Blog Post

Gesundes Kinzigtal: The accidental population health manager?

February 2, 2017

    Gesundes Kinzigtal (“Healthy Kinzigtal”) is one of the better known—and most demonstrably successful—experiments in population health management in Europe. And it exists because of a mistake.

    A little over a decade ago, Helmut Hildebrandt, the CEO of OptiMedis AG, a management company in Hamburg, Germany, was invited to meet with a nearby doctor group to discuss a potential partnership. He had been looking for a local partner in northern Germany to try out his population health management ideas. Unfortunately, the doctor group turned out instead to be in the south of Germany in an area with a similar name—a six-hour train ride away! Despite the mistake, the proposed partnership presented a perfect opportunity.

    Twelve years and countless train miles later, the beautiful Kinzig valley served as the location of the Global Forum’s second executive study tour. In early December, the Advisory Board and a group of executives and doctors from hospitals and commissioners across Europe met in the new Gesundes Kinzigtal learning and health centre in Haslach. Our aim was to understand more about the programme and to discuss its implications for our members’ health systems.

    Gesundes Kinzigtal model leads to significant improvement

    I encourage you to read our case study for more detail, but I wanted to share some of the thoughts I had from seeing this community in action.

    At its heart, Gesundes Kinzigtal started as a multispecialty group of doctors who were feeling increasingly isolated and who had become dissatisfied with the quality of patient care. They wanted the system to recognise and incentivise proper care for the increasing number of complex multi-chronic patients they were seeing. To do so, they created an alliance of doctors to cultivate a more collegial and cooperative atmosphere in the area. However, they did not have the time or the skillsets to change and manage a new system.

    This is where OptiMedis came in. They created a partnership with the doctor group and negotiated a bold, ten-year risk-agreement with two of the major insurance companies in the region to manage their populations and to share any savings.

    Across the last decade, the programme has delivered cost savings, quality and mortality improvements, and increases in patient and doctor satisfaction. It has made these improvements while also increasing doctors’ income through payment for the extra work that chronic patients require.

    Key components contribute to model’s success

    For me, I think this re-connection of doctors with each other has been key to the success of the programme. Doctors have a strong sense of ownership of direction and outcomes—nothing feels imposed upon them. This is quite an achievement, as the management company does an enormous amount behind the scenes to contract, build communications systems, and manage projects. Data sharing is also a key component, since it takes advantage of the doctors’ professional competitiveness to bring people in line with best practices. Finally, the energy in the building among the staff and doctors was palpable—they were very engaged in the work they were doing to improve health. These four components—doctor ownership, management support, data sharing, and doctor engagement—have proven a powerful combination.

    However, I also sensed a certain frustration among the group. While they have achieved the holy grail in population health management, it has taken a long time for the world to beat a path to their door. There are two things that may be holding other health systems back from duplicating this approach: the long initial period until break-even and the need for very long-term contracts. This work requires upfront investment and does not pay off immediately.

    Model expands beyond Kinzig valley

    There is some question as to whether a programme that works in a relatively small, rural community can be translated to larger, more diverse population centres. This objection will soon receive a real-world test: the model is being trialed in parts of Hamburg and other places around the world, and we will be tracking those developments carefully in the Global Forum.

    Other staff from the group talked about the history of the partnership and some of the many projects they have put in place to manage costly populations. We all left the study tour with a better understanding of how the system was designed, along with its potential strengths and weaknesses. However, what I will take away from the visit is that adjusting incentives can be the catalyst that allows care providers do the best job they can—and to do it well.

    I hope you will join us for future study tours. I don’t know where they will be yet, but I can promise they will be an inspiring and useful experience.

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