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The BARMER Institute for Health Care System Research

The current Situation in Germany in Health Care. The BARMER Institute for Health Care System Research. - Research Focus & Utilization of Data -. 2018 iFHP Biennial Conference Lisbon , 24-27 June 2018 U. Repschläger. The BARMER Sickness Fund.

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The BARMER Institute for Health Care System Research

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  1. The current Situation in Germany in Health Care The BARMER Institute for Health Care System Research - Research Focus & Utilizationof Data - 2018 iFHPBiennial ConferenceLisbon, 24-27 June 2018U. Repschläger

  2. The BARMER Sickness Fund The BARMER ist a nationwidestatutoryhealthinsurance in germany- 9.3 Mio. insuredlives Uwe Repschläger- Working in thegermanhealth care systemsince 1992, since 2000 forthe BARMERresponsiblefor:- controlling, riskmanagements, datamanagement, strategicanalysis- patientclassificationsystems- companystrategy- memberof an expert committeeofthegermanhealthministry(expenditureforcastofhospitalcosts)

  3. AGENDA A shortoverviewoverthegermanhealth care system and thecurrentgermansituation The new BARMER Institute – focusthemes and (utilizationof) data

  4. The German „Health Care Market“ (1) 4 3 ~ 5.5 Mio. Employeesin Health care (2017) ~ 365 Mrd. € Expenditures(11.2% ofthe national output [3.263])(2017) ~ 4.400 € / person (368) (12.2% / 44.2 Mio.) 82.8 Million Population(2017, notable increasingsince 5 years) 1) ~100% coverdbyinsurance 1) legal requirement

  5. The German „Health Care Market“ (1) 4 3 ~ 5.5 Mio. Employeesin Health care (2017) ~ 365 Mrd. € Expenditures(11.2% ofthe national output [3.263])(2017) (368) 82.8 Million Residents(2017, notable increasingsince 5 years) ~100% coverdbyinsurance INSURANCE-SYSTEM (2018) HEALTCARE PROVIDERS 157 Sickness Funds- 110 public „GKV“(72,8 Mio. insuredlives)- 44 privat(8,8 Million insuredlives) - 170.000 registered physicians (ambulatorytreatment)- 72.000 dentists- 1.950 hospitalswith 499.000 beds(160.000 physicians in hospitals)- 19.800 publicpharmacys- a.s.o.…. 1) 1) public = publicbodies (non profitorganisations,noserviceproviders)

  6. The German „Health Care Market“ (2) INSURANCE-SYSTEM (2018) 157 Sickness Funds- 110 public „GKV“ (72,8 Mio. insuredlives)- 44 privat(8,8 Million insuredlives) (officials, self-employedpersons, employees > upperincomelimit [59.400 € / year]) nationwideorlocal (federalstate) BARMER ist a nationwidestatutoryhealthinsurance(founded 1912)- 9.3 Mio. insuredlives(11.2% /12.8% marketshare, secondlargestsichnessfund) - 15.000 employees- 32 billion € annual turnover(14% of all 110 statutoryhealthinsurance [228 bill. €])- 400 agencys & 50 processingcentresofexpertise(hospital, sick-pay, care, telephonyservice, a.so.)- headquarters in Berlin & Wuppertal, 16 stateoffices

  7. The German „Health Care Market“ (3) The „Organisation of Financing & Competition“ in the GKV (110 sicknessfunds) „Health Care Fund“ Members all themoney Fed. Insurance Office Sickness Fund healthinsurancecontributions 15.7% oftheincome(50% member / 50% employer) Executionof aFiscalCompensationbased on morbidity(80 diseases) newdistribution ~ 95% oftheserviceofferareequal – so wehaveprimarly a „price-competition“ betweenthesicknessfunds,littlecompetitionbased on products in germany

  8. The German „Health Care Market“ (4) The currentsituation in germany: „The germanhealth care systemhas, foronce, relativlylittle (cost)problems. relativlyconstantcontributions / pricesofthesicknessfundsoverthe last threeyears a lotofmoney in thesystem (18 bill € reservesbythepublicsicknessfunds (GKV)) why?

  9. The German „Health Care Market“ (4) The currentsituation in germany: „The germanhealth care systemhas, foronce, relativlylittle (cost)problems ! relativlyconstantcontributions / pricesofthesicknessfunds a lotofmoney in thesystem (18 bill € reservesbythe GKV) why? Increasingwages(healthinsurancecontributionsare ~15.7% ofthewages) Decreasing rate ofunemployment Immigrationofmanyyoung and healthypeople

  10. The German „Health Care Market“ (4) Increasingwages (healthinsurancecontributionsare ~15.7% ofthewages) Decreasing rate ofunemployment Immigration ofmanyyoung and healthypeople employees Public sicknessfundshospitals: +2.9% /+1.6%

  11. The German „Health Care Market“ (5) So thereis (currently) nocost-problem in thehealth care system- (bytheway, increasingcostsforthenursing care insurance) ….but there ist ghostcomingup on thehorizon, disturbingthecalm… „DIGITALIZATION“ ….and thatmakesthe (traditional) sluggishgermansicknessfunds a littlenervous. Ustoo.

