Pay-for-performance scheme PROvalue Endo starts in Germany

Press Release 

24 November 2022 (Berlin). A new pay-for-performance scheme (P4P) for endoprosthetics has been introduced, led by Techniker Krankenkasse (TK), Germany’s largest statutory health insurer. The aim is to improve care around inpatient treatment services by agreeing on incentives as well as higher quality requirements to avoid postoperative complications. With four more insurances joining and seven providers already included, PROvalue Endo paves the way for value-based reimbursement in routine care.

(translation based on announcement by TK)

Every year in Germany, approximately 400,000 hip and knee implants are carried out and hip arthroplasty is the most frequently performed musculoskeletal surgery. The rate of postoperative complications in the implantation of endoprostheses of the hip joint is between two and ten percent, with loosening or dislocation of the total endoprosthesis and joint infections being the most common.

Quality contract for close monitoring and value-based reimbursement

Using the instrument of so-called “quality contracts”, the German regulators enable healthcare providers and payers to form value-based agreements beyond the current standard of care. In combination with the company Heartbeat Medical as initiator and technical partner, the TK has developed one such agreement – the new PROvalue Endo P4P scheme – which has been rolled out in selected hospitals. In testing since mid-September, a high number of patients have already been successfully enrolled in the program.

The contract includes ongoing monitoring of the patient by the treating hospital for one year. Heartbeat Medical developed the digital platform used for this scheme and includes comprehensive automated notifications to benchmark individual treatment and recovery paths. This enables any complications that may arise to be identified at an early stage and provides patients with additional safety. The contract also opens up the possibility for clinics to receive a value-based remuneration based on health related quality of life.

Thomas Ballast, deputy chairman of the TK board, said, “We want to reduce the fear of postoperative complications and use this offer to lower the revision rate, improve the treatment outcome and thus increase the quality of life.” As TK is open to other project partners to join the TK-initiated PROvalue Endo contract has been joined by the commercial health insurer HKK, DAK Health, the commercial health insurer KKH and the Hanseatic health insurer HEK. Together, the insurers represent almost 20 million policy holders.

Accompaniment throughout the entire treatment path by digital PROMs

Data from a digital collection of standardized patient-reported outcome measures (PROMs) used for screening and monitoring purposes will be used to improve care. By virtue of these PROMs, the patient will be accompanied throughout the entire treatment path to ensure that complications are detected in a timely manner, as well as inform providers about possible under-, mis-, or overtreatment.

In the event of adverse postoperative PROM scores, patients will be immediately contacted by telephone by the service provider. With data from the selected quality indicators measured up to one year after the start of treatment, an accompanying scientific study will assess whether this scheme results in further development of quality in the hospitals.

 

Link to the original press release by TK

PROvalue Endo in the media: background by Ärzteblatt

 

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