Innovation Fund project “Prospective regional cross-sectoral care planning” (ProReVers) launched

Zaske: “Opening clause for regular regional planning”

What connects Templin, Prignitz, and Ostprignitz-Ruppin? They share an infrastructure with plenty of room for improvement, a vast landscape, and a small population, many of whom have reached old age. Prignitz stands out in particular: with only 36 inhabitants per square kilometer (as of 2021), the district has the lowest population density of all German districts. Ostprignitz-Ruppin and Templin follow with 40 and 41 inhabitants per square kilometer, respectively. Prignitz and Ostprignitz-Ruppin are also among the structurally weakest areas in Brandenburg and among those with high future risks. Recently, something else has connected the three districts and their municipalities: the Innovation Fund project "ProReVers" (1), which builds on the experiences of the very first Innovation Fund project, IgiB-StimMT (2), but at the same time goes significantly beyond it.

> The IgiB-StimMT project has not only shown by example that, but also how the transformation of inpatient care into more outpatient care forms can be successful with acceptance among the affected and involved population. With the structural migration, an outpatient-inpatient center has been established in Templin, which combines outpatient and inpatient services – and also reflects the objectives of the Brandenburg state government according to its coalition agreement (3). In particular, the on-call medical practice and other project elements such as the "decision unit" for clarifying the situation of patients in an inpatient environment without inpatient admission and the coordination and advice center for effective support of citizens and patients through low-threshold
Advice and through a corresponding case-'
The innovation committee of the Federal Joint Committee (G-BA) has highlighted the positive aspects of the management of hospitals and physicians in private practice and recommended them for consideration for transfer to standard care. Even though the withdrawal of a pediatric department by converting it into a pediatric practice is within the scope of the statutory health insurance system (KVG), and a consortium of physicians' networks, the hospital, the city of Templin, and the Association of Statutory Health Insurance Physicians has entered into a contract to develop the Templin Central Health Region:
The StimMT project has made it clear how limited rational development opportunities are in the German healthcare system and how little scope the Social Code (SGB V) leaves for sensible developments.
This is precisely where the research project "Prospective Regional Cross-Sectoral Care Planning," or "ProReVers" for short, launched in October and funded by the Innovation Fund, comes in. It has truly groundbreaking plans. Several well-known players from the Templin project are on board. These include the AOK Nordost (Northeast German Health Insurance), the KV Brandenburg (Brandenburg Health Insurance Association), and AGENON – the Society for Research and Development in Healthcare. AGENON had already conducted a feasibility study for Templin in 2014 and the preliminary study "Empirical Analyses of Epidemiology, Reasons for Treatment, and Care in the Middle Area of Templin" a year later. AGENON was a member of the project's leadership team and also orchestrated the project and funding management.
New project partners of “ProReVers” under the consortium leadership of
AGENON, KMG Kliniken SE, and the Brandenburg Medical School. The research project, funded by the Innovation Fund with €1.1 million for 28 months, is supported by the Brandenburg State Hospital Association and the Brandenburg Ministry of Social Affairs, Health, Integration, and Consumer Protection (MSGIV).
The term "outpatient care" alone represents a mammoth task. Michael Zaske, Head of Department 4 (Health) at MSGIV, explains: "If we anticipate an outpatient care rate of 20 percent, then these additional outpatient services will have to be provided by someone if hospitals gradually reduce their inpatient services." From his perspective, it would be logical if the manpower freed up in the inpatient sector could also provide outpatient care in the region.
However, the necessary conversion of inpatient to outpatient services and the opening of hospitals to outpatient care represent only one side of the coin. The other – equally important – side is the reduction of avoidable hospitalizations and the re-shoring of hospitalizations to outpatient care. "In approximately 20 percent of hospitalizations, treatment could have been provided in the doctor's office through needs-based outpatient care – if the appropriate services were available," explains Dr. Sebastian Liersch, health economist at AOK Nordost, highlighting the reality.
To end this structural mismatch, the entire outpatient and inpatient care sector must be analyzed and then planned jointly. The prospective regional care planning to be developed and tested through the Innovation Fund project attempts precisely this: It lays the foundation for cross-sectoral planning of inpatient and outpatient care capacities, something many experts have been calling for for decades, taking local conditions into account.
This is another mammoth task that politicians – with the exception of Brandenburg – are afraid to tackle. Inpatient and outpatient capacities in this country are still only allowed to be planned separately. Although it must now be clear to all stakeholders that both outpatientization and the reduction of purely inpatient capacities, especially in structurally weak regions, will only work in conjunction with outpatient care services.

