CMSA Today - Issue 4, 2021

“I asked myself why this SLTA system was not available in Germany, specifically at the University Hospital in Frankfurt. The answer, of course, has to do with the DRG hospital reimbursement system and the funding of new and innovative services. If the costs of the SLTA technology are not reflected in the collective agreement system, a hospital cannot bill the service or can only bill with complex individual approvals.”

service for as many patients in Germany as possible. So, from the beginning the contract was open for other insurance companies to join as a benefit for their members. And indeed, by mid-April 2021 the following companies with a total of 15 million mem bers are participating: IKK classic, BKK Pfalz, Techniker Krankenkasse and IKK Suedwest. WHAT WAS THE KEY ELEMENT THAT MADE THIS EFFORT A SUCCESS? This was made possible by the willingness to cooperate on the part of Prof. Dr. Felix Rosenow, those responsible at Medtronic, Jan-Philipp Spierling and Dr. Lutz Herbarth. Without all those involved being open to this new way of bringing care into statu tory health insurance, we would never have been able to conclude the contract and bring this innovative technology to our patients in Germany. Direkt Healthy, has a master’s degree in healthcare and hospital management and more than 30 years’ experience in leading healthcare management positions. A member of CMSA since 2010, he is also a DKMS Ambassador and Life Safer: We delete blood cancer – get swabbed. This article will outline how two dis tinct federal government departments, the Department of National Defence (DND) and Veterans Affairs Canada (VAC), coor dinate their respective case management (CM) services and apply CM best practices to support CAF members during the critical transition period. This article will also outline key components, tools and approaches that CAF and VAC coordinate to support positive outcomes for transitioning CAF members. CM services are available to ill and injured serving CAF members who have protracted or severe health issues and are provided by nurses in a primary care setting. The tran sition process from military to civilian life can take years, and early engagement with a nurse case manager (NuCM) is crucial in preparing members and their families in their Johann Achim Beißel , MHA, department head for inpatient care , BIG

policyholders? They would act as a designer of medical care. And so, I came up with the idea of launching a “concerted action in healthcare” involving three different parties who all have the well-being of the patient in mind. Namely we as a health insurance company, together with a hospital and a medical device provider, would create a com prehensive contract that would enable us to work together to provide special care (SLTA technology) for the treatment of epilepsy patients in Germany. After I had convinced the decision-mak ers at my insurance company (BIG Direkt Healthy) of the potential of my idea, I was able to establish contact with Medtronic at a medical trade fair in Munich. Also, Prof. Dr. Felix Rosenow found the idea of draft ing a contract interesting. A workshop was held on the possible implementation of such HOW DID YOU FACILITATE THIS COLLABORATION?

a contract for special care. This workshop was followed by many more phone calls and votes, until finally, after a long contract development, the contract could be submit ted to the Federal Social Security Office (BAS) in Bonn for review in August 2020. After approval by the BAS, the “Contract for the diagnosis, treatment and care of patients with structural, focal, therapy-resistant epi lepsy using stereotactic laser thermal abla tion (SLTA)” was signed on October 26, 2020, and put into effect. This means that BIG Direkt Healthy has actually gone from payer to player, to the designer of innovative inpatient care in statutory or public health insurance. DID YOU FOCUS ONLY ON THE MEMBERS FOR BIG DIREKT HEALTHY? Due to the fact the SLTA contract is designed for an orphan disease, it was my intention as a case manager to offer that COORDINATED CASE MANAGEMENT: IMPROVING OUTCOMES FOR TRANSITIONING CANADIAN ARMED FORCES MEMBERS BY MEGHAN MACDONALD, RSW, MSW, AND ANNA BOTTIGLIA, RN, BscN At present, close to 40% of Canadian veterans report difficulties transitioning from the Canadian Armed Forces (CAF) to civilian life (LASS, 2019). Additionally, the literature on military transitions underlines the need for early intervention as critical to a member’s long-term transition success, and can significantly alter a member’s long-term psychosocial outcomes.

AUGUSTO CABRAL/SHUTTERSTOCK.COM

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CMSA TODAY

Issue 4 • 2021