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
1
Research project
Institute for Health Care Management and Research
2
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
3
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
Institute for Health Care Management and Research
4
survey of the German statutory health
insurance –
methodological approach
Institute for Health Care Management and Research
5
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
Institute for Health Care Management and Research
6
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)
Institute for Health Care Management and Research
7
Methodological approach 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
8
Results of the survey
Institute for Health Care Management and Research
9
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)
Institute for Health Care Management and Research
10
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)
Institute for Health Care Management and Research
11
„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
Institute for Health Care Management and Research
12
Discussion and conclusions
Institute for Health Care Management and Research
13
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
14
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
15
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
Institute for Health Care Management and Research
16
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
17
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
Institute for Health Care Management and Research
18
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: sonja.ivancevic@medman.uni-due.de
http://www.uni-due.de/medizinmanagement
Institute for Health Care Management and Research
19