Experience with platform-

based decision support

as plug-in for GP

information systems

CompuGROUP Holding AG

Matthias Leu – Vice PresidentBarcelona, March 16st 2010

Doctors Information

Systems (DIS)

Doctors view at an „ordinary“

chronic disease patient

Chronic disease:

diabetes

10

Result: the patient is a

candidate for a disease-

management program e.g.

diabetes

Online – offline

patient registration

Doctors NEW view at an „ordinary“

chronic disease patient

Disease Management:

Diabetes Project aktiv + vital

AVplus

The five aspects of AVplus

1. “real-time managed care” through structured medical data

2. suggested treatment patterns for physicians

3. special life-style modification programs motivate patients

4. evidence-based pathways support “at the moment of decision”

5. the better the physicians perform, the better the payment

1. “real-time managed care”

through structured medical data

- „patient scanner“ identifies suitable patients out of the DIS data base

- patient-data transferred automatically online to the “path-server”

- a centralized database on the “path-server” checks and steers all

processes

13

Recommondation for the patient:

Join special disease-management-program

Example of patient scanner in the doctors software

2. benchmarking – Only two values

represent the quality of treatment

1. diabetic:

HbA1c – below 7,0% (or reduction of 0,3% / quarter)

BP – below 135 mmHg (or reduction of 3 mmHg / quarter)

2. diabetic high risk patient:

Triglycerid – below 200 mg/dl (or reduction of 150 mg/dl / quarter)

BP – below 135 mmHg (or reduction of 3 mmHg / quarter)

- doctors surgeries are compared transparently to each other (ranking)

- significant under-performers have to be discussed in quality-circles

- the centralized database checks all steps –

and gives feedback

3. special lifestyle-modification

programs motivate patients

Anti smoking

Exercise therapie,

sports…

Nutrition Consulting

- personalized mailings and print-outs for patients.

Steering via doctors software and web portal.

- patient compliance is rewarded

- focus on educational programs for lifestyle-modification

AVplus patient web portal

4. Evidence-based pathways support

“at the moment of decision”:

- Accepted guidelines are the basis of every medical pathway – selected

and modified with the help of a medical board (manned with THE medical

experts e.g. the most famous diabetologist)

- Managed care company develops its own medical pathways

- the medical pathway supports with hints and recommendations via DIS

Our goal is simple:

Latest medical knowledge is available for the doctor at the moment of need.

Without complicated flow-charts.

Without learning by heart.

4a. Medical treatment paths

4a. Medical treatment path in DIS

including economic perspectiveWho? Share What?

Insurant 100,0% STARTShort test

members mag.

Customer

Receives

info

STOP

Med.

Aux. personnel

Offer-

primary

prevention

programme

Spec. Dr. 15.0%Screening

risk

Cardio.

diagnostics

DMP criteria

fulfilled no

yes no

GP 85.0%Screening

risk

Register

DMP & IC

preparation

Customer

consents to

DMP & IC yes

Undertake

DMP & IC

registration

DP centreProcess

TE/EWE

Health ins.

company

Prepare-

case

management

Weighting [%] 100% 95.0% 40.0% 60.00% 5.00% 35%

Best case [Days] 1 0 0 0 0

Worst case [Days] 5 5 0 3 15

Resources [Minutes] 10.00 30.00 2,00 5,00 5,00

Additional means [Aid Short questionnaire Screening tool Exertion ECG

; full body

status

TE/ EWE Information

brochure

TE/ EWE;

secure mail

Work time costs

[Euros]

€ 13,67

€ 41.00 € 2.73 € 2.50 2,50 EUR Meterial costs

[Euros]

-

- - € 2.00 - EUR One-off cost

[Euros]

€ 5.00

- - - 25,00 EUR Total costs

[Euros]/ Case €18.67 € € 41.00

€ 2.73 € 4,.50 27,50 EUR

4b. Evidence-based pathways support

“at the moment of decision”:

To-do-list for the steering process with precise instructions and information

for e.g. a necessary referral to specialist (in this example to a nephrology

clinic because the KREA-number is 2,6). The software shows also e.g. a list

of diabetes consultant centers (synchronized with GEO-data of the patient)

or exact information about other health providers.

