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OptiMedis AG Borsteler Chaussee 53 D – 22453 Hamburg Tel: +49 40 226 211 49 0 e-mail: h.hildebrandt@optimedis.de Web

Talking business: Integrated Care and its ROI April 2 nd 2014: 50 th Anniversary of RIZIV Special Event on “National Implementation of Integrated Care” in connection with the 14th International Conference on Integrated Care, Bruxelles. Helmut Hildebrandt .

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OptiMedis AG Borsteler Chaussee 53 D – 22453 Hamburg Tel: +49 40 226 211 49 0 e-mail: h.hildebrandt@optimedis.de Web

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  1. Talking business: Integrated Care and its ROIApril 2nd2014: 50th Anniversary of RIZIV Special Event on “National Implementation of Integrated Care” in connectionwiththe 14th International Conference on Integrated Care, Bruxelles Helmut Hildebrandt OptiMedis AGBorstelerChaussee53D – 22453 HamburgTel: +49 40 226 211 49 0e-mail: h.hildebrandt@optimedis.de Web: www.optimedis.de • Gesundes Kinzigtal GmbH • Strickerweg 3d • D – 77716 Haslach • Tel: +49 7832 – 974 89 0 • e-mail: h.hildebrandt@gesundes-kinzigtal.de • Web: www.gesundes-kinzigtal.de

  2. The Triple Aim* ofGood & ResponsibleHealth Care Improve the health of the population Efficient ( ow) per capita costs of care Enhance the patient care experience * Berwick DM, Nolan TW, Whittington J. (2008), The triple aim: care, health, and cost. Health Affairs 2008 May/June;27(3): 759-69. Regional organizedaccountable health care systems (coopnetworks) cantake on responsibilitytoactastheintegrator

  3. Regional organizedaccountable health cares systems (coopnetworks) cantake on responsibility Regional Care Company Ownedpartiallybyproviders, hospital, municipality, civilfoundation, seniorsorganisation, sportsclub …. publichealthorganisation Problem: Providers couldcreateoverloadofservices (highercosts) Solution / Governance: This RCC is being paid by the insurance for the achieved health outcome in € (related & adjusted to the normal profit ratio) instead for the number of disease/health services

  4. Kinzigtal is in theSouthwestof Germany Start: 2006 withfourcourageouspartners:AOK Baden-Württemberg and LKK – and Gesundes Kinzigtal GmbH(2/3 shares MQNK e.V. and 1/3 OptiMedis AG) Concerned Population: 33,000 insureds of AOK andLKK 58% of all the GPs and specialists of the region are partners / altogether around 500 staff from partnering providers in communication loop Nearly 10,000 patients have already chosen the free membership, getting surplus health care services, coaching and free preventive offers – but staying free in their decision to chose any provider (like in the regular system) Providers gettheir normal fee plus targetedadd-on feesthrough Gesundes Kinzigtal … around 5-10% surplus … forthoseservices GK wantsthemtodeliver

  5. Gesundes Kinzigtal GmbH: Population-based Integrated Care for a whole Region Know-how of regional problems in health careprovision + links to all institutionsandproviders Know-how in health economy, healthsciences, prevention, controlling- andmanagerialissues ownership: 66,6% MQNK e.V. (Ärztenetz) 33,4% OptiMedis AG Twoconvincedpartners: A localphysiciannetwork „Ärztenetz MQNK“and a managementcompany „OptiMedis AG“thatstemsfrom a healthsciencebackground Twopartnerswithpassionandmotivationtoprovetheeffectivenessof a betterorganized regional healthcaresystem in thehandof a dedicated Regional Care System A companywith a businessmodelthatrewardsinvestments in betterhealth & andbetterfocusedhealthcare … ifitresults in improvedearningsforthepayor (= healthinsurance) = lesscostsofcare (in comparisonwith national standard)

