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BGM-innovativ: Workplace, cross-provider healthcare management of company health insurance funds

Scientific project leader

Prof. Dr. Holger Pfaff

Operative project leader

Dr. Anna Choi

Project execution

Dr. Birthe Lehmann

Lara Lindert

Co-operation partners

BKK Federal Association

15 company health insurances and 22 companies

Institute of Medical Statistics and Computational Biology (IMSIE)

Insurance Agencies of the German Statutory Pension Insurance

German Society for Medical Rehabilitation (DEGEMED)

Duration

04/2017 - 03/2021

Funding institution

Innovation Committee (Innovationsausschuss) of the Federal Joint Committee (G-BA)

Project description

BGM-innovativ for employees with musculoskeletal disorders is a response to the specific needs for healthcare in companies. The objective of the program is to offer sick or vulnerable employees targeted support tailored to their individual needs during recovery and the provision of healthcare. This will be ensured by cross-carrier and cross-sector coordinated healthcare.

The various social security carriers are faced with similar needs for action in preventive, curative and rehabilitative treatment, care and support. However, their measures have been taking place in a largely disjointed and uncoordinated manner so far. For this reason, BGM-innovativ intends to establish close cooperation and coordination between the relevant health insurance carriers, pension providers and companies. Thus BGM-innovativ is an approach to combat insufficient cross-sector healthcare cooperation for employees with musculoskeletal disorders.

The program aims to avoid disease and chronification, reduce disease duration and days of absence and to permanently maintain capacity for work. Companies and employees will be supported in the field of corporate healthcare management (BGM) by healthcare management oriented to each individual workplace situation. A central innovation of BGM-innovativ is the case manager of the company health insurance funds, who is the personal contact for policy holders, organizes specific and appropriate healthcare and coordinates the interfaces between the various parties. The case manager leads the employees through the healthcare process and involves them in all planning and decision-making processes. BGM-innovativ has a multimodal structure and intends to establish workplace-relevant, individualized and cross-sector healthcare measures. Depending on the stage of the disease and the impact on the employee, these measures may be early intervention, rehabilitation or reintegration.

We refer to BGM-innovativ as a metaconcept; instead of creating additional structures and services, it strengthens cross-system thinking and the awareness of the various parties. Key factors like the case manager, who takes over a guiding role for policy holders in the healthcare process, will be implemented once and can then be applied in further contexts, indications, sectors, regions and health insurance funds. Whereas the supported project primarily focusses on musculoskeletal diseases, should the project be successful, the concept could be applied to the healthcare processes of different, high-prevalence diseases.

IMVR will coordinate the evaluation of the BGM-innovativ program. The design of the study employs a mixed-method approach and consists of both an accompanying, process-oriented (formative) and a result-oriented (summative) evaluation

 

Summative evaluation using a randomized trial

The summative evaluation aims to check the effectiveness of the program using a randomized controlled trial (RCT). The participants are randomly divided into two treatment groups before the program commences for this purpose. All participants receive a standardized questionnaire at the beginning and in the end of the program. Furthermore, additional key figures, like information regarding incapacity for work, are evaluated. Using the pre-post comparison and the comparison of the two groups in each module, robust conclusions can be drawn on the effectiveness of the program. Additional qualitative interviews with some participants supplement the summative evaluation.

Formative evaluation using qualitative methods

Formative evaluation with qualitative implementation research meant to identify those factors conducive and restrictive to implementation of the program will take place alongside it. Relevant parties (like case managers and company physicians) will be asked about their subjective experiences of implementation of the program in focus groups and expert interviews. These surveys will take place at several points throughout the project to obtain as comprehensive a picture as possible.

The results of the evaluation will make an important contribution to evidence-based corporate health and healthcare management. They will promote cross-carrier and cross-sector cooperation between the various healthcare parties and therefore improve the targeted and individual support of sick employees during recovery and in the provision of healthcare.