Sickness Funds and the Pharmaceutical Industry: a New Relationship?

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On Friday 3rd March, Dr Jan Van Emelen, Innovation Director at Neutral Mutualities presented on “Mutualities and pharmaceutical industry: a new relationship?”. Access to new, often very expensive medications is a hot topic and our speaker discussed the role of the mutualities in this process, using new models for disease management. He shared ideas on our potential interaction with this process as pharmaceutical physicians.

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Sickness Funds and the Pharmaceutical Industry: a New Relationship?

  1. 1. Sickness Funds and the Pharmaceutical Industry: a New Relationship? Jan Van Emelen Director Innovation 02.03.2012
  2. 2. 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 2Réunion - Date
  3. 3. Our Values Independent health insurance funds are  Independent and political neutral  Sceptical but constructive  Transparent  Dynamic and innovative  Rational and scientific  Competition but solidarity 3Réunion - Date
  4. 4. 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 4Réunion - Date
  5. 5. 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 5Réunion - Date
  6. 6. Context in HC system Functions Services Governance Accessibility Quality of Care HR Management Service delivery Financial contribution Financing system 6Réunion - Date
  7. 7. Context in health care system Functions Poliitcal, Willingness Datamanagement, Governance Corporate governance Care model Acute + HR Management Service delivery Role Chronic Training, Prevention Agreement Financing system Budget (macro) Financial model 7Réunion - Date
  8. 8. 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 8Réunion - Date
  9. 9. 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 9Réunion - Date
  10. 10. 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 10Réunion - Date
  11. 11. Zorg TV Partners 11Réunion - Date
  12. 12. Coach 1. Education 2. Empowerment 3. Action Plan 4. Monitoring 12Réunion - Date
  13. 13. Applied to different diseases 13Réunion - Date
  14. 14. PHR : software for family 14Réunion - Date
  15. 15. 15Réunion - Date
  16. 16. 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 16Réunion - Date
  17. 17. 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 17Réunion - Date
  18. 18. 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 18Réunion - Date
  19. 19. 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) 19Réunion - Date
  20. 20. Conclusion : invitation to partner - Health care insurers - Patients organisations - Industry - Health care providers - Universities 20Réunion - Date
  21. 21. l’Union Nationale des Mutualités Libres regroupe :de Landsbond van de Onafhankelijke Ziekenfondsen groepeert :

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