Medical Insurance Support Calls for DMPs - Sales Unit

Initial Situation

A national statutory medical insurance fund includes among its members numerous chronically-ill persons such as diabetics, hypertonics or COPD patients. Owing to its membership structure, the medical insurance fund is under substantial financial pressure–particularly because only part of the chronically-ill persons regularly make the required visits to their physician and the medical insurance fund thus does not receive the full support from the RSA. The previous measures to get patients into disease management programs (DMPs) such as regular informational letters have no satisfactory effect on the patients’ motivation to visit their physician.

Solution

The Sales Unit develops a comprehensive DMP support concept which, on the one hand, integrates the patients registered in DMPs if they fail to show up for one of their medical appointments and, on the other hand, also addresses chronically-ill patients who have not yet registered in a DMP. Both groups are queried during the personal telephone call regarding their satisfaction with the current support as chronically-ill persons by the medical insurance fund and the treating physician. In this regard, the telephone dialogues are conducted in a delicate manner and with the required sensitivity in order to convey to the patients the positive image of a medical insurance fund which is interested in its members’ well-being. The insured persons who have already registered are thus reminded in a pressure-free manner about participating in the DMP whereby insured persons who have not yet registered receive important arguments for registration as well as–upon request–the required registration materials.

Through the empathetic and positive support, the number of chronically-ill persons who are fully participating in the DMPs has substantially increased over the course of one year’s time. The increased rate provides the medical insurance fund with the additional income from the RSA to which it is entitled based upon its membership structure so that it can continue to fulfil its role as a health service provider in a substantially better manner than in the past.