Within the state of Baden-Württemberg (roughly 11 million inhabitants ), they initiated the “Facharztvertrag Kardiologie” (medical specialist’s contract in cardiology) as the first German selective contract, which, for patients, led to the “AOK FacharztProgramm” (AOK medical specialist’s program) being rolled-out in early 2010. In late 2009, German health insurers AOK (Allgemeine Ortskrankenkasse) Baden-Württemberg and Bosch BKK (Betriebskrankenkasse) started a program in coordinated ambulatory cardiology care together with MEDIVERBUND (independent group representing physicians’ interests) as a management organization, the Bundesverband Niedergelassener Kardiologen (nationwide association of practice-based cardiologists) and the Berufsverband niedergelassener fachärztlich tätiger Internisten (professional association of practice-based internists). While a substantial number of German physicians entered a selective contract in their field, insight into the actual adoption of a contract’s components in routine practice is still limited. In return, they receive higher and more secure reimbursement compared to usual healthcare. required to strictly adhere to clinical guidelines and regulations, follow standardized methods of documentation and communication, and provide services such as faster access to medical care and a broader scope of diagnostic procedures. Participating medical specialists are, e.g. The legislation allows health insurers to conclude contracts with medical specialists to provide “exceptional ambulatory medical care” for patients, adding to a vast range of variations in the provision of health care to foster integration within the ambulatory sector of the rather fragmented German health system. In 2009 Germany introduced “Selektivverträge” (selective contracts) based on §73c (§140a since 2015) in book five of the German Social Security Law (SGB V). While managed care first emerged in the United States of America, several other countries apply similar concepts. The study has been registered as a non-interventional observation study at the German Clinical Trials Register under ID: DRKS00013070. Though not a clinical study, we deemed registration appropriate to ensure transparency. Both control mechanisms and tailoring of the program to medical care seem needed. Contextual factors posed individual challenges to participating physicians which can’t be captured by an encompassing program. Implementation of this program was mixed. A range of regional and practice-related contextual factors influenced implementation and outcomes. Procedures for communication and cooperation between medical specialists and general practitioners were only partially adhered to and standardized communication was not implemented. However, access to medical care was not completely as intended due to high numbers of patients participating in the program and prioritization by physicians. Most components of the program regarding medical care were well implemented. Analyses were performed using SPSS Statistics, mainly with regard to differences within and between groups of physicians. Quantitative data was obtained using anonymous written questionnaires completed by participating and non-participating medical specialists as well as general practitioners cooperating with the program. Interviews were analyzed through content-structuring qualitative content analyses via MAXQDA. Qualitative data was obtained through structured telephone interviews with participating and non-participating medical specialists as well as general practitioners cooperating with the program and general practitioners not cooperating. We collected data from primary care practices of medical specialists and general practitioners within Baden-Württemberg. We aimed to determine to what extent medical specialists and cooperating general practitioners implemented the program, which components they adapted, and which contextual factors they deemed relevant. Still, only little data on the actual implementation exists. With many prerequisites and conditions involved, its implementation cannot be expected to be self-directed. A high number of cardiologists participate and the program has served as blueprint for programs in other medical fields. It aims for efficient, medical guideline-oriented cardiology care to reduce avoidable hospitalizations as well as costs of care. In 2009 health insurers AOK and Bosch BKK introduced the “FacharztProgramm Kardiologie” - a program for coordinated ambulatory cardiology care in the German state of Baden-Württemberg.
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