An overview Gesundes Kinzigtal from agreement to realization

An overview Gesundes Kinzigtal from agreement to realization Helmut Hildebrandt – Chairman of the Board Opti. Medis AG & CEO Gesundes Kinzigtal Ltd Christian Melle, Project Leader Health Care and Research Department Gesundes Kinzigtal Gmb. H

Introduction � � The total population of the Ortenaukreis included the western and central Kinzigtal region has 410. 000 inhabitants. – the service area of the Gesundes Kinzigtal has 71. 000 Manufactural and medium sized industrial sector is very well established and builds the core of the economical strength in this region (unemployment rate is less than 4% and one of the lowest ones in Germany). � Characterized by its agricultural environment (especially wine and fruit growing) and its rural spirit Gesundes Kinzigtal Gmb. H � Because of the mild climate the region is very attractive for tourism. � And sports like hiking and moutainbiking for example.

2015: Status Quo of Gesundes Kinzigtal is a valley formed by the river Kinzig flowing to the rhine (Baden-Württemberg) Inhabitants: 71, 000 Shared Savings Contract for all inhabitants insured by AOK and LKK: 31, 000 Total cost of the relevant insurants ~ 75 Mio € Management Company with a variety of different professions organizes care across all sectors (14 FTE) Gesundes Kinzigtal Gmb. H 3

Our fragmented healthcare systems are engineered for “repair” but not for “maintenance” and not at all for “prevention” and “innovation”. Gesundes Kinzigtal Gmb. H

Can’t we do better? Innovating the health system to be more efficient and to produce health. Gesundes Kinzigtal Gmb. H

A new business model: Shared Health Savings Contracts In “Shared Health Savings Contracts” we generate an economical benefit for purchasers for a defined population through wise investments, prevention and optimized care. Gesundes Kinzigtal Gmb. H

Challenges in the future of Kinzigtal 1. Demografic change 2. urbanisation Population Health care must be reconsidered Improve the health status of the population Gesundes Kinzigtal Gmb. H Efficient per capita costs of care „Triple Aim“ Enhance the patient care experience Triple Aim - better health, better health care and lower health care costs © Hildebrandt 2012, in Anlehnung an Berwick DM, Nolan TW, Whittington J. (2008), The triple aim: care, health, and cost. Health Affairs 2008 May/June; 27(3): 759 -69. 7

We improve health care in three dimensions: Based on the Triple Aim principles of Donald M. Berwick (et al. ) (2008). Health Affairs, vol. 27 no. 3, 759 -769 Gesundes Kinzigtal Gmb. H

Many years of experience with Gesundes Kinzigtal and the scientific evaluation shows that it works. Gesundes Kinzigtal Gmb. H

Gesundes Kinzigtal produces value in three Dimensions: Participants die 1. 4 years later (78. 9 vs 77. 5 control) 5. 613 Mio € surplus improvement for the two sickness funds in the Kinzigtal region in 2013 against 75 Mio € norm costs Gesundes Kinzigtal Gmb. H 98. 9 % of enrollees who set an objective agreement with their physician would recommend becoming a member to their friends or relatives

4. 65 Mio € Delta in Year 8 for 31, 355 insurees of AOK Shared between AOK and Gesundes Kinzigtal Ltd Gesundes Kinzigtal Gmb. H

It even produces value in three further dimensions: Quality of life and professional satisfaction of providers: 15 % increase in income for partnering physicians per case + higher satisfaction through better cooperation (with other providers and patients + viceversa). Community building and securing health care for the region: Local municipalities are calling on Gesundes Kinzigtal to secure the supply of health care and the staff for physician and nursing practices. Healthy workforce: Companies are calling on Gesundes Kinzigtal to get support for health promotion management and activities around health at the workplace. Gesundes Kinzigtal Gmb. H

Accountability = the Driver Financially: If Gesundes Kinzigtal Ltd. does not improve the delta between the relative health care costs for the 33, 000 insured people in Kinzigtal … then it does not get any money. Ethically: If Gesundes Kinzigtal Ltd. does not improve the responsiveness of the local health care provision and improve the health of the population and would not generate a value for them… people would not join & Kinzigtal would not be successful (because all 33, 000 have freedom of choice between many providers) … and physicians and other health professionals would leave the model Gesundes Kinzigtal Gmb. H

How do we do that? Gesundes Kinzigtal Gmb. H

Hard and ever ongoing working in a continuous quality improvement cycle Integration of health care & social care clinical wisdom & scientific competence (health sciences) targeted prevention & mobile innovation electronic data exchange & analysis of Big Data for improvement community organizing & health promotion health care & public health Gesundes Kinzigtal Gmb. H Psychosocial Interventions / Public Health Physicians/ Medical Professions Citizens & Patients Research & Development / Innovations Organization / Management

