A decade ago, on July 1, 2010, care began in Baden-Württemberg in the first AOK specialist contract for the field of cardiology. There are now over 2,800 specialists and psychotherapists from 12 specialist areas taking part in a total of seven contracts. Since 2013, AOK Baden-Württemberg has also been offering its specialist doctor program together with Bosch BKK. Together with the contract for family doctor-centered care (HZV), the selective contracts embody a unique, structured full care outside the KV system, AOK Baden-Württemberg is convinced. Modern working conditions without budgeting for medical fees and more consultation time would enable doctors to provide comprehensive and demonstrably better care for the insured. Scientific evaluations have also shown that patients with chronic heart failure or coronary heart disease actually live longer than with standard care.
> According to a joint statement, the contracts were never designed as a test laboratory for the contracting partners. Rather, the legal framework was used to comprehensively redesign outpatient care on a voluntary and competitive basis, which is becoming increasingly important given the increase in multimorbid and chronically ill patients.
Together with the general practitioners' association and MEDI Baden-Württemberg, the AOK Baden-Württemberg therefore concluded the first nationwide HZV contract on a full care basis in 2008. According to the explanation, a fundamental difference in the selective contracts lies in the structured and binding cooperation between general practitioners and specialists: The general practitioner acts as a coordinator with a direct line to the treating specialist, so that those patients in particular who, in his opinion, have specialist medical competence are treated promptly need. In terms of content, the focus is on identifying key diagnoses and coordinated evidence-based care pathways based on current scientific findings.
“Real success story”
Johannes Bauernfeind, Chairman of the Board of AOK Baden-Württemberg, comments: “Thanks to the changes in the Fair Fund Competition Act that have already been reached, we can continue to provide people with sustainable, quality-assured care in the future, which is based on the recommendations of the Health Advisory Council on sustainable structures . Supported by over 8,000 closely cooperating doctors and psychotherapists, the general practitioner and specialist program is a real success story in the German healthcare system, which we will continue together.” The next contract for the field of pulmonology will follow in the fall.
Budgeting of medical fees, a lack of confidence in the ability of the collective contract system to be reformed and more individual design options were and are important motives for participation in specialist contracts. Dr. Werner Baumgärtner, CEO of MEDI Baden-Württemberg and MEDI GENO Germany, emphasizes: “For over twelve years, tailor-made structures on site have been improving the working conditions of the practice teams and outpatient patient care in equal measure. We therefore rely on Baden-Württemberg
When it comes to selective contracts, Berg continues to rely on the proven full pension system. And with SpiFA as a strong cooperation partner, we want to give specialist contracts more impact nationwide in the future.” The work of the currently around 500 relief assistants in the specialist practice (EFA) also plays an important role. It has been funded since 2014 and enables more intensive and improved care for patients, thus relieving specialists of important routine work.
Dr. Gertrud Prinzing, board member at Bosch BKK, adds: “The contracts give the participating doctors time for intensive care and detailed information and advice for their patients. In this way, chronic illnesses in particular can be better illuminated: For example, if there are influencing factors from the social environment, such as stress or strain, the patient can be treated holistically and individually.” In the spirit of interdisciplinary collaboration, employees from the AOK social service or the Bosch BKK patient support department could also be deployed, who would provide those affected with advice and support.
Numbers in detail
In AOK Baden-Württemberg's family doctor and specialist program, the number of participants and doctor's fees will continue to rise at a high level in 2019. At 636 million euros, the total fees paid to doctors in the contracts are a good 7 percent higher than the previous year. Of this, 492 million euros (plus 6%) are attributable to the HZV contract with almost 1.7 million insured persons (plus 4%).
In the joint specialist program run by AOK and Bosch BKK, the fee is 144 million euros (plus 12.5 percent). The number of participating insured persons rose to 718 thousand (plus 9.6 percent). Including employed doctors, 5,150 general practitioners and pediatricians as well as around 2,800 specialists and psychotherapists now take part in the care.
The contractual partners are very satisfied with the development and will continue to develop the selective contract landscape in 2020. A new specialist contract for the field of nephrology started on April 1st, which will be followed by another one for pneumology in the fall. Bauernfeind states: “Due to the changes in the Fair Health Insurance Competition Act that were achieved last year when we were still on the home stretch, there is now planning security for existing and new contracts, so that we will continue the growth course together with the doctor partners in the coming years.” The head of the health insurance company also describes the corona crisis as a challenge and drive for further digitalization and specifically wants to systematically expand the electronic doctor networking that, in his opinion, was successfully launched in 2019. In digital support processes, there would be great opportunities and potential for improving care, especially in selective contracts due to the regional freedom of design. <<
