What are DMPs?
Disease Management Programs are structured treatment programs for chronically ill people. The G-BA identifies the chronic diseases that are suitable for a DMP. The legal basis for DMPs is § 137f SGB V, including the DMP-A-RL, and the RSAV. The aims for the programs are:
- treatments in line with the latest medical research across all facilities.
- a coordinated approach to help prevent unnecessary complications, hospital stays and consequential harm.
The DMPs are based on the current medical knowledge concluded from the existing clinical treatment guidelines. They include requirements on
- the medical treatment according to the current scientific knowledge
- the quality assurance
- the enrollment of people who have SHI in a program
- specific training for physicians and patients
- specifications for the documentation and the evaluation.
At regular intervals, the G-BA updates and evaluates existing DMPs according to the most recent guidelines.
In June 2020, 7.2 million SH-insured people were enrolled in one or more DMPs and 8,955 programs were approved by the BAS.
How are DMPs working in practice?
- The BAS checks whether the DMP meets the requirements set out in the G-BA guidelines. Then the BAS can approve the DMP.
- Patients with certain chronic diseases that are covered by these DMPs can sign up for such a treatment program with their SHI fund.
- These SHI funds then negotiate regional contracts with physicians and / or hospitals for the DMP.
Existing DMPs
The following chronic conditions are covered by a DMP:
- breast cancer (to be updated in 2021)
- bronchial asthma (to be updated in 2021)
- chronic back pain
- chronic heart failure
- COPD
- coronary heart disease
- depression
- diabetes mellitus type 1 and type 2
- obesity (in development)
- osteoporosis
- rheumatoid arthritis (since 1 Oct 2021)
DMP rheumatoid arthritis
This DMP targets adult patients with a confirmed diagnosis of rheumatoid arthritis. Correct and careful diagnosis is very important in this disease to differentiate the various non-inflammatory rheumatic causes, especially from the degenerative joint changes. In addition, it is also crucial to assess the further course of the disease and to choose the optimal therapeutic strategy.
The key aims of the DMP are to
- achieve a long-lasting remission, i.e. almost complete freedom from inflammation and symptoms or a low level of disease activity
- avoid joint damage
- improve functionality and mobility
- reduce pain, and
- increase the life expectancy by also treating comorbidities.
The G-BA has included a wide range of therapeutic measures in the DMP requirements. In detail, the DMP covers lifestyle-related training, physical and occupational therapy, recommendations for drug therapy with glucocorticoids or disease-modifying anti-inflammatory drugs in three therapy stages, and “tapering” of drug administration.