The aims are reached by different preventionand healthcare programs Gesundes Kinzigtal Gmb. H Primary prevention Lectures Smoke cessation Courses Healthcare programs More subjects Heart failure Support of young GPs Metabolic syndrom Quality indicators Back pain Electronic health record Mental Crisis Intervent Depression etc. Research projects etc. Health professionals support the idea of integrated care Gesundes Kinzigtal Gmb. H 16

Developing a health care program consists of 5 steps Indication related and structured care programs organised through a central management authority ensure the optimal care of the patient Bottom up approach wanted (patient level etc. ) A comprehensive development process is necessary to obtain a care program Project-impulse Data research/ analisis Project- order Conceptual design Cost-benefit analisis Testing stage Approval of medical advisory board Gesundes Kinzigtal Gmb. H 17

Just one example of the interventions around diabetes • Health coaching High cost patients Rising risk patients progressing 5% • Attention on polymedication – regular training • HK-progr: Physicains plus nursing (improving Interaction) • Active multi-specialty support for patients through disease management 20% • HK-progr. : Psychotherapy acute / depression • Selfhelp+ self management training for chronic patients (in preparation … Stanford SDSM) • HK-progr. : Healthy weight (adipositas) Insured in risk 40% • HK-Progr. : blood pressure okay • Developing jointly health goals • Cooperating with sports clubs • Unspecified. training in health literacy (for Healthy insured – before getting into risk 35% • patients and pracitices) Health Festivals + health promotion within kindergartens, schools, companies • Supporting the existing preventive offers of health insurances Gesundes Kinzigtal Gmb. H

Just diabetes: We succeed in reducing hospitalisations PMV, a department of University of Cologne, is our external scientific evaluation agency Gesundes Kinzigtal Gmb. H 19

Outcome: fractures in patients with known osteoporosis Percentage of osteop. patients with fracture Controls Gesundes Kinzigtal Gmb. H 20

…it´s not all about data - other important factors to gain success in integrated care Build confidence between stakeholders excellent public relations and frequent contact to citizens Standard IT-infrastructure in physicians´practice Gesundes Kinzigtal Gmb. H 21

For the best quality of healthcare a network across the boundaries of professions and institutions was set up in the last seven years Municipalities Sportclubs and Studios Schools Companies Sickness Funds Gesundes Kinzigtal Gmb. H 22

Long-term perspective of the model ensures incentives for the right care Strengthen the financial independence: • Long-term contracts enable the freedom of decision within the model • Attract additional sickness funds to benefit also from the health effects for their insured persons • Development of new business fields which are independently financed (e. g. ) • World of Health “Gesundheitswelt” • Occupational Health Management: financed by enterprises • Health academy and Health Courses: financed by participation fees • Additional project related funds from third parties Gesundes Kinzigtal Gmb. H 23

Lessons Learned: The „Triple Aim“ can be reached – requirements for success Long-term contract as an incentive for sustainable health investments and prerequisite for a meaningful evaluation Regional approach for trustfully cooperation of all shareholders involved Data availability for sustainable controlling Eye-level approach for a good cooperation between management, health professionals, and patients Co-Ownership of the local physician network as an additional incentive for initiative and engagement The quality challenge can be fulfilled: we improve health, quality AND reduce costs at the same time! Gesundes Kinzigtal Gmb. H 24

What makes our regional integrated care model unique? Regional care company as “integrator” + partly ownership through local providers Investment for the first three years (until earnings are big enough for ROI) Going / thinking beyond healthcare + entrepreneurial health sciences spirit Emotional quality between providers, professions, management and patients Comprehensive implementation of technology: ICT & data -driven management approach “Coopetition” = cooperation and competition through transparency and benchmarking Balanced payment system oriented towards achieving the Triple Aim Innovative culture and friendly interactions “open source” mindset 10 years contract with sickness fund to refinance investment Gesundes Kinzigtal Gmb. H

The Time has Come: what can we do to support similar initiatives abroad? - I Opti. Medis collaborates with partners in an “open source” environment • 6 more regions in Germany within the next two years and • 2 other countries besides Germany with each 3 regions, e. g. in • the Netherlands (Opti. Medis-NL already founded) • Switzerland • Interest as well in UK, Belgium, Austria + Australia Ready for replication: Quality indicators, evaluation protocols, program outlines, incentive systems, guidebook, data warehouse, reporting system … Gesundes Kinzigtal Gmb. H

Let‘s get in contact Helmut Hildebrandt h. hildebrandt@optimedis. de Opti. Medis AG Borsteler Chaussee 53 22453 Hamburg Phone +49 40 226221490 Mobile +49 172 4215165 Gesundes Kinzigtal Gmb. H Christian Melle Eisenbahnstr. 17 77756 Hausach c. melle@gesundes-kinzigtal. de Web: www. optimedis. com www. gesundes-kinzigtal. com Newsletter: www. optimedis. com/newsletter