Experience with Platform-based Decision Support as plug-in for GP Information Systems. Leu M. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

1. Experience with platform-
based decision support
as plug-in for GP
information systems
CompuGROUP Holding AG
Matthias Leu – Vice President
Barcelona, March 16st 2010

2. Doctors Information
Systems (DIS)

3. Doctors view at an „ordinary“
chronic disease patient
Chronic disease:
diabetes

4. Doctors NEW view at an „ordinary“
chronic disease patient
Result: the patient is a
candidate for a disease-
management program e.g.
diabetes
Online – offline
patient registration
10

5. Disease Management:
Diabetes Project aktiv + vital
AVplus

6. 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

7. 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
Recommondation for the patient:
Join special disease-management-program
13
Example of patient scanner in the doctors software

8. 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

9. 3. special lifestyle-modification
programs motivate patients
- 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
Nutrition Consulting
AVplus patient web portal
Anti smoking
Exercise therapie,
sports…

10. 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.

11. 4a. Medical treatment paths

12. 4a. Medical treatment path in DIS
including economic perspective
Who? Share What?
Short test Customer
Insurant 100,0% START members mag. Receives STOP
info
Offer-
Med. primary
prevention
Aux. personnel
programme
Screening Cardio. DMP criteria
Spec. Dr. 15.0%
risk diagnostics fulfilled no
yes no
Customer
Register Undertake
Screening consents to
GP 85.0%
risk
DMP & IC
DMP & IC yes
DMP & IC
preparation registration
Process
DP centre TE/EWE
Prepare-
Health ins. case
company 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 TE/ EWE Information TE/ EWE;
; full body brochure secure mail
€ 13,67
status
-
[Euros] € 41.00 € 2.73 € 2.50 2,50 EUR
Meterial costs € 5.00
Work time costs [Euros] - - € 2.00 - EUR
One-off cost
[Euros] - - - 25,00 EUR
Total costs Case €
€18.67 € 41.00
[Euros]/
€ 2.73 € 4,.50 27,50 EUR

13. 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.

14. 5. the better the physicians perform,
the better the payment
1/3 of cost-reductions acrue to the doctors, 1/3 to health insurance,
1/3 to management company
HbA1c
variable
Variable
BP
Extra doctor´s fee
60,00€
per
Documentation Specialist
15,00€
Lump-sum
30,00€
per patient / per year
fixed salary
40,00€
patient
Lump-sum per patient

15. First evaluation of the
projects in Hessen
November 2009
University
Cologne

16. Number of documentations
Pilot region Hessen: 6000
4.474 GPs and
6.09 mio. inhabitants. 5000
Market share AOK
4000
ca. 40%
3000
Subscriber AVplus:
180 doctors (limited 2000
by AOK) and
8.093 patients 1000
(Feb. 2010).
45 AOK diabetic or 0
Nov. Dez. Jan. Feb.
07 07 08 08 März Apr. Mai Juni Juli Aug. Sep.
risk patient per 08 08 08 08 Okt.
08 08 08 08 Nov. Dez. Jan. Feb. März Apr. Mai
08 08 09 09 Juni Juli Aug. Sep.
09 09 09 09
doctor. 09 09 09

17. Four main patient groups
By means of CG-Software
(e.g. patient scanner, find-rik-
form) the doctors identify
Risk
patients not 1.976 diabetes high risk
recognized patients and other diabetes
by insurance sub groups.
31%
= 1.976 patients Diabetics not
recognized by
Diabetics patient, insurance
recognized and doctor
by insurance 62,4% 2,6%
= 3.928 patients = 166 patients
Not recognized
diabetics
by insurance
3,5%
= 223 Patienten
Evaluation by

18. Trend analysis AVplus - cost savings and
the 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]

19. Benchmarks – high risk patients
Starting situation:
We looking at the development
70,0% of the benchmarks from all risk
63,9% patients who had started in the
60,0% 60,2%
AVplus program below the
55,2% 54,9%
50,0% 50,9% benchmarks of BMI, blood
48,4%
44,4%
47,0% pressure (RR syst.) und
43,5%
40,0% Triglycerid (ED 0,0%).
37,7% BMI
RR syst
30,0%
Triglyceride Result after a period five quarter:
60 % of the risk patients reach
20,0%
the Triglycerid benchmark (below
10,0%
200 mg/dl). 55% reach the
3,6% 4,6% benchmark RR syst. below 135
2,9% 2,7%
0,0% 0,0% 1,3% mmHg and 4,6% reach the
ED Q1 Q2 Q3 Q4 Q5 Q = 3 month
target range BMI between14,5
und 24,5.

20. Benchmarks - diabetics
Starting situation:
We looking at the development of
60,0%
the benchmarks from all diabetics
53,9% who had started in the AVplus
50,0%
47,8%
46,4%
program below the benchmarks
44,6%
of BMI, syst. blood pressure (RR
40,0% 40,4%
syst.) und Triglycerid and HbA1c
35,4% 35,4% 35,8% 34,6%
33,7% 32,9%
31,2%
BMI (ED 0,0%).
30,0% 30,9%
HbA1c
27,8%
RR syst
22,4% Triglyceride
Result after a period five quarter:
20,0%
54 % of the risk patients reach
the Triglycerid benchmark (below
10,0%
200 mg/dl). 40% reach the
2,5% 2,2%
3,6% 3,7% 3,6% benchmark RR syst. below 135
0,0% 0,0%
ED Q1 Q2 Q3 Q4 Q5
Q = 3 month mmHg, 31 % the HbA1c below
7% and 3,6% reach the target
range BMI between14,5 und
24,5.

21. Matthias Leu
Vice President
CompuGROUP Holding AG
Maria Trost 21
56070 Koblenz - Germany
Telefon: +49 (0) 261 8000 1906
E-Mail: leu@compugroup.com