Since 2013, Section 64b SGB V has offered the possibility of further developing inpatient psychiatric and psychosomatic care through model projects aimed at cross-sector, patient-centered care. The legal framework includes, for example, that patients do not have to be enrolled on their own, as is necessary for IV contracts. In addition, all health insurance companies can participate, and providers no longer have to negotiate their own IV contract with each cash register in a laborious manner. A key difference from the predecessor models is the obligation to evaluate as set out in Section 65 SGB V.
The common feature of all model projects is the formation of a total budget from an inpatient hospital budget and the proceeds of the psychiatric outpatient clinic (PIA), whereby the individual models differ in terms of how the budget is financed (advance payments during the year, care rates, quarterly flat rates, PEPP).
The goals of these innovative remuneration systems are, on the one hand, to make performance more transparent; on the other hand, previous false incentives are to be reduced, so that a more cost-effective use (efficiency) of the existing funds to care for insured persons (adults, children and adolescents) is achieved.
The degree to which these goals are achieved and the respective determinants of goal achievement are to be scientifically investigated. Hypotheses are made for this in each case. These should be checked on the basis of suitable parameters.
The objectives of the contracts are:
(A) the implementation and further development of improved patient care through cross-sectoral treatment planning and delivery,
(B) the strengthening of in-patient treatment options with consecutive improved adaptation of the duration and intensity of treatment to the specific treatment needs of affected insured persons,
(C) continuous treatment and stabilisation of patients, taking into account their social and professional environment,
(D) increasing the acceptance of patient-oriented psychiatric, psychotherapeutic and sociotherapeutic interventions
(E) the creation of performance transparency,
(F) achieving a more cost-effective use (efficiency) of existing means of care for insured persons (adults, children and adolescents).
The degree to which these goals are achieved and the respective determinants of goal achievement are to be scientifically investigated. Hypotheses are made for this in each case. These should be checked on the basis of suitable parameters.
The evaluation is based on an analysis of routine data (often referred to as “secondary data”) from Statutory Health Insurance (GKV). A prospective and retrospective (for the models already running), secondary data-based non-randomized parallel group study is planned, which is comparable to the previous evaluation “EVA 64".