Preparation for inpatient and outpatient care planning

Brandenburg is the notable exception. The largest of the new federal states in terms of area is active with two flagship projects in health services research.
By January 31, 2026, the "ProReVers" project will be used to compile a strengths and weaknesses analysis for the Prignitz and Ostprignitz-Ruppin region. Taking into account suitable healthcare innovations and involving key local stakeholders, such as AGENON-
Managing Director Steffen Bohm explains that "a cross-sectoral planning matrix" has been developed as an example, which is intended to demonstrate the possible cross-sectoral development path for shaping the local healthcare landscape over the next five years. This "exemplary" approach is intended because there is no legitimacy for binding specifications. With this "toolbox of methods," which enables cross-sectoral planning of inpatient and outpatient care that functions reliably even under challenging conditions—such as an aging population and poorly developed infrastructure—"ProReVers" goes beyond the "Brandenburg Healthcare Needs Analysis" (VBA).
The "Brandenburg Supply Needs Analysis" (conducted by AGENON and IGES) also lays the foundation for determining current and future demographically dependent supply needs. This will be done for five supply regions (VG), starting with VG 4 Lausitz-Spreewald (a report is already available), followed by VG 1 Prignitz-Oberhavel, VG 2 Uckermark-Barnim, VG 3 Havelland-Fläming, and VG 5 Oderland-Spree. Based on this, it should then be possible to derive the supply capacities required to meet demand, including a comparison with the current situation. MSGIV department head Zaske, who supports both "ProReVers" and the care needs analysis (4) funded by the Brandenburg Economic Development Agency (WFBB), commented: "One of the most important framework conditions is that hospitals are also allowed to provide outpatient services. This applies wherever there is no oversupply in the outpatient sector, which is essentially the case in rural areas."
This is precisely where both projects – “ProReVers” on the one hand, and the VBA Brandenburg on the other – come in, by analyzing regional conditions and, in the case of the VBA, bringing together the stakeholders in dialogue conferences in order to jointly develop proposed solutions.
For the head of the health department at MSGIV, both projects are equally important. Because, as always, "No matter what good ideas you have, they always have to be implemented in practical, real-life situations on the ground—both in Prignitz and Ostprignitz-Ruppin, as well as in the other five healthcare regions of our state."
The prerequisites for future cooperation structures are to be laid by the end of 2024, so that they can culminate in a formal planning process the following year and be legally incorporated into inpatient and outpatient planning in 2026. Zaske: "That's our plan at the moment." A plan with which the state intends to comprehensively prepare for the upcoming hospital reform—Zaske also calls it the "healthcare reform"—with the goal of not only implementing a fifth hospital plan (together with Berlin, by the way) starting in 2026, but also of having already prepared in advance with a participation-oriented approach.
This is helped by the fact that in Brandenburg, there has been very close cooperation in outpatient needs planning for many years as part of the "Brandenburg Way" (5) and with the help of the Section 90a State Committee. For a long time, there have been repeated attempts to anticipate the necessary legal changes and to reach effective agreements through voluntary consultations. Among other things, there is discussion about authorizations, the possibility of institute outpatient clinics – with which hospitals are permitted to provide corresponding outpatient services – and hybrid DRGs.
Zaske is fully aware that the necessary freedom of action is not yet available. Lege artis, inpatient-outpatient care planning cannot even
not be: Formally, the federal states
only carry out inpatient planning, while the KVs have to carry out outpatient planning separately through the outpatient planning committees. Zaske: "It would be better if Federal Health Minister Lauterbach would allow us to regularly conduct regional planning through federal legislative opening clauses, instead of having to plan 100 percent by sector as before."
This is where Zaske – like the AOKs with their concept “Health Regions – Designing Sector-Independent Care” (see interview Dr. Richard p. 12 ff., 6)
– to the ongoing parliamentary process to finally provide a legal basis for important regional planning options in the Social Code (SGB V), which were deleted from the draft bill of the Health Care Strengthening Act. "But that doesn't go nearly far enough for us," explains Zaske. In his view, the states finally need to begin regional care planning; this would be "timely and necessary."
A very first step, for example, would be for the federal states, in cooperation with the Association of Statutory Health Insurance Physicians and the health insurance funds in the regions, to determine what may and may not be provided with outpatient care in the future – "this is precisely why we need an opening clause." This is also necessary in light of the current cabinet decision on the Hospital Care Improvement Act (KHVVG). This hospital reform has given the federal states a strong impetus, increasing the pressure to convert hospital locations into outpatient-inpatient health centers across the country. This is "entirely in our interest," says Zaske; and also something that the federal states in particular have been pushing for many years by demanding that the federal government improve the necessary framework conditions.

