Intensified collaborative care: amodel of successful acting in ambulatory cardiology

Abstract

In the cardiological care of outpatients in Germany, selective contracts have been established in in addition to the usual representation in the collective system, i.e., in the system of the associations of statutory health insurance physicians (Kassenärztliche Vereinigungen, KV). One example is the KardioExpert (Cardioexpert) contract between the Professional Association of Cardiologists in Private Practice (BNK) and the Barmer Ersatzkasse and Ford Betriebskrankenkasse (BKK). This supplementary contract extends regular outpatient care for patients with heart failure; more than 20,000 patients are now included nationwide. Another example is afull care contract in accordance with §73c or §140a of BookV of the German Social Code (SGBV), which in Baden-Württemberg regulates all cardiological care for participating patients as an alternative to the collective contract. The cardiology contract according to §73c, which has been in place in Baden-Württemberg since 2010, was scientifically evaluated and was able to show a24% reduction in mortality within 1year and a16% reduction in the hospitalization rate for patients with heart failure. Furthermore, overall health care costs were reduced in the intervention group. At the same time, participating physicians also benefit through non-budgeted reimbursement, which is approximately 15-20% above KV levels. The Cardioexpert contract also shows similar data and benefits. Overall, these cardiology contracts show in amodel way that better care can be implemented more cost-effectively and with awin-win situation for all sides. Nationwide expansion, especially of the full care contracts, has so far failed due to the reluctance of the cost bearers. Astart could be made here with legal regulations, such as the obligation of health insurance companies to enter into such contracts.