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Gesundes Kinzigtal GmbH
An overview Gesundes Kinzigtal from agreement to
realization
Christian Melle, Project Leader Health Care and Research Department
Helmut Hildebrandt – Chairman of the Board OptiMedis AG & CEO Gesundes Kinzigtal Ltd
Gesundes Kinzigtal GmbH
The total population of the Ortenaukreis included the western and central Kinzigtal region has 410.000 inhabitants. – the service area of the Gesundes Kinzigtal has 71.000
Characterized by its agricultural environment (especially wine and fruit growing) and its rural spirit
Because of the mild climate the region is very attractive for tourism.
And sports like hiking and moutainbiking for example.
Manufactural and medium sized industrial sector is very well established and builds the core of the economical strength in this region (unemployment rate is less than 4% and one of the lowest ones in Germany).
Introduction
Gesundes Kinzigtal GmbH
2015: Status Quo of Gesundes Kinzigtal
Kinzigtal is a valley formed by the river
Kinzig flowing to the rhine (Baden-
Württemberg)
Inhabitants: 71,000
Shared Savings Contract for all inhabitants
insured by AOK and LKK: 31,000
Total cost of the relevant insurants ~ 75 Mio €
Management Company with a variety of
different professions organizes care across
all sectors (14 FTE)
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Gesundes Kinzigtal GmbH
Our fragmented healthcare systems are
engineered for “repair” but not for “maintenance”
and not at all for “prevention” and “innovation”.
Gesundes Kinzigtal GmbH
Can’t we do better?
Innovating the health system to be more efficient
and to produce health.
Gesundes Kinzigtal GmbH
A new business model: Shared Health Savings Contracts
In “Shared Health Savings Contracts” we generate
an economical benefit for purchasers for a defined
population through wise investments, prevention
and optimized care.
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Challenges in the future of Kinzigtal
Triple Aim - better health, better health care and lower health care costs © Hildebrandt 2012, in Anlehnung an Berwick DM, Nolan TW, Whittington J. (2008), The triple aim: care, health, and cost. Health Affairs 2008 May/June;27(3): 759-69.
„Triple Aim“
Health care must be reconsidered
Entwicklung der Bevölkerung
2012 2015 2020%-Entwicklung
2020 zu 2012
Berghaupten 2419 2414 2395 99%
Biberach 3366 3336 3292 98%
Fischerbach 1690 1672 1646 97%
Gengenbach 10810 10605 10263 95%
Gutach 2217 2191 2158 97%
Haslach 6911 6847 6729 97%
Hausach 5772 5723 5635 98%
Hofstetten 1735 1749 1752 101%
Hornberg 4290 4231 4128 96%
Mühlenbach 1690 1692 1684 100%
Nordrach 2009 1983 1936 96%
Oberharmersbach 2538 2515 2498 98%
Ohlsbach 3194 3162 3123 98%
Oberwolfach 2758 2739 2716 98%
Steinach 4003 4010 4032 101%
Wolfach 5746 5670 5516 96%
Zell a.H. 7983 7902 7760 97%Summe 71143 70456 69283 97%
1. Demografic change 2. urbanisation
Population
Enhance the patient
care experience
Efficient per capita costs of
care
Improve the health status of
the population
Gesundes Kinzigtal GmbH
We improve health care in three dimensions:
Based on the Triple Aim principles of Donald M. Berwick
Donald M. Berwick (et al.) (2008). Health Affairs, vol. 27 no. 3, 759-769
Gesundes Kinzigtal GmbH
Many years of experience with Gesundes Kinzigtal and the scientific evaluation shows that it works.
Gesundes Kinzigtal GmbH
Gesundes Kinzigtal produces value in three Dimensions:
Participants die 1.4
years later (78.9 vs
77.5 control)
98.9 % of
enrollees who
set an objective
agreement with their
physician would recommend
becoming a member to their
friends or relatives
5.613 Mio €
surplus
improvement
for the two sickness
funds in the Kinzigtal
region in 2013 against
75 Mio € norm costs
Gesundes Kinzigtal GmbH
4.65 Mio € Delta in Year 8 for 31,355 insurees of AOK
Shared between AOK and Gesundes Kinzigtal Ltd
Gesundes Kinzigtal GmbH
Quality of life and professional
satisfaction of providers: 15 % increase in
income for partnering physicians per case + higher
satisfaction through better cooperation (with other
providers and patients + viceversa).
Community building and securing health
care for the region: Local municipalities are
calling on Gesundes Kinzigtal to secure the supply
of health care and the staff for physician and
nursing practices.
Healthy workforce: Companies are calling on
Gesundes Kinzigtal to get support for health
promotion management and activities around
health at the workplace.
It even produces value in three further dimensions:
Gesundes Kinzigtal GmbH
Accountability = the Driver
Financially: If Gesundes Kinzigtal Ltd. does not improve the
delta between the relative health care costs for the
33,000 insured people in Kinzigtal … then it does
not get any money.
Ethically: If Gesundes Kinzigtal Ltd. does not improve the
responsiveness of the local health care provision
and improve the health of the population and would
not generate a value for them… people would not
join & Kinzigtal would not be successful (because
all 33,000 have freedom of choice between many
providers) … and physicians and other health
professionals would leave the model
Gesundes Kinzigtal GmbH
How do we do that?
