Interview: Dr Jan Van Emelen, Association Internationale de la Mutualité
publication date: Aug 31, 2009
Chronic diseases cost around 75% of healthcare budgets and account for 80% of premature deaths in Europe so it is an area of great interest for the mutual insurers who meet medical treatment costs across much of Europe. As new methodologies emerge to treat chronic diseases, so the role of the mutual insurers will change. We interview Dr Jan Van Emelen, who heads up the working group on disease management at the Association Internationale de la Mutualité (International Association of Mutuals), on this change of role and on what needs to be done to re-engineer healthcare in the 21st century.
HCE: Could you give us your view on how chronic disease management is managed in Europe?
JVE: Managed is too grand a word. Each country is different but we are still basically stuck in the post 1945 model where insurers passively pay for intervention. This is based on the concept of solidarity – disease is a phantom and we do not know where it will strike hence the need for insurance. But this is no longer the case. Today there are plenty of risk assessment tools which enable insurers to ascertain where chronic disease is most likely to occur and to take early action. It is no longer a phantom! And we know that good disease management programmes which enable the patient to take charge of their treatment and to develop good new dietary and exercise habits really work.
HCE: Yet chronic disease management programmes are in their infancy.
JVE: Indeed they are. There is no clear picture of what really works and what does not. No idea of what processes need to be put in place. What the EU has been funding is a lot of IT projects covering everything from ehealth cards to devices to monitor diseases. And this reflects the fact that there are a lot of very big IT companies – Siemens, Bosch, Microsoft, Intel – who are all keen to enter the market with new devices.
HCE: So you would argue that this is the wrong way round. That we should be concentrating on what is the right content and the right processes, rather than on IT?
JVE: Precisely. We need to first concentrate on content. What does the programme look like which delivers the best achievable results for patients with COPD? Then we need to focus on processes and the role for the different providers. Only then should we be designing the IT systems. Otherwise, all we end up with is a series of IT projects which are incompatible and which can not be compared to each other and where the content and processes have not been thought through properly.
HCE: So what is your AIM disease management group doing?
JVE: We started in February 2008 and we are gradually setting up working parties to look at different chronic diseases and how they should best be treated. The latest, for instance, is on type 2 diabetes. Members are mainly from the national unions of mutuals and are often the director general. They appreciate that disease management is the future and that it is the best way of reducing costs and providing high quality care.
HCE: I hear you also plan to set up some sort of European disease management centre.
JVE: Yes that is right. We have invited about 8 national unions of mutuals to form such a centre so that they can work together more closely. That way we can actually run and measure pilots and identify best practice.
HCE: What works in chronic disease management?
JVE: I don’t want to go into specific examples, but much work has been done by Professor Reinhard B u sse at the University of Berlin in identifying the best approach.
However, we do know that big savings are possible. We have been working closely with Maccabi Health Care Services, the second largest health maintenance organisation in Israel where the average expenditure on healthcare is $2,000 per capita compared to $3, 3 00 per capita in Belgium and yet the leading indicators suggest that the Israeli system delivers a better quality of care. Maccabi has many US and European employees and they have managed to produce something which meshes together the best from both continents.
HCE: Thank you
HCE: Could you give us your view on how chronic disease management is managed in Europe?
JVE: Managed is too grand a word. Each country is different but we are still basically stuck in the post 1945 model where insurers passively pay for intervention. This is based on the concept of solidarity – disease is a phantom and we do not know where it will strike hence the need for insurance. But this is no longer the case. Today there are plenty of risk assessment tools which enable insurers to ascertain where chronic disease is most likely to occur and to take early action. It is no longer a phantom! And we know that good disease management programmes which enable the patient to take charge of their treatment and to develop good new dietary and exercise habits really work.
HCE: Yet chronic disease management programmes are in their infancy.
JVE: Indeed they are. There is no clear picture of what really works and what does not. No idea of what processes need to be put in place. What the EU has been funding is a lot of IT projects covering everything from ehealth cards to devices to monitor diseases. And this reflects the fact that there are a lot of very big IT companies – Siemens, Bosch, Microsoft, Intel – who are all keen to enter the market with new devices.
HCE: So you would argue that this is the wrong way round. That we should be concentrating on what is the right content and the right processes, rather than on IT?
JVE: Precisely. We need to first concentrate on content. What does the programme look like which delivers the best achievable results for patients with COPD? Then we need to focus on processes and the role for the different providers. Only then should we be designing the IT systems. Otherwise, all we end up with is a series of IT projects which are incompatible and which can not be compared to each other and where the content and processes have not been thought through properly.
HCE: So what is your AIM disease management group doing?
JVE: We started in February 2008 and we are gradually setting up working parties to look at different chronic diseases and how they should best be treated. The latest, for instance, is on type 2 diabetes. Members are mainly from the national unions of mutuals and are often the director general. They appreciate that disease management is the future and that it is the best way of reducing costs and providing high quality care.
HCE: I hear you also plan to set up some sort of European disease management centre.
JVE: Yes that is right. We have invited about 8 national unions of mutuals to form such a centre so that they can work together more closely. That way we can actually run and measure pilots and identify best practice.
HCE: What works in chronic disease management?
JVE: I don’t want to go into specific examples, but much work has been done by Professor Reinhard B u sse at the University of Berlin in identifying the best approach.
However, we do know that big savings are possible. We have been working closely with Maccabi Health Care Services, the second largest health maintenance organisation in Israel where the average expenditure on healthcare is $2,000 per capita compared to $3, 3 00 per capita in Belgium and yet the leading indicators suggest that the Israeli system delivers a better quality of care. Maccabi has many US and European employees and they have managed to produce something which meshes together the best from both continents.
HCE: Thank you