  6. Networking – around 160 partnersand 500 peopleinvolved in thecareprocess

  7. WithFive Key SuccessFactorsforHealthImprovement….

  8. Integration of a networkof SMEs = a businesseffort Whatarethe „normal“ costs in business ? Lookingintothe „production“ of Integrated Care …. => comparabletotheintegrationofthesupplychainofotherbusinesses Aligningtheincentives / ICT-integration / aligningandconvincingthe SMEs working in theprovisionof care whoarecompetitors … => comparableto „clustermanagement“ projectsofnewtechnologies Activatingthepatientstousethefull potential oftheirresources in reducingcosts …. => comparabletomassmediacampaigning like HIV-campaigns / comparabletousingconsumersown time insteadofemployees (bankingbusiness)

  9. LookingintoCosts / Finances Kinzigtal – 33 000 insuredpeople => 74 000 000 € total costsof care per year Investment = Costsforaligning / administration / campaigning / analyzing => 2 200 000 € per year (meanoverfiveyears) Results = GainforHealthInsurances / Sickness Funds => brutto: 5 000 000 € per year (meanoverfiveyears)=> netto: 2 300 000 € per year (meanoverfiveyears) (after sharingtheresultwith Gesundes Kinzigtal GmbH and after taking off theowntransactioncosts … estimated)

  10. Intangible „Welfare“ Benefits Reductionofmortality .. prolongationoflife Improvementofthehealthstatusofthepopulation Improvementofthecooperativebasisofprofessions (importantforhelpingpatientsand relatives toreducetheiranxietylevel) Strengtheningtrustintothehealth care system Improvementofattractivenessofthehealthprofessionstogetyoungtalentsinterested (war fortalents will raiseproblemswithsmallerworkforceandmoreelderly)

  11. Governanceand Investments Need tointerestmultidisciplinarynetworks in improvinghealthstatusandinvestintohealth … not just fortheshortrun but forthelongrun Need for a regional interested (social) entrepreneurcapabletoinvestintothetransitionfromacute care oftodayinto a chronic care andpersoncentered care ofthefuture => comparabletothe ACO-organisations in the US / Kaiser Permanente Start-Up Investment … whopaysandwhoearnsthe ROI afterwards?

  12. Wearelookingforwardtoyourcomments & cooperation Helmut Hildebrandt, Vorstand, OptiMedis AG, Borsteler Chaussee 53, D – 22453 Hamburg Tel: +49 40 226 211 49 0 e-mail: h.hildebrandt@optimedis.de www.optimedis.de See video + website www.gesundes-kinzigtal.de

  13. SomeLiterature – extra website on evaluation in german/englishwww.ekiv.org Hermann C, Hildebrandt H, Richter-Reichhelm M, Schwartz FW, Witzenrath W. Das Modell „Gesundes Kinzigtal“. Managementgesellschaft organisiert Integrierte Versorgung einer definierten Population auf Basis eines Einsparcontractings [The „Gesundes Kinzigtal“ model: A managementcompanyorganises a population-basedintegratedcaresystem on thebaseof a shared-savingsapproach]. Gesundheits- und Sozialpolitik 2006;(5-6):11-29. [in German]. Hildebrandt H, Hermann C, Knittel R, Richter-Reichhelm M, Siegel A, Witzenrath W. S Gesundes Kinzigtal Integrated Care: improving population health by a shared health gain approach and a shared savings contract. International Journal of Integrated Care [serial online] Vol. 10, 23 June 2010 Available from: www.ijic.org Hildebrandt H, Schulte T, Stunder B. Triple Aim in Germany: Improving population health, integrating health care and reducing costs of care in the Kinzigtal-region – lessons for the UK? Journal of Integrated Care, Vol. 20 Iss: 4, pp.205 - 222 (2012). Emerald Group Publ. DOI: 10.1108/14769011211255249 Siegel A, Köster I, Schubert I, StösselU. Utilization Dynamics of an Integrated Care System in Germany: Morbidity, Age, and Sex Distribution of Gesundes Kinzigtal Integrated Care´s Membership in 2006-2008. In (Janssen C, Swart E, Lengerke T v. Ed) Health Care Utilization in Germany. Springer 2014 DOI 10.1007/978-1-4614-9191-0 pp.321-335

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