Gesundes Kinzigtal GmbH
Integration of
health care & social care
clinical wisdom & scientific
competence (health sciences)
targeted prevention & mobile
innovation
electronic data exchange &
analysis of Big Data for improvement
community organizing & health promotion
health care & public health
Hard and ever ongoing working in a continuous quality improvement cycle
Organization /Management
Physicians/ Medical
Professions
Psychosocial Interventions / Public
Health
Research & Development /
Innovations
Citizens & Patients
Gesundes Kinzigtal GmbH
The aims are reached by different prevention- and healthcare programs
Primary prevention
Lectures
Smoke cessation
Courses
Healthcare programs
Heart failure
Metabolic syndrom
Back pain
Mental Crisis Intervent
Depression
etc.
More subjects
Support of young GPs
Quality indicators
Electronic health record
Research projects
etc.
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Health professionals support the idea of integrated care
Gesundes Kinzigtal GmbH
Gesundes Kinzigtal GmbH
Developing a health care program consists of 5 steps
Indication related and structured care
programs organised through a central
management authority ensure the optimal
care of the patient
Bottom up approach wanted (patient level
etc.)
A comprehensive development process is
necessary to obtain a care program
Cost-benefit analisis
Approval of medical advisory board
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Project-impulse
Data research/ analisis
Project- order
Conceptual design
Testing stage
Gesundes Kinzigtal GmbH
• Active multi-specialty support for patients through disease management
• HK-progr.: Psychotherapy acute / depression
• Selfhelp+ self management training for chronic patients (in preparation … Stanford SDSM)
Just one example of the interventions around diabetes
High
cost
patients
Rising risk patients progressing
Insured in risk
Healthy insured – before getting into risk
20%
40%
35%
5%
• HK-progr.: Healthy weight (adipositas)
• HK-Progr.: blood pressure okay
• Developing jointly health goals
• Cooperating with sports clubs
• Unspecified.training in health literacy
(for patients and pracitices)
• Health Festivals + health promotion
within kindergartens, schools,
companies
• Supporting the existing preventive
offers of health insurances
• Health coaching
• Attention on polymedication – regular training
• HK-progr: Physicains plus nursing (improving Interaction)
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PMV, a department of University of Cologne, is our external scientific
evaluation agency
Just diabetes: We succeed in reducing hospitalisations
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Outcome: fractures in patients with knownosteoporosis
Percentage of osteop.patients with fracture
Controls
Gesundes Kinzigtal GmbH
…it´s not all about data - other important factors to gain success in integrated care
Build confidence between
stakeholders
excellent public relations and
frequent contact to citizens
Standard IT-infrastructure in
physicians´practice
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Gesundes Kinzigtal GmbH
For the best quality of healthcare a network across the boundaries of professions and institutions was set up in the last seven years
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Sportclubs and
Studios
Municipalities
Sickness FundsCompanies
Schools
Gesundes Kinzigtal GmbH
Long-term perspective of the model ensures incentives for the right care
Strengthen the financial independence:
• Long-term contracts enable the freedom of decision within the model
• Attract additional sickness funds to benefit also from the health effects for their
insured persons
• Development of new business fields which are independently financed (e.g.)
• World of Health “Gesundheitswelt”
• Occupational Health Management: financed by enterprises
• Health academy and Health Courses: financed by participation fees
• Additional project related funds from third parties
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Long-term contract as an incentive for sustainable health investments and prerequisite for a meaningful
evaluation
Regional approach for trustfully cooperation of all shareholders involved
Data availabilityfor sustainable controlling
Eye-level approachfor a good cooperation between management, health professionals, and patients
Lessons Learned: The „Triple Aim“ can be reached – requirements for success
Co-Ownership of the local physician networkas an additional incentive for initiative and engagement
The quality challenge can be fulfilled: we improve health, quality AND reduce costs at the same time!
Gesundes Kinzigtal GmbH
Regional care company as “integrator” + partly
ownership through local providers
Investment for the first three years
(until earnings are big enough for ROI)
Going / thinking beyond healthcare +
entrepreneurial health sciences spirit
Emotional quality between providers,
professions, management and
patients
Comprehensive implementation of
technology: ICT & data-driven management
approach
“Coopetition” = cooperation and
competition through transparency and
benchmarking
Balanced payment system oriented
towards achieving the Triple Aim
Innovative culture and friendly interactions
“open source” mindset
10 years contract with sickness fund
to refinance investment
What makes our regional integrated care model unique?
Gesundes Kinzigtal GmbH
The Time has Come: what can we do to support similar initiatives abroad? - I
OptiMedis collaborates with partners in an “open source”
environment
• 6 more regions in Germany within the next two years and
• 2 other countries besides Germany with each 3 regions, e.g. in
• the Netherlands (OptiMedis-NL
already founded)
• Switzerland
• Interest as well in UK, Belgium, Austria
+ Australia
Ready for replication: Quality indicators,
evaluation protocols, program outlines,
incentive systems, guidebook, data
warehouse, reporting system …
Gesundes Kinzigtal GmbH
Let‘s get in contact
Web: www.optimedis.comwww.gesundes-kinzigtal.com
Newsletter: www.optimedis.com/newsletter
Helmut Hildebrandt
h.hildebrandt@optimedis.de
OptiMedis AG
Borsteler Chaussee 53
22453 Hamburg
Phone +49 40 226221490
Mobile +49 172 4215165
Christian MelleEisenbahnstr. 17 77756 Hausachc.melle@gesundes-kinzigtal.de