Integrated care BARMER

Barmer Health Insurance, with approximately 9.4 million insured members, is one of the two largest health insurance funds in Germany. Effective January 1, 2018, Barmer Health Insurance joined the Integrated Care Agreement for migraine, headache and facial pain, cranial neuralgia, and neuropathic pain (IV-K) pursuant to Section 140a of the German Social Code, Book V (SGB V), between the Kiel Pain Clinic and Techniker Krankenkasse (TK). This provides Barmer Health Insurance members with access to an innovative, nationwide headache treatment network.

This agreement represents a milestone for the care of migraine and headache patients. For the first time, it enables nationwide, cross-sectoral and interdisciplinary networking of outpatient and inpatient therapy. Close collaboration, increased knowledge, improved information exchange among all involved parties, and joint work using clearly defined treatment pathways form the basis for modern and efficient treatment outcomes.

• The supply chain will be significantly improved. Patient benefit is the focus of the network:
• Orientation of services to the needs of patients
• optimized treatment based on current scientific knowledge
• cross-sectoral, specialized treatment pathways
• direct implementation of international scientific findings for healthcare provision
• organized treatment chain
• ongoing evaluation
• Nationwide follow-up care for patients living far away via video consultation
• Exchange among those affected through digital self-help communities

Patient satisfaction with the integrated care provided by the nationwide headache treatment network is very high. Scientific evaluation shows that pain is sustainably relieved, quality of life is restored, the ability to work is reinstated, and costs are reduced. The network has received numerous awards, including recognition as the best implementation of integrated care nationwide.

Migraines and other chronic headaches affect 54 million people in Germany. They are among the ten most debilitating conditions and the three most expensive neurological diseases. To overcome the entrenched sectoral barriers and medical specialty boundaries, the nationwide headache treatment network was initiated. It represents a milestone for the care of headache patients. For the first time, it enables nationwide, cross-sectoral and interdisciplinary networking of outpatient and inpatient therapy. Close collaboration, increased knowledge, improved information exchange among all involved parties, and joint work using clearly defined treatment pathways form the basis for modern and efficient treatment outcomes.
The treatment network is geared towards the specialized care of severely affected patients with chronic headache disorders. It encompasses all serious and complex primary and secondary headache disorders, as well as head and facial neuralgia. It focuses on additional serious and complex comorbidities, such as medication overuse, medication intolerances, psychological and social complications, and organ damage.
A nationwide network of outpatient and inpatient pain therapists in private practices and hospitals works hand in hand to provide optimal pain relief across disciplines and sectors using state-of-the-art methods. For therapy-resistant conditions, highly intensive, supraregional, and interdisciplinary inpatient treatment is available at the Kiel Pain Clinic. This concept offers, for the first time, nationwide coordinated treatment without the limitations of specialty boundaries or bureaucratic reimbursement systems.
More details Information about the treatment process can be found here.

The integrated networked supply consists of three phases:

• Phase I: Specialized diagnostics, selection of cross-sectoral treatment pathways, treatment on site
• Phase II: Inpatient, cross-sectoral neurological and behavioral medicine treatment at the Kiel Pain Clinic
• Phase III: Outpatient monitoring of progress and success, cross-sectoral monitoring of the therapy process on site

 

The pain condition is diagnosed and the treatment plan is coordinated. The measures include:

• Standardized medical history and evaluation of external findings
• Pain analysis
• Clarification of the diagnosis
• Development of a therapy plan
• Upon fulfillment of the admission criteria, registration for inpatient treatment within the framework of Phase II
• An admissions conference, together with the referring physician, decides on admission

In this section, the cross-sectoral neurological-behavioral medicine treatment takes place on an inpatient basis at the Kiel Pain Clinic, with the integrated therapy procedures being used simultaneously in a coordinated manner.

• Refinement, updating and supplementation of neurological and behavioral medicine diagnostics (multiprofessional individual case diagnostics)
• Analysis of the biological, psychosocial and economic conditions of chronic pain
• Reduction of pain-induced disability.
• Improvement of future performance
• Specific diagnosis and treatment of psychological and social illness conditions and their impact on the experience of illness
• Advice on individual pain disorders, their mechanisms of development, and pharmacological and non-pharmacological treatment methods for self-control and self-treatment of pain disorders
• Advice on issues of remaining work capacity and possible initiation of vocational rehabilitation measures
• Offering a multidimensional inpatient treatment concept that combines drug and non-drug strategies, including
  • Identifying and avoiding trigger and amplification mechanisms
  • Medication break/withdrawal
  • Dietary change
  • Relaxation techniques, e.g. progressive muscle relaxation
  • Biofeedback methods
  • Stress management training
  • Operant and cognitive procedures
  • Self-confidence training
  • physiotherapy
  • Physical therapy methods
  • Stimulation procedures
  • Drug-based pain prophylaxis
  • Drug therapy for attacks, etc.

