Diabetes Care in The Netherlands: - Novo Nordisk

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Insurers are supporting quality improvement, but they areconfrontedInsurers arewithsupporting(perceived)qualityfinancialimprovement,disincentivesbut they areconfronted with (perceived) financial disincentivesPerception that investing in diabetes care is only delaying and noteliminating complications and therefore not generating revenues• This perception is invalide but will need to be addressed specificallyLowDifferences in risk exposure to primary care and specialist• The risk and budget allocation mechanism lead to a lower risk burden for theinsurer for hospital care versus primary careImpactHigh quality diabetes care may attract more than fair-share diabetespatients• Diabetes patients seem to be on average loss-making even after budgetallocation corrections(Hospital) capacity that is freed up by quality improvements, tends to fillup with other patients (leading to double cost)• Cost benefits on the patient-level often lost due to extra volume from otherpatientsHighInsurers do invest in initiatives – but they tend to see it as a qualitydifferentiator with no or modest economic benefitsSource:Booz & Company analysisBooz & Company 14