  12. „Data“ arethemostimportantressourceofthe digital economy data and dataanalysisaregainingmore and moreimportance in business„date arethenewoil / thenewcoal“ & „long time ago“ industrialera 21. century < 18. century 19. century

  13. The BARMER Institute for Health Care System Research sicknessfundsneed a professionalutilizationoftheirdata„data“ are an importantcompetitionparameter in health care „who ist gettingthemost out ofhisdata…?“ naturallaythebarmeris „usingdata“ for different purposes in routinebusinesssinceyearsand we publish different studiessincemanyyears – but: wedecided, toconcentrate and expand „digitalization“ „dataanalysis“ & „healthresarch“= formationof a „digital department“ & formationofour own resarchinstitut in 2018

  14. AGENDA A shortoverviewoverthegermanhealth care system and thecurrentgermansituation The new BARMER Institute – focusthemes and (utilizationof) data

  15. The BARMER Institute for Health Care System Research sicknessfundsneed a professionalutilizationoftheirdata - handlingdata(availability, quality) - understandingdata - utilisation(productsforcustomers, f.e. appsforsicknesspay / electronicalpatientrecord)

  16. BARMER Institute – Research Focuses & Activities TheBARMER Institut für Gesundheitssystemforschung (BIfG)in it´sselfconceptionis a competencecenterforhealthsciences, withresarchfocus on thefollowingthemes: - dataanalytics - financingsystems - insurancesystems - healthservicesresearch - medicine (keyissues) wecreate and developindependentorin partnershipanalysis and conceptsespeciallytosystemquestions in healthsystem TheBIfGis an independent organizational unitwithin BARMER(1 manager, 22 employees) A Science boardisusedtoexchangeinformation and hold contactwithuniversities, scienceand stakeholders in thehealth care system.

  17. BARMER Institute – Research Focuses & Activities example „Morbidityorientedclassificationsystems“ • Morbidity-basedriskstructureequalisation= financialcompensationbetweensicknessfunds- forthe 110 sicknessfunds in germany (since 2009)- based on diagnoses (inpatient & outpatientdiagnosis, validatedbydrugprescription)- (onlyfor) 80 diseases • Morbidityadjustedpaymentforhospitals - DRG-System (since 2004) • Morbidityajustedpaymentforambulatoryphysicians(since 2008) [only „sizethepie…“] The Institut applys different „grouper“ – offical and self-programmed(simulations,assementsofresults…)

  18. Breakeven AnalysisBARMER (Federal States) -107 € +1 € -227 € +34 € -74 € example -23€ +8 € -19 € -89 € +6 € +40 € -61 € -47 € -29 € -47 € +49 €

  19. BARMER Institute – Research Focuses & Activities example „Predictive Models“ • predictionoftotalscosts(regions, populations) • predictionofhospitalcases / hosptalcosts / hospitalpropability • predictionofdiseases / morbidity(regions, populations) • predictionoftheeffectsofthedemographicchange(expanditure, care) • a.s.o. toknowtoday „what will propabliy happen tomorrow“ is an keyissue in business

  20. BIG DATA in Health Care – some Details „Big Data“isdefiniedas continuousgrowingquantities auf data, and usingthisdata Synonyms: „Big Data“, „Advanced Analytics“, „Predictive Analytics“, „Deep Dive“, „Data Mining“, („AI“), …. Big Data in Health Care has a specialimportance, because exeptionalquantitiesofdataareavailable(BARMER p.a.: > 2.5 Mio. hospital-cases, > 100 Mio. drug-prescriptions, >100 Mio. amb. accounts, > 45 Mio. therapeuticappliances, Total > 250 Mio. accounts p.a., ~ 1 bill. diagnosis). > germany: > 2.2 billionaccounts p.a. > 9 billiondiagnosis p.a. „every 6 monthunder a newterm“

  21. „BIG DATA“ Details - BARMER thepresentdatabasefor ~ 11 millonindividualsin ourDataWareHouse: individual identifiablehospital-dataover15 years– goodquality(diagnosis [icd-10], procedures [ops], costs, lengthofstay, hospital….) individual identifiabledrug-dataover20 years– „perfekt“ quality(centralpharmaceuticalnumber [ddd, agent, producer], costs.) individual identifiableoutpatientdiagnosisover10 years– „average“ quality(missingguidlineforcoding) individual identifiabletherapeuticappliancesover20 years– goodquality(part. missingcodes) „coredata“ foreach individual - sex, age, residence, income, employer, qualification – goodquality The realizings out of such data and theusingareimportantfor all ofus- google: „wepredictyour individual mortalityrisk, based on our 37 billiondata….- E.Musk: „ai ist moredangerousthannuclearweapons…weneed a regulatoryauthority“