Bohm: “sensible local supply solution”
Until then, it's a matter of doing your own homework. "ProReVers" involves an "empirical analysis of the healthcare and population structure, as well as the actual utilization of healthcare services locally," explains Bohm. It will be interesting, for example, to see which healthcare services are used and with what frequency. In addition to official data from hospitals and doctor's offices, this will also incorporate, for the first time, assessments from the local population.
To ensure that the entire project is not planned without taking the real needs of the population into account, part of the research project is a large-scale survey launched in April of this year of 10,000 of the more than 50,000 AOK Nordost insured people in the project districts. "That's what's special about the project," explains AOK Nordost health economist Liersch. "We don't just want to look at the numbers, but give the residents of the Prignitz and Ostprignitz-Ruppin regions the opportunity to describe their personal impressions of the healthcare situation: What services do you use? How accessible are medical services for you? Are certain doctors missing? How satisfied are you generally with the healthcare?"
Bohm considers the insured survey to be one element among others. It should be noted that data collected in this way are of a different significance in terms of their reliability and significance than, for example, epidemiological or demographic data. However, it is right and important to give the population a voice, as such sentiment can reflect real-life situations of supply bottlenecks and problems.
According to Bohm, all the data, weighted and taken together, can contribute to creating a "sensible local supply solution." Bohm: "The idea of 'ProReVers' is to create something that doesn't yet exist." By this, he means a methodology and a basis in the form of a structured regional dossier with a defined set of empirical analyses for regional cross-sectoral supply planning. However, regional cross-sectoral supply planning – and here he has to fully agree with Zaske – does not currently exist. It became abundantly clear to all those involved in the previous project in Templin that regional cross-sectoral planning cannot be predetermined from scratch, but must always be developed against the backdrop of the specific local circumstances.
According to Bohm, this requires, first and foremost, the freedom to detach oneself from the sector-specific perspective and to answer questions such as: What performance
Which treatments are better provided on an outpatient basis, and which are better provided on an inpatient basis? How much cardiology is needed in a healthcare region to ensure decent care for the population?
According to Bohm, structural reforms under outpatient care necessarily require that
1. the country plans to provide fewer inpatient services,
2. the health insurance companies agree to fewer inpatient services in the budget negotiations,
3. quantity reductions justified by outpatient treatment are not fully collected in arbitration proceedings and
4. funds released can actually be used to finance outpatient care.