• Offering individual and group therapy, behavioral medicine treatment concepts for coping with acute and chronic pain conditions
• Everyday behavioral medicine and sociotherapeutic measures for reintegration into family and work
• Development of follow-up and long-term care concepts hand in hand with the pre- and post-treatment physician for outpatient follow-up treatment

 

Over a period of one year after enrollment in the integrated care program, outpatient progress and success monitoring is carried out at regular intervals and the therapy is individually adjusted.

• Standardized assessment of therapy efficacy at three-month intervals
• Short-term inpatient readmission if necessary
• Patient seminars on coping with illness
• Cross-sector training courses for participating doctors, psychologists, etc.

 

Detailed information about the treatment process can be found on our website Homepage and in our Clinic information brochure
Further individual information regarding inpatient admission can be found here by email or can be obtained via the central management telephone. Please be so kind as to familiarize yourself with the general formalities beforehand on our website. In this internet age, we no longer send brochures and documents by post.
Phone: 0431-20099120
Fax: 0431-20099129
iv-netz@schmerzklinik.de

Registration for outpatient pre- and post-treatment as well as to the outpatient follow-up examinations In our headache center, as part of integrated care, this is possible via:
Phone: 0431-20099400
Fax: 0431-20099409
praxis@schmerzklinik.de

For your outpatient treatment, please gather the following documents and bring prepared copies of all documents to your appointment for our records: Migraines and chronic headaches affect around 54 million people in Germany and are the number one widespread health problem. According to the WHO, they rank third among the most disabling diseases in the world. The EU considers them to be among the three most expensive neurological disorders. Nationwide, more than three billion individual doses of painkillers are taken annually, 85% of them for headaches.
The treatment of headaches exemplifies how the sectorally fragmented healthcare system, based on collective bargaining agreements, can itself contribute to illnesses becoming chronic and pain persisting indefinitely. Traditional standard care for headache patients takes place in segregated sectors of the healthcare system. Many sufferers with chronic headaches resort to self-treatment outside the professional system due to its perceived lack of effectiveness. They seek information about various treatment options for migraines and headaches from friends, acquaintances, the popular press, the internet, and pharmacies. Dissatisfied with medical treatment, they often abandon professional therapy and, disappointed, turn to alternative methods. Over months and years, the headache condition becomes even more chronic, and serious organ complications, often resulting in severely debilitating psychological consequences, lead patients back to expensive medical treatment.
This results in very high direct and indirect costs. The individual consequences are severe. High follow-up costs also arise from the treatment of late complications such as mental illnesses, kidney failure, liver damage, gastrointestinal ulcers, and damage to the cardiovascular system.
All the knowledge developed nationally and internationally for the treatment of migraines, headaches, and chronic pain is made directly available to patients through integrated care within the standard healthcare system. Collaboration between innovative health insurance companies and specialists has enabled significant advances in care nationwide, extending beyond standard services. These advances will be maintained and expanded.

The Kiel Pain Clinic was founded in 1997 as a scientific model project at the University Hospital of Kiel by Prof. Dr. Hartmut Göbel and initially supported by the AOK (a major German health insurance provider). Following successful scientific evaluation by the health insurance companies, the concept was adapted for nationwide care in 2007 in cooperation with the Techniker Krankenkasse (a major German health insurance provider), creating an innovative treatment network with over 450 independent pain therapists across Germany. The approximately 50 member health insurance funds of the BKK (a regional association of company health insurance funds) Northwest are also contractual partners. Today, the nationwide center collaborates with regional pain therapists in private practices and hospitals within the framework of multimodal pain therapy, employing coordinated treatment plans.

To ensure sustainable care for all patients, the center was included in the Schleswig-Holstein state hospital plan at the end of 2013. In addition, according to a service agreement pursuant to Sections 108 No. 3 and 109 of the German Social Code, Book V (SGB V), the center provides acute inpatient treatment (Section 39 Paragraph 1 SGB V) for insured persons of all health insurance funds residing outside of Schleswig-Holstein for the following indications: chronic pain due to diseases of the central, peripheral, and autonomic nervous systems, including the muscles, within the framework of neurological-behavioral medicine treatment procedures.

• Barmer Doctors' Report 2017
• PM Migraine and Headache
• Further analyses and detailed background information can be found in the Physician Report 2017 ( PDF , 5 MB ).