  22. „BIG DATA“ Details - BARMER > 12.000 tables> 57 billionlines> 1.5 trillionitems thepresentdatabasefor ~ 11 millonindividualsin ourDataWareHouse: individual identifiablehospitaldataover15 years– goodquality(diagnosis [icd-10], procedures [ops], costs, lengthofstay, hospital….) individual identifiabledrugdataover20 years– „perfekt“ quality(centralpharmaceuticalnumber [ddd, agent, producer], costs.) individual identifiableoutpatientdiagnosisover10 years– „average“ quality(missingguidlineforcoding) individual identifiabletherapeuticappliancesover20 years– goodquality(part. missingcodes) „coredata“ foreach individual - sex, age, residence, income, employer, qualification – goodquality The realizings out of such data and theusingareimportantfor all ofus- google: „wepredictyour individual mortalityrisk, based on our 37 billiondata….- E.Musk: „ai ist moredangerousthannuclearweapons…weneed a regulatoryauthority“ additional officialstatistics…

  23. BIG DATA – whatisrequired? a meaningfulutilizationofthisdatarequires a high (interdisciplinary) competence: mathematics / statistics programming / databanks suitabletechnology knowledgeofthedata („what´sincluded“ – „what not“) expierence in handlingdata (handlingunsharpnessa.s.o.). knowledgeofthe des functionalcontext…. time neededworkingwithdata: 60 %datapreparation („obligation“)20 % analysis („freestyle“)20 % interpretation („art“)

  24. Data Mining - Algorithms and Tools algorithms(Statistics / Mathematics) Logistic Regression Neuronal networks Decisiontrees … tools IBM SPSS Statistics / Modeler SAS SQL-Server / Analysis-Services SAP-HANA Statistiksoftware „R“ …

  25. Using „BIG DATA“ in Health Care predictionofthefuturerequirementofcapacities (based on population- and morbidityforecasts) thedigitizationofmedicalimaging and otherdataenables a fast secondopinionwithoutconsulation ai enablesthecomputertoadivisethedocororsuggestthebesttreatment. digitizationofdatamakesit possible, toavoid negative dual examination(f.e. x-ray) sicknessfunds: -pricingin greaterdetails - moreefficentprocessing - identificationofindividualswithinterventioncapability (DMP) - customersegmentation - product design - identificationoftrickery / regress …..

  26. DATA in Health Care vs. Data ProtectionRegulations but…. Digitalization&Dataleadtomoreand more Informationand tomoreopportunities Data ProtectionRegulationsEU / Germany frictions

  27. - outpatient-report- drug-report- hospital-report- therapeuticappliances-report- dental-report- … BARMER – 8 Annual Reports

  28. BARMER – 8 Annual Reports Publications 2015-2017 (extract) - influencingfactorsforhospitalpropability(upto 60%)- influenceofthedemograpicchangetotheexpenditures [12%-18%, 2005-2015] - the real incomeofthe registered doctors in germany… - riskstructurecompensationin germany (development, effects) - costsofthe last monthin life - cost-benefit-analysis for different selecteddrugs - minimumquantityforhospitalsand theireffectforquality - effectsofthemigrationtothecostofhealth care- the care ofasyleesin germany

  29. BARMER Science-Congress Issue: „Assessment in Health Care – Blessing orCurse?“ Moderation: Prof. Dr. Wolfgang Greiner, Lehrstuhl für „Gesundheitsökonomie und Gesundheitsmanagement“ an der Universität Bielefeld Prof. Dr. Jürgen Windeler, Leiter des Instituts für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG ) : Nutzenbewertung bei Arzneimitteln und Medizinprodukten – Erfahrung mit dem AMNOG auf andere Themen übertragbar? Prof. Dr. Heinz Rothgang, Abteilungsleiter Gesundheit, Pflege und Alterssicherung, SOCIUM Forschungszentrum Ungleichheit und Sozialpolitik, Universität Bremen: Bewertungsverfahren - Pflegenoten - Impulsreferat Julian Witte (M. Sc.); wissenschaftlicher Mitarbeiter Lehrstuhl für Gesundheitsökonomie und Gesundheitsmanagement; Fakultät für Gesundheitswissenschaften; Universität Bielefeld: Bewertungsverfahren - AMNOG - Impulsreferat Dr. Mani Rafii, Mitglied des Vorstands der BARMER: Bewertungsverfahren zur Qualitätssteigerung – Impulsreferat Podiumsdiskussion: Prof. Rothgang, Herr Witte, Herr Dr. Rafii 27. September 2018, Berlin

  30. ThankYou !

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