For the first time this year, HZV practices will receive a fee surcharge for appropriate offers, for example in the form of climate-resilient advice or employee training,” emphasizes Johannes Bauernfeind.