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Effectiveness and cost-effectiveness of care management programs for the indications

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

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Effectiveness and cost-effectiveness of care management programs for the indications

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  1. 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 Institute for Health Care Management and Research

  2. Research project Institute for Health Care Management and Research

  3. 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) Institute for Health Care Management and Research

  4. 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 • surveyof the German statutory health insurance Institute for Health Care Management and Research

  5. survey of the German statutory health insurance – methodological approach Institute for Health Care Management and Research

  6. Methodologicalapproach 1/2 • Empirical qualitative survey • standardized questionnaire • subjects: • existence of care management programs for both indications • evaluations regarding their effectiveness and/or cost-effectiveness • 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 Institute for Health Care Management and Research

  7. Respondentstatutoryhealthinsurances • BKK Verkehrsbau Union • BKK vor Ort • Daimler Betriebskrankenkasse • DAK-Gesundheit • Deutsche BKK • HEK - Hanseatische Krankenkasse • hkk • IKK Brandenburg und Berlin • IKK classic • IKK gesund plus • IKK Nord • IKK Südwest • KKH-Allianz (Ersatzkasse) • Knappschaft Bahn See (KBS) • Mhplus Betriebskrankenkasse • Novitas BKK • Pronova BKK • Schwenninger Betriebskrankenkasse • Siemens-Betriebskrankenkasse (SBK) • Techniker Krankenkasse (TK) Institute for Health Care Management and Research AOK Baden-Württemberg AOK Bayern AOK Bremen/Bremerhaven AOK Hessen AOK Niedersachsen AOK Nordost AOK Nordwest Direktion Dortmund AOK Nordwest Landesdirektion Kiel AOK Plus AOK Rheinland/Hamburg AOK Rheinland-Pfalz/Saarland AOK Sachsen-Anhalt Audi BKK Bahn-BKK Barmer GEK Betriebskrankenkasse Mobil Oil BIG direkt gesund BKK Essanelle BKK Gildemeister Seidensticker BKK Pfalz

  8. Methodologicalapproach 2/2 • Postal questionnaire • Survey period: • november 2012 • Follow-up • resend of 20 questionnaires in january 2013 • Telephone enquiry • february-march 2013 Institute for Health Care Management and Research

  9. Resultsofthesurvey Institute for Health Care Management and Research

  10. Survey participation More than 90% ofstatutoryinsuredpopulation response rate 65% numberofinsurants ca. 53 Mio. (76%) Institute for Health Care Management and Research

  11. Number of existing managed care programs for Multiple Sclerosis and Alzheimer‘s disease Institute for Health Care Management and Research

  12. „InterdisciplinaryHealth-Care Model forPatientswith Multiple Sclerosis in North Rhine“ Nelles et al. 2010 • 2-Year Follow-Up (pre-post comparison) • sample: 319 patients • results: *p<0,05 ¹ statedaretheaccountingsofpatientswithat least onevisitoftheinstitution in the last 12 months.ARR= absolute riskreduction; RRR= relative riskreduktion Institute for Health Care Management and Research

  13. Discussion and conclusions Institute for Health Care Management and Research

  14. 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 Institute for Health Care Management and Research

  15. 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 Institute for Health Care Management and Research

  16. Annual costs of illness for Alzheimer’s disease in GermanyLeicht et al. 2011 statutory health insurance services23% source: Leicht et al. (2011) Net cost of Dementia by disease stage Institute for Health Care Management and Research

  17. 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 Institute for Health Care Management and Research

  18. Conclusions Institute for Health Care Management and Research 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

  19. 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 • Thanksforyourkindattention! Contact: Sonja Ivancevic Institute for Health Care Management and Research University Duisburg-Essen phone: +49-(0)201-183-6835 Mail: sonja.ivancevic@medman.uni-due.de http://www.uni-due.de/medizinmanagement Institute for Health Care Management and Research

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