>> „It’s time to review existing programs and tackle new ones,“ said Prof. Dr. hc Herbert Rebscher, Chairman of the Board of DAK, in his statement at the „10 Years of Disease Management Programs“ event on September 19 in Berlin. Initial skepticism has subsided, and more than 650,000 insured individuals now participate in his health insurance fund’s disease management programs (DMPs) – with a continuing upward trend. Rebscher continued: „The statutory evaluations, as well as the additional evaluations conducted by the health insurance fund itself, show that the programs are meeting expectations.“ On the one hand, the quality of care is improved, and on the other hand, secondary illnesses are prevented. And what particularly pleases the head of the health insurance fund: the analyses also show a reduction in benefit expenditures. Therefore, in his presentation, he advocates for the further development of the programs to be multidimensional: structural, procedural, and content-related.
For Dr. Christian Graf, Head of Healthcare Programs at Barmer GEK, Disease Management Programs (DMPs) have become an integral part of quality-oriented care for chronically ill patients within the statutory health insurance system. However, he notes that only partial evidence of their effectiveness exists to date. "To obtain further evidence regarding the benefits of the programs, a statutory evaluation should be conducted," Graf will explain in his presentation. For Holger Söldner, Head of Healthcare Management at Deutsche BKK, ten years of DMPs mean "continuous optimization of analyses, internal and external processes, and adaptation to the constantly changing demands on personnel and processes," but also that, from Deutsche BKK's perspective, the investment has paid off for the benefit of the customer, as he will demonstrate in his presentation.
Professor Dr. Roland Linder, head of the Scientific Institute of the Techniker Krankenkasse (WINEG), holds a somewhat different opinion regarding the effectiveness of disease management programs (DMPs). Using innovative methodology, WINEG conducted a benefit assessment of the "T2DM" DMP by analyzing routine data from the Techniker Krankenkasse from 2006 to 2008. Linder stated: "The results showed no significant differences in the incidence of relevant comorbidities between the DMP participants and the control group, and no cost savings were apparent."„
The panel discussions planned for the morning and afternoon program (see pp. 16/17) will therefore be particularly exciting, led on the one hand by Prof. Dr. Dr. Alfred Holzgreve, Director of Clinical Research and Academic Teaching of the Vivantes Network for Health GmbH, Berlin, and on the other hand by Prof. Dr. Reinhold Roski, the editor of „Monitor Versorgungsforschung“ (MVF).
In it, Linder, among other things on behalf of TK, will demand that in the future, "given the still unclear state of studies and the immense program costs," the best possible evidence must be presented for the benefit assessment of disease management programs (DMPs). This could be achieved through a cross-insurer evaluation of statutory health insurance routine data – ideally through randomized controlled trials (RCTs).
A similar task has so far been undertaken by the Federal Insurance Office (BVA), which is therefore also the cooperation partner of this specialist congress. Its president will deliver the opening address after a brief welcome by MVF publisher Roski and a greeting from Dr. Josephine Tautz (Deputy Head of Division 213 "Joint Federal Committee, Structured Treatment Programs (DMP)" at the Federal Ministry of Health).
„The introduction of Disease Management Programs (DMPs) was primarily aimed at preventing under-, over-, and inappropriate care for the important and growing patient group of chronically ill individuals,“ explains Dr. Maximilian Gaßner. Currently, over 11,000 ongoing programs and almost six million participating insured individuals demonstrate the success of the DMPs. This is because these patients receive cross-sectoral care through targeted care management based on current medical findings.
The Federal Insurance Office (BVA) assumes two key positions here, Gaßner continued: „Firstly, we are responsible for the approval process of the Disease Management Programs (DMPs). Secondly, we compile the collected medical and economic data across health insurance and regional boundaries and evaluate it within the framework of the legally mandated comparative evaluation.“ Thus, ten years after the start of the debate on DMPs in Germany, it is time to draw an initial conclusion. Gaßner: „At the congress, the goals and successes of the DMPs in Germany, from their beginnings to current developments, will be presented.“
Dr. Christian Gawlik is responsible for the evaluation at the BVA (Federal Office of Administration), working closely on a scientific level with Prof. Dr. Karl Wegscheider, a member of the BVA's scientific advisory board. "Essentially, two problems need to be addressed," Wegscheider will explain. These are creating a mathematical compensation for structural differences and correctly accounting for potential random effects. In the current DMP (Disease Management Program) comparison, both goals are therefore achieved simultaneously through the use of adjusted empirical Bayesian estimators, which are derived within the framework of fitting a mixed linear model and subsequently visualized. The presentation will demonstrate the functionality of this methodology using an example.
Gawlik (Department VI 4, Fundamental Medical Issues and Evaluation of Disease Management Programs (DMPs) for Chronically Ill Patients at the Federal Insurance Office (BVA)) will present the specific benefits that individual health insurance funds can derive from these analyses. "The documented medical parameters and the additional economic data collected are used for a comparative evaluation of the DMPs," Gawlik will explain. After risk adjustment, the BVA receives aggregated data from the evaluation institutes commissioned by the health insurance funds. This data allows for a comparative analysis of the insured individuals' health status and the cost situation within the DMPs. Gawlik: "This information enables the health insurance funds to manage quality assurance processes internally and in collaboration with healthcare providers." Currently, data is available for type 2 diabetes mellitus for the period from July 2003 to July 2008 and for coronary heart disease (CHD) for the period from January 2005 to December 2009.
Beyond simply comparing the disease management programs (DMPs), the analysis revealed interesting trends that point to the sustainable effects of structured healthcare delivery systems. Furthermore, linking analyses of DMP-specific quality assurance and administrative costs with medical data could provide insights into the efficiency of the DMPs.
Many presentations will also address the key factors for successful Disease Management Programs (DMPs). Therefore, Prof. Dr. Stefan G. Spitzer, Chairman of the Board of the German Society for Integrated Care (DGIV), will focus his presentation primarily on the interface problems of such projects. He will specifically address the coordination of medical collaboration, technical and technological requirements, and remaining legal obstacles to implementing the principle of integrated care within structured care concepts. <<
by Peter Stegmaier