5. the better the physicians perform,

the better the paymentV

ari

ab

leL

um

p-s

umExtr

a d

octo

r´s f

ee

Lump-sum per patient

patient

fixed salary

40,00€

per

Documentation

15,00€

variable

60,00€

1/3 of cost-reductions acrue to the doctors, 1/3 to health insurance, 1/3 to management company

Specialist

30,00€

per patient / per year

HbA1c

BP

First evaluation of the

projects in HessenNovember 2009

University

Cologne

Number of documentations

0

1000

2000

3000

4000

5000

6000

Nov. 07

Dez. 07

Jan. 08

Feb. 08

März 08

Apr. 08

Mai 08

Juni 08

Juli 08

Aug. 08

Sep. 08

Okt. 08

Nov. 08

Dez. 08

Jan. 09

Feb. 09

März 09

Apr. 09

Mai 09

Juni 09

Juli 09

Aug. 09

Sep. 09

Pilot region Hessen:

4.474 GPs and

6.09 mio. inhabitants.

Market share AOK

ca. 40%

Subscriber AVplus:

180 doctors (limited

by AOK) and

8.093 patients

(Feb. 2010).

45 AOK diabetic or

risk patient per

doctor.

Four main patient groups

Riskpatients not recognized

by insurance31%

= 1.976 patients Diabetics not recognized by

patient, insuranceand doctor

2,6%= 166 patients

Not recognizeddiabetics

by insurance3,5%

= 223 Patienten

Diabeticsrecognized

by insurance 62,4%= 3.928 patients

Evaluation by

By means of CG-Software

(e.g. patient scanner, find-rik-

form) the doctors identify

1.976 diabetes high risk

patients and other diabetes

sub groups.

Trend analysis AVplus - cost savings andthe increase of quality

The medical care of

patients in the

programme is

fundamentally more

favourable than in

the usual diabetes

treatment.

The patients in the

programme live

longer than a

“normal” diabetes or

risk patient.

=> Improve quality

for less money!

Source: Dresden International University, Dresden, November 2009 , [patients from AOK aktiv + vital: n=4.760]

Benchmarks – high risk patients

0,0% 1,3%2,9% 3,6% 2,7%

4,6%

0,0%

37,7%

44,4%47,0%

50,9%

54,9%

0,0%

43,5%

48,4%

55,2%

63,9%

60,2%

0,0%

10,0%

20,0%

30,0%

40,0%

50,0%

60,0%

70,0%

ED Q1 Q2 Q3 Q4 Q5

BMI

RR syst

Triglyceride

Starting situation:

We looking at the development

of the benchmarks from all risk

patients who had started in the

AVplus program below the

benchmarks of BMI, blood

pressure (RR syst.) und

Triglycerid (ED 0,0%).

Result after a period five quarter:

60 % of the risk patients reach

the Triglycerid benchmark (below

200 mg/dl). 55% reach the

benchmark RR syst. below 135

mmHg and 4,6% reach the

target range BMI between14,5

und 24,5.

Q = 3 month

Benchmarks - diabetics

0,0%2,5% 2,2%

3,6% 3,7% 3,6%

0,0%

22,4%

27,8%

32,9%30,9% 31,2%

0,0%

35,4% 35,4% 35,8%34,6%

40,4%

0,0%

33,7%

44,6%

47,8%46,4%

53,9%

0,0%

10,0%

20,0%

30,0%

40,0%

50,0%

60,0%

ED Q1 Q2 Q3 Q4 Q5

BMI

HbA1c

RR syst

Triglyceride

Starting situation:

We looking at the development of

the benchmarks from all diabetics

who had started in the AVplus

program below the benchmarks

of BMI, syst. blood pressure (RR

syst.) und Triglycerid and HbA1c

(ED 0,0%).

Result after a period five quarter:

54 % of the risk patients reach

the Triglycerid benchmark (below

200 mg/dl). 40% reach the

benchmark RR syst. below 135

mmHg, 31 % the HbA1c below

7% and 3,6% reach the target

range BMI between14,5 und

24,5.

Q = 3 month

Matthias Leu

Vice President

CompuGROUP Holding AG

Maria Trost 21

56070 Koblenz - Germany

Telefon: +49 (0) 261 8000 1906

E-Mail: leu@compugroup.com