The agreement was developed in 2022 by Heartbeat Medical as initiator and technical partner together with Techniker Krankenkasse and Helios ENDO-Clinic Hamburg. Since then, the initiative has evolved into one of the largest quality‑oriented arthroplasty programs in Europe, with over 50 participating healthcare payers. The goal is to reduce complications and revision rates, measurably improve health‑related quality of life, and transparently link quality performance to reimbursement.
PROM‑Based Monitoring and Steering as a Structured Standard of Care
A core element of the program is structured digital monitoring over 12 months following hip, knee, or shoulder joint replacement. Standardized data on quality of life, pain, and functional outcomes are collected along the entire treatment pathway. Defined threshold values trigger automated alerts when needed, enabling care teams to intervene at an early stage.
Depending on the joint type and timing of the survey, between 6 and 24 percent of patients at Helios ENDO-Clinic Hamburg are proactively contacted during follow‑up in order to initiate targeted measures based on the collected outcomes. This creates a structured, needs‑based aftercare pathway that enables close patient support even months after hospital discharge.
Results and MCID Underscore High Quality of Care
The collected outcomes clearly demonstrate the high quality of care delivered at Helios ENDO-Clinic Hamburg: 92.65 percent of monitored patients state that they would choose to undergo the same surgery again under similar circumstances. A total of 94.57 percent report a noticeable improvement in their health‑related quality of life. The documentation rate of 98.39 percent ensures a high level of data completeness and provides a robust foundation for the evaluation of outcome‑based reimbursement programs by the German Institute for Quality Assurance and Transparency in Healthcare (IQTIG).
A key benchmark for assessing treatment success is the Minimal Clinically Important Difference (MCID). It defines the smallest change in a patient‑reported outcome (PROM) that is perceived by patients as clinically meaningful — in other words, an improvement that is concretely noticeable in everyday life. Twelve months after surgery at Helios ENDO-Clinic Hamburg, 83.26 percent of insured patients undergoing knee procedures and 92.53 percent of those undergoing hip procedures achieved this clinically relevant improvement, as measured using joint‑specific PROM instruments. This means that the vast majority of patients achieve not only measurable gains but also functionally meaningful progress in mobility and quality of life.
The structured and continuous use of PROM data enables targeted and timely management of follow‑up care. Deviations from expected recovery trajectories are identified early, helping to avoid unnecessary outpatient visits, hospital readmissions, and inefficient treatment pathways. At the same time, necessary interventions can be initiated more quickly, reducing risks of complications or revision surgery. By combining standardized monitoring, clearly defined thresholds, and structured clinical feedback loops, the program establishes a reliable data foundation for delivering high‑quality care that is also economically sustainable.
Stakeholder Perspectives
Philip Wettengel, Managing Director of Helios ENDO-Clinic Hamburg, reflects positively on the initiative: “As a highly specialized orthopedic clinic, our ambition is not only to achieve excellent outcomes but also to demonstrate them in a robust and transparent way. With PROvalue, we have consistently extended our responsibility beyond the inpatient stay by integrating structured digital long‑term monitoring into routine care. This allows us to support our patients far beyond discharge, identify relevant changes at an early stage, intervene in a targeted manner, and make actual treatment success transparently measurable. More than 6,000 monitored procedures show that this approach works both medically and in terms of responsible, value‑oriented care delivery.”
Yannik Schreckenberger, Founder and CEO of Heartbeat Medical, emphasizes the clinic’s pioneering role: “With more than 6,000 monitored patients, Helios ENDO-Clinic Hamburg demonstrates how PROMs can become an integral part of high‑quality care. When treatment outcomes are systematically measured and actively used, the foundation is created for genuine quality improvement and for reimbursement models that consistently align with value delivered to patients.”
Regulatory information
PROvalue™ Endo operationalizes outcome‑based reimbursement agreements within the German statutory healthcare framework of Social Code V §110a and combines baseline measurement phases with structured intervention periods. The objective is the systematic and demonstrable improvement of patient‑relevant endpoints while simultaneously enhancing economic efficiency.