Value-based reimbursement contract PROvalue enrols over 4000 endoprosthetic patients and secures support of 47 healthcare payers

The objective for all PROvalue programmes is the continuous assessment and improvement of patients’ quality of life. To this end, the health insurance Techniker Krankenkasse and the value-based healthcare company Heartbeat Medical initiated a new generation of value-based reimbursement contracts in the field of arthroplasty at the end of 2022, which covers all planned hip, knee and shoulder operations with total or partial joint replacements. The core element of the quality contract is a one-year monitoring period by the treating clinic using a bespoke digital platform. Patients are continuously, digitally surveyed via the platform by Heartbeat Medical using Patient-Reported Outcomes Measures (PROMs) to allow monitoring throughout the entire treatment pathway. Automated threshold-based notifications allow early adjustments by the care for the patient’s benefit.

Heartbeat Medical’s preliminary findings from the first 4,000 participants in PROvalue Endo show a response rate of 92 percent and a relevant effect on care. Not only do an average of 15 percent of PROM surveys trigger a threshold-based telephone follow-up by the hospital, but an average of 30 percent of calls also result in additions to the care pathway. This additional care can be in the form of readmission to the hospital, physiotherapy or measures that patients implement themselves can positively affect recovery and health-related quality of life and would remain undetected without PROvalue Endo monitoring.

Despite its growth to 13 hospitals across all provider types and the additional initiation of the PROvalue Endo Plus programme, which specialises in pain management, the PROvalue programme maintains consistency in the core data sets and threshold automations. This allows granular and risk-adjusted analysis across healthcare sites of different characteristics. At the same time, the accession of numerous health insurance funds, which cover a total of 60 percent of those with German statutory health insurance, enables the creation of a secure and high-quality data pool for the further development of the PROvalue programme and the evaluation of value-based healthcare in Germany by the national Institute for Quality and Transparency in Healthcare (IQTIG).

“One of the guiding principles of PROvalue has always been the best possible preparation for transferring digital innovation into routine care,” said Yannik Schreckenberger, founder and Managing Director of Heartbeat Medical. “We are very optimistic about the national evaluation process, but we will also use the time and findings from the growing PROvalue network to launch the next generation of outcome-based reimbursement models this summer.”