Developing Efficient Managed Care programs for the Chronically Ill – Ethic, Economic, Legal and Social Aspects

1. Developing Efficient Managed Care programs for the Chronically Ill – Ethic, Economic, Legal and Social Aspects Dr. Sarah Mostardt Lennart Weegen, M.A. Lasse Korff, M.A. Sonja Ivancevic Dr. Anke Walendzik Prof. Jürgen Wasem Institute for Health Care Management and Research

2. background Institute for Health Care Management and Research • care for the chronically ill in the German health care system has been characterized as deficient • a particular problem is the coordination between different health care sectors (outpatient, inpatient, rehabilitative) and between different (medical) disciplines • preventive and rehabilitative treatment are often disregarded and not based on the principles of evidence based medicine • the optimization of the care structures through managed care in order to eliminate existing deficits has become a common goal of relevant players within the health care system • the contents, outcomes and effectiveness of managed care programs is of high importance to improve care for the chronically ill

3. aimofresearchproject • analysis of possibilities and requirements for efficient managed care and the identification of potential limits • development of a multidimensional concept for intersectional collaboration and new forms of managed care programs with a focus on: • aspects of the health care system design and health economics • medical ethical aspects and possibly social and constitutional dimensions • impact on patients, providers, health plans, health industry and policy makers Institute for Health Care Management and Research

4. interdisciplinaryprojectteam • Health economics: • Prof. Wasem (University Duisburg-Essen) • Ethic subproject: • Prof. Marckmann (University Munich) • Medical experts: • Prof. Gräßel (University Erlangen) • Prof. Hartung(UniversityDüsseldorf) • Legal experts: • ifrequired • unrestrictedgrant: • Janssen-Cilag GmbH Institute for Health Care Management and Research

5. researchdesign preperation stage - selecting indications workpackageI analysis of the current care situation of the chronically ill (esp. care deficits) in the German health system and existing managed care programs (including evaluations) workpackage II identification of international approaches to solve existing care deficits and review of international evaluations of care management workpackage III – development of scenarios for optimization workpackageIV - recommendations for action workpackageV - dissemination of the project results Institute for Health Care Management and Research

6. selection of indications • criteria: • involvement of several sectors of the health system • somaticand mental indication • one indication with existence of several care management programs • clearlydefinedindication • alzheimer'sdisease • multiple sclerosis (MS) Institute for Health Care Management and Research

7. methods - workpackage I • analysis of : • the current care situation in the German health care system • existence of care management programs - alzheimer'sdiseaseand multiple sclerosis • methods: • systematic national literature review • survey of • the German statutory health insurance • patient organisations • medical societies Institute for Health Care Management and Research

8. methods - workpackageI • analysis of the current evaluations of care management programs - alzheimer'sdiseaseand multiple sclerosis • methods: • systematic national literature review • survey of the German statutory health insurance Institute for Health Care Management and Research

9. methods - workpackage II • identification of current international solutionsfortheidentified deficits in care • analysis of the current international evaluations of care management programs - alzheimer'sdiseaseand multiple sclerosis • => comparative countries: Sweden, Netherlands, USA • methods: • systematic international literature review Institute for Health Care Management and Research

10. methods - workpackageIII • developingscenarios for optimization • methods: • exploratory and semi-structured interviews • preparation of the data in WP I and WP II • definition of relevant objectives and development of scenarios for optimization • discussion of scenarios in interdisciplinary workshops with players in the health care system Institute for Health Care Management and Research

11. methods - workpackage III • validationofscenariosforoptimization • methods: • consolidation of the workshop results • preparation and conducting of a Delphi process Institute for Health Care Management and Research

12. methods - workpackageIV and V • the results of the workshop and the Delphi process build a foundation for developing recommendations • planning public events; background discussions, monographs and articles Institute for Health Care Management and Research

13. tasksofthemedicalexperts • qualitiy control regarding the identified care deficits (WP I) • findingsuitablecontactpersonsforinterviews (WP I and II) • participationattheworkshoptodevelopscenarios (WP III) • quality control of the elaborated resultsin the WP III (WP III) • participation in the Delphi process (WP IV) Institute for Health Care Management and Research

14. Aimoftheethicsubproject analysis of the ethical implications of the current situation of the chronically ill in the health care system development of an ethical criteriologyfor an ethically responsible care of the chronically ill development of recommendation for actions in the specific scenarios for selected indications ethical assessment of the developed scenarios recommendations for an prospective ethically responsible care of the chronically ill Institute for Health Care Management and Research

15. Work flow subprojectethic research project WP 1 analysis of the current health care situation WP1 analysis of the ethical implications of the current situation (analytic) WP1 development of an ethical criteriology(empirical) WP2 identify deficits exploratoryinterviews WP2 ethical criteriology WP3 development specific scenarios (ethic) WP3 developingscenarios for optimization 3.1 development/workshop WP4 Empirical Validation of the scenarios: Ethical implications 3.2 Validation: Delphiprocess WP5 recommendations WP4 recommendations WP5 ddissemination of results Institute for Health Care Management and Research

16. Currentresults • See: • Presentation S. Ivancevic (this session): • 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 • Poster L. Weegen (poster walk 2): • Situation Review of Care Deficits and Management Programs for Multiple Sclerosis in Germany • Poster L. Korff (poster walk 2): • Situation Review of Care Deficitsand Care Management ProgramsforAlzheimer'sDisease in Germany Institute for Health Care Management and Research

17. Developing Efficient Managed Care programs for the Chronically Ill – Ethic, Economic, Legal and Social Aspects • Thanksforyourkindattention! Contact: Dr. Sarah Mostardt Lehrstuhl für Medizinmanagement Universität Duisburg-Essen phone: +49-(0)201-183-3180 Mail: sarah.mostardt@medman.uni-due.de http://www.uni-due.de/medizinmanagement Institute for Health Care Management and Research