Health Insurance Reforms In Europe: Recent Changes And Their Implications

Health Insurance Reforms In Europe: Recent Changes And Their Implications – Last week I attended the International Conference on Integrated Care (ICIC18) in the Netherlands, leaving with a sense of hope that Europe is on the verge of a monumental healthcare reform. However, the realist in me believes that it will take years for Western Europe’s healthcare systems to transition to providing value-based healthcare.

The quadruple aim (figure below) was mentioned several times at ICIC, highlighting what providers within Europe want to achieve when implementing integrated care. However, outlining these goals is the easy part. There are major challenges across Europe in terms of implementing the organizational restructuring, payment reform, and methods of measuring success that will be needed to achieve the Quadruple Aim. Each of these points was discussed in detail during the conference.

Health Insurance Reforms In Europe: Recent Changes And Their Implications

With this in mind, care providers in Europe continue to struggle with a lack of coordination across sectors and verticals. Additionally, smaller providers looking to transition are often dwarfed in size by larger payer organizations that are not necessarily eager to transition from existing fee-for-service (FFS) models.

European Health Union

In a population-based approach, the payer transfers its risk to providers who are incentivized to reduce healthcare costs through improved management of the health of their population. The savings are then shared between the payer and the provider. However, payers for taking high-risk patients may be set back by reducing their incentive to opt out of the reward FFS model. Let’s take Germany as an example.

As with most developed countries, the German healthcare system is under stress due to an increase in multimorbid patients and an aging population. This population requires more complex treatment where good coordination between healthcare, social care and mental health providers is often essential. However, separate payment models for inpatient and outpatient care (as well as long-term and social care) make it particularly difficult to align incentives between sectors.

Instead of providing funding through taxation, citizens finance a statutory health insurance (SHI), or sickness fund, with contributions from their employer’s salary. Government is responsible for accessibility and quality of care; However, regulation is delegated to national associations leaving regional governments with little role in the financing or delivery of health care.

In sickness funds, funding is pooled and then redistributed through capitation, taking into account chronic disease rates and age-related demographic factors. GPs and ambulatory specialists in Germany are generally self-employed and are able to negotiate their own contracts with sickness funds on an FFS basis. Acute care payments are based on guidelines provided by diagnosis-related groups (DRGs) that use a fixed-price capitation model. The current model provides little financial incentive for providers to shift to a value-based payment system, while also limiting interactions between inpatient and outpatient settings.

Pdf) Health Care Reforms In Cee: Processes, Outcomes And Selected Explanations

Despite the lack of incentives mentioned above, in 2006 Germany’s Gesunds Kinzigtal region was one of the first regions in Europe to develop a population health management-based approach to healthcare provision. The project was set up between two disease funds in the region and a healthcare management and technology company Optimedis AG.

Optimedis established a data warehouse to generalize and aggregate different types of care and insurer data in the region. In addition, the population was divided by patient age and disease per physician, providing an analysis of outcomes between different treatments and individual caregivers. This allowed Optimedis to highlight potential differences in care between practices in the local area.

The initial analysis allowed Optimedis to create tailored disease management programs and distribute them among ambulatory providers to better manage chronically ill patients. To achieve this, financial incentives were provided to GPs who enrolled their patients in these specific disease management programmes.

The project was run as a cost-saving model with sickness funds, Optimidis and some care providers benefiting from the savings made across healthcare arrangements. Between 2007-2015, an estimated €35.5M has been saved against the risk-adjusted normal costs of care in Germany for the 33,000 patients involved in the project.

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The long-standing success of the partnership has resulted in a high level of interest elsewhere, resulting in Optimedis taking on a number of partnership or advisory roles in the UK, the Netherlands and Belgium. However, despite the apparent success, it took more than 10 years to establish its next German project in Hamburg.

Before a cost-savings contract is drawn up, Optimedis will run a preliminary analysis on the target population to assess whether savings can be made within the region. However, the data needed to run the initial analysis is usually held by sickness funds, which are not always able or willing to share data with a third-party organization.

With the latest project in the Bilstadt/Horn areas of Hamburg, where the population experiences below average life expectancy and suffers from a high level of morbidity, disease funds seek a value-based approach to improve outcomes within the region. runs The initial phase of the new project involves setting up walk-in clinics for GPs to refer chronically ill patients and connecting the EHR to the regions.

The ICIC18 conference was filled with examples of other European countries using PHM technology to support the development of integrated care networks. Examples include:

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A key focus for government-led PHM initiatives in Europe is to support better coordination and shared responsibility in healthcare provision between local providers and to give healthcare systems the freedom and funding they need to implement change, such as consolidation of smaller providers. Hard to get in Germany without. Generate change from the bottom-up.

Germany’s latest reform came in 2015 through its Health Care Strengthening Act, which aimed to remove barriers to implementing integrated care systems and provided additional innovation funding of €300M. However, it still relies on local champions taking the initiative from the bottom-up, rather than driving organizational reforms top-down like in the US or UK.

In July, Germany’s eHealth initiative (providing a comprehensive country-wide EHR for both providers and payers) will be completed, likely overcoming some issues with data sharing between payers and providers. This can speed up the process of data collection and setting up PHM projects for companies like Optimedis.

While providers want to reach the quadruple goal, PHM development in Germany is predicted to be limited to small initiatives focused on pockets of the population with high levels of disease or elderly patients.

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The market analysis presented above is derived from research compiled for Signifier Research’s report “Population Health Management – ​​EMEA, Asia and Latin America – 2018” which is scheduled to be published in June 2018. The report includes a deep dive into national and regional projects. Local champions or global sellers in 20 countries and territories. The report will also accompany accurate market sizing and forecast data and insights on initiatives and potential barriers to growth during the period 2017 to 2022.

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