Mrs Sonja Ivancevic
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Transcript Mrs Sonja Ivancevic
Effectiveness and cost-effectiveness of
care management programs for the indications
Alzheimer's disease and multiple sclerosis Results of an empirical survey of the German
statutory health insurance
Sonja Ivancevic
Lennart Weegen, M.A.
Lasse Korff, M.A.
Dr. Anke Walendzik
Prof. Jürgen Wasem
Dr. Sarah Mostardt
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Research project
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Research project
Developing efficient managed care programs for the
chronically ill – ethic, economic, legal and social
aspects
Aim
analysis of possibilities and conditions for efficient care
management programs
identification of potential limits
Selected indications:
Alzheimer‘s disease (AD)
Multiple sclerosis (MS)
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Research project
Sub-project:
inventory of health economic evaluations concerning care
management programs for Multiple sclerosis and
Alzheimer´s disease
identification of effective and cost-effective aspects of
existing care management programs for developing new
efficient care programs
methodological approach:
systematic review
survey of the German statutory health insurance
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survey of the German statutory health
insurance –
methodological approach
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Methodological approach 1/2
Empirical qualitative survey
standardized questionnaire
subjects:
existence of care management programs for both
indications
evaluations regarding their effectiveness and/or costeffectiveness
Sample:
40 largest of the totality of 144 statutory health insurances
selected by the number of insured population
selection contains 90% of statutory insured population
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Respondent statutory health insurances
AOK Baden-Württemberg
BKK Verkehrsbau Union
AOK Bayern
BKK vor Ort
AOK Bremen/Bremerhaven
Daimler Betriebskrankenkasse
AOK Hessen
DAK-Gesundheit
AOK Niedersachsen
Deutsche BKK
AOK Nordost
HEK - Hanseatische Krankenkasse
AOK Nordwest Direktion Dortmund
hkk
AOK Nordwest Landesdirektion Kiel
IKK Brandenburg und Berlin
AOK Plus
IKK classic
AOK Rheinland/Hamburg
IKK gesund plus
AOK Rheinland-Pfalz/Saarland
IKK Nord
AOK Sachsen-Anhalt
IKK Südwest
Audi BKK
KKH-Allianz (Ersatzkasse)
Bahn-BKK
Knappschaft Bahn See (KBS)
Barmer GEK
Mhplus Betriebskrankenkasse
Betriebskrankenkasse Mobil Oil
Novitas BKK
BIG direkt gesund
Pronova BKK
BKK Essanelle
Schwenninger Betriebskrankenkasse
BKK Gildemeister Seidensticker
Siemens-Betriebskrankenkasse (SBK)
BKK Pfalz
Techniker Krankenkasse (TK)
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Methodological approach 2/2
Postal questionnaire
Survey period:
november 2012
Follow-up
resend of 20 questionnaires in january 2013
Telephone enquiry
february-march 2013
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Results of the survey
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Survey participation
More than
90% of
statutory
insured
population
questioned
insurances
(n=40)
response rate
65%
survey participation
(n=26)
number of
insurants ca.
53 Mio. (76%)
insurances offering
care management
programs for MS or AD
(n=11)
no survey
participation
(n= 14)
insurances not offering
care management
programs for MS or AD
(n= 15)
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Number of existing managed care programs
for Multiple Sclerosis and Alzheimer‘s
disease
insurances offering
care management
programs for
MS or AD (n=11)
care management
programs
Multiple Sclerosis
(n=6)
care management
programs
Alzheimer's disease
(n= 4)
evaluation
planned
(n=1)
evaluation
planned
(n=1)
evaluation of program
outcomes / costeffectiveness
(n=4)
no evaluation of
program outcomes /
cost-effectiveness
(n=1)
evaluation of program
outcomes / costeffectiveness
(n=1)
program beeing
developed (n.a.)
(n=1)
no evaluation of
program outcomes /
cost-effectiveness
(n=1)
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„Interdisciplinary Health-Care Model for
Patients with Multiple Sclerosis in North
Rhine“ Nelles et al. 2010
2-Year Follow-Up (pre-post comparison)
sample: 319 patients
results:
patient treatment¹
number of patients
special care/neurology
general practitioner
acut care hospital
rehabilitation
social services
nursing home
self-help group
bevor baseline 24-Follow-up ARR
RRR
OR (Base/24M)
319
319
310 (97,2%)
310 (97,2%)
0,00%
0,00%
1,00 [0,4;2,6]
222 (69,6%)
251 (78,7%)
9,10%
13,10%
0,60 [0,4;0,9]
82 (25,7%)
29 (9,1%)
-16,6%*
-64,60%
3,60 [2,2;5,5]
30 (9,4%)
19 (6,0%)
-3,40%
-36,70%
1,60 [0,9;2,3]
5 (1,6%)
8 (2,5%)
0,90%
60,00%
0,60 [0,2;1,9]
2 (0,6%)
2 (0,6%)
0,00%
0,00%
1,00 [0,1;7,2]
50 (15,7%)
38 (11,9%)
-3,80%
-24,00%
1,37 [0,9;2,2]
*p<0,05
¹ stated are the accountings of patients with at least one visit of the institution in the last 12 months.
ARR= absolute risk reduction; RRR= relative risk reduktion
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Discussion and conclusions
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Discussion
For both indications currently available evaluations
do not allow a qualified assessment of the
effectiveness of care managemnt programs
Low number of published evaluations:
sensitive data, only for internal use
Possible causes for the failure of evaluation:
internal controlling is considered as sufficient
disproportionately high effort
Managed care programs in development
evaluation occurs with delay
No involvement in evaluations of contractual partners
or no information about results
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Discussion
Limited incentives for the statutory health insurance
in developing care management programs for
Alzheimer’s disease
excluded from Morbi-RSA
low costs of illness for the health insurance
most costs apportioned to informal carers and care
insurance
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Annual costs of illness for
Alzheimer’s disease in Germany
Leicht et al. 2011
14000
11,996 €
12000
10000
8000
statutory health insurance services
23%
5,942 €
6000
4000
5,620 €
3,662 €
1,460 €
2000
765 €
505 €
585 €
other outpatient
treatment
medical
supplies/
dentures
0
hospital
out-patient
physician
treatment
drugs
inpatient care
home care
informal care
source: Leicht et al. (2011) Net cost of Dementia by disease stage
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Discussion
Care management programs for Multiple sclerosis
imply more incentives for the statutory health
insurance
more potentials in cost-reduction
high hospitalisation rate
ambulant treatment of episodes possible
considered in Morbi-RSA
Usually longer interval between initial diagnosis and
care dependency
long period of cost responsibility of health care insurance
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Conclusions
Ambiguity about effectiveness of care management
programs for MS and AD
To ensure the goal-orientation and avoid misallocations
the measurement of success is necessary
Evaluation of effectiveness and cost-effectiveness for
developing new care programs required
Need for more transparency to enable orientation on
best-practice
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Effectiveness and cost-effectiveness of
care management programs for the indications
Alzheimer's disease and multiple sclerosis Results of an empirical survey of the German statutory health
insurance
Thanks for your kind attention!
Contact:
Sonja Ivancevic
Institute for Health Care Management and Research
University Duisburg-Essen
phone: +49-(0)201-183-6835
Mail: [email protected]
http://www.uni-due.de/medizinmanagement
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