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.

1. Sickness Funds and the Pharmaceutical
Industry: a New Relationship?
Jan Van Emelen
Director Innovation
02.03.2012

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
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Réunion - Date

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
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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
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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
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6. Context in HC system
Functions Services
Governance Accessibility
Quality of Care
HR Management Service delivery
Financial
contribution
Financing system
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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
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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
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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
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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
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11. Zorg TV Partners
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12. Coach
1. Education
2. Empowerment
3. Action Plan
4. Monitoring
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13. Applied to different diseases
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14. PHR : software for family
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15. 15
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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
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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
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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
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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)
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Réunion - Date

20. Conclusion : invitation to partner
- Health care insurers
- Patients organisations
- Industry
- Health care providers
- Universities
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21. l’Union Nationale des Mutualités Libres regroupe :
de Landsbond van de Onafhankelijke Ziekenfondsen groepeert :