Sickness Funds and the Pharmaceutical

Industry: a New Relationship?

Jan Van Emelen

Director Innovation

02.03.2012

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Who are the Independant « health »

insurance funds?

18% of Belgian Market

Permanent growth

Compulsory and complementary health insurance

Services of social economy

Information on health, healthcare and insurance issues.

Union and 7 health insurance funds

Innovation oriented, chronic disease management

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Independent health insurance funds are

Independent and political neutral

Sceptical but constructive

Transparent

Dynamic and innovative

Rational and scientific

Competition but solidarity

Our Values

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1. Context : shifts

1. Epidemiology

• Chronic conditions leading cause of morbidity & mortality , cost driver

• Demographic - Long Term care : budget and workforce

• Globalisation and warming up : new diseases

2. Economy

• Labor shortage : need for efficiency

• Budget restrictions – need for efficiency

• Mandating

3. Society

• Quality and safety : need validation system

• P4P - More homecare instead of hospitalisation

• Prevention - Individual care – patient empowerment

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Chronic diseases anno 2010

(Cfr . Reinhardt Busse – European Observatory)

Burden :

Epidemiologic

Economic

How to tackle :

Prevention

Disease Management

Integrated care

Challenges

Technical innovation : Pharmaceutical, IT

Organisation innovation : model

Financing innovation: model with incentives

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Context in HC system

Governance

Service delivery HR Management

Financing system

Accessibility

Quality of Care

Financial

contribution

ServicesFunctions

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Context in health care system

Service delivery HR Management

Financing system

Functions

Governance

Care model

Acute +

Chronic

Prevention

Poliitcal,

Willingness

Datamanagement,

Corporate governance

Role

Training,

Agreement

Budget (macro)

Financial model

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Vision

VISION : Integrated customised care

• Integrated : creating efficiency

1.primary & secondary care :

2.medical care and social care

• Customized

1.Focusgroups in each lifetime period

2.Stratified medecines

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Consequences

Paradigm shift: new medical model

Paradigm shift: new financial model in support

Role and functions of stakeholders in change

Partnerships between insurers, health care

providers, industry, authorities.

RM, DM, CM and public health initiative for elderly

people

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2. MLOZ innovation in Belgium

New type of innovative insurance : Chronic conditions and

dental care : Dentalia+

Pilotprojects education-coaching : zorgTV

Creation of Consortium DM – EU evolution

Prejudicial question privacycommission – new prevention

systems

RCT – COACHING diabetes type 2

PHR

Planning : coaching of patients with other diseases

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Zorg TV Partners

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1. Education

2. Empowerment

3. Action Plan

4. Monitoring

Coach

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Applied to different diseases

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PHR : software for family

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3. MLOZ at EU level : AIM

Disease Management working group

1. Exchange of information - workshops

2. Field visits- Ehtel (Odensee, Schotland NHS)

3. Mandate for developing

- EU project – foundations

- Establishment research institute and service

centre

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Joint Venture

Epposi : Model for chronic care

- Public health infrastructure

- Patient empowerment

- Practice level (self-management, decision support, delivery

system, clinical information system,

- Community linkages

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Target

Target: Enable Modus Operandi for CDM -

EU funded project – proposal in answer to 3d call of

the EU Public Health (support EIP)

- Consensus project : building the foundation for

innovative change management : work packages

- Establish EU independant centre (structure tbd)

Research

Services

validation

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EU project

Foundations for change - deliverables :

1. Benchmarking system for management processes - strategy

2. Care managament pathways protocols and RA

3. Design business models including financial models

4. Design change models toward chronic conditions

management

5. Development and pilots of products and services

6. Organisational sustainable Business plan

With 11 related Work packages (vertical and horizontal)

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Conclusion : invitation to partner

- Health care insurers

- Patients organisations

- Industry

- Health care providers

- Universities

l’Union Nationale des Mutualités Libres regroupe :

de Landsbond van de Onafhankelijke Ziekenfondsen groepeert :