>> The Mambo innovation project is a care program for people with multiple chronic illnesses. The project, funded with 3.4 million euros by the Innovation Fund in the second wave of “new forms of care” from 2017, was designed for insured persons of pronova BKK (consortium leader) who are based in the Leverkusen supply region. In total, around 15,000 multimorbid patients insured by pronova BKK live in Leverkusen, of which almost 50% were already cared for in the Leverkusen health network (project partner) before the project started. This can be attributed to the predecessor project proVABENE, an IV contract between pronova BKK and the Leverkusen Regional Health Network. This was launched at the beginning of 2014 with the aim of improving coordinated treatment by general practitioners and specialists for people suffering from chronic illnesses.
In Mambo, by October 2019, 2,390 patients with at least 3 chronic illnesses and/or at least 7 medications were able to be enrolled in one of the health network's current 23 specialist and family doctor practices. Actually, all 80 general practitioners and specialists organized in the Leverkusen health network could take part and benefit. The fact that the majority have not yet done so shows once again how difficult it is to set up such voluntary innovation projects and - as evaluation partner Prof. Dr. As Holger Pfaff from the Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR) of the Medical Faculty of the University of Cologne put it at this year's German Health Services Research Congress (DKVF) - "getting the machine running".
In order to increase the number of patients included as well as participating general practitioners as well as the actual intervention time, the model project originally planned until mid-2020 is to be extended by one year - which roughly corresponds to the time that the project partners actually needed after the funding supplement was awarded Not only to establish a cross-disease meta-strategy and the necessary structures using the example of complex multimorbid patients, but also to actually start working with patients and doctors.
What made matters worse was that the original project duration (January 1, 2017 to December 31, 2019) had already been delayed by a good six months (July 1, 2017 to June 30, 2020) due to the delay in the funding decision. This meant that the recruitment period, which was estimated to be nine months, could only start with a delay, with this starting on April 1st. was preferred. At the same time, the framework conditions had to be created that would enable the treating doctor to receive all patient-relevant and sector-wide information - as planned in the project. This included, among other things, the creation of an electronic patient record (ePA), which is, however, much more than just a collection of data: the integrated “risk cockpit” is intended to enable the doctor to see at a glance which options for action are available to him are most urgent for certain patients. Following the patient's consent, integrated into this situation report are, among other things, the longitudinal billing data from the health insurance company, with which pronova wants to support the doctor - for example in the form of a patient-specific medication account. With this action and application-oriented ePA
(certainly another component that should make the leap into standard coverage), there is, however, a problem on the side: the previously active software partner has stopped working on the ePA, which makes it necessary to find a new system provider.
Another core module of Mambo is free process advice from a management consultancy for the participating doctor. As part of this, practice processes are to be optimized and exactly defined which activities can be carried out at the counter by the Mambo-MFA* in order to relieve the doctor's workload and give him more time for patient consultations - also thanks to the situation report available at the start of the consultation admit. At this point, another of Mambo's target criteria becomes visible: This project is not only about improving patient care, but also specifically about improving the work and quality of life of the doctors involved and also the practice staff, which the IMVR uses questionnaires is evaluated.
A very central project module is the “Continuous Improvement Process”, or CIP for short. This can be imagined as a project committee that meets regularly, but to which interested care partners from other sectors (clinic, nursing, rehabilitation) that have not previously been included in the project for purely pragmatic reasons (keeping complexity down) can join - what do these too. In the CIP meetings, the care needs and goals are formulated together. But we also discussed where what needs to be changed and how it needs to be further optimized. The resulting culture of conversation and communication alone holds project manager Dr. rer. nat. Thorsten Wolf from pronova for a soft skill from Mambo that should not be underestimated. “The project has brought us much closer to the doctors,” explains Wolf, who appreciates being able to talk to the treating doctors, which is “a great asset in itself” and “the learning curve is immense.” Because, says Wolf: “The unfiltered opinion of the treating doctors is incredibly valuable beyond all the numbers and data.”
Ultimately, this model project will also have to be measured by whether the defined goals have been achieved through better care. For this purpose, the implementation process is recorded through a formative evaluation. Every year, the factors that promote or inhibit implementation are identified and reported back to those involved in the process. In addition, a summative evaluation should focus on the structures, processes and results of the intervention. As a result of the project, the quality of care and care efficiency are to be improved and the collaboration between the various disciplines is to be optimized.
Despite all this, at Mambo, as at all Innovation Fund projects, the focus is on the patient. The main aim of the care program is to enable additional “care time” and to ensure that optimal care is provided
• stabilization of the state of health,
• increasing the quality of life,
• improving care coordination,
• avoiding hospital stays,
• a holistic view of their current personal situation - in the doctor's office as well as in the home environment.

In addition to the doctor and his practice team, the monitoring and communication assistants, or MONIKA for short, are responsible for the latter. The qualified nursing staff with special additional training employed by the Leverkusen Health Network can be booked on a case-by-case basis by the doctor involved in the project in order to have a positive influence on the course of the disease. This can be understood as case management with digitally supported coordination with the doctor, whereby the MONIKAs work either by telephone or in the advice center or in person in the home environment. Examples of core tasks include:
• Medication and adherence check
• Query of medically relevant parameters (e.g. in heart failure patients)
• Training and information (e.g. nutrition, fall prevention)
• Holistic view of the home and health situation, organization of everyday support measures, help in finding care services in nursing homes, short-term care places, social law application procedures
• Support for relatives of people suffering from dementia
It is currently unclear what will happen to the MONIKAs after the project ends. Interim financing for the next year is not the problem because project funds that have not yet been used can be used here. “We are currently in the process of calculating how much a MONIKA costs and what effects can be offset,” explains Wolf. Of course, these are primarily effects such as avoiding hospital stays, improved medication and adherence. But this cannot be quantified at this point, even if – according to Wolf – “it feels like we can see effects in two indication areas”: heart failure and COPD. Wolf, who is fully behind the project: “This still needs to be evaluated in detail, but the actual intervention period is still too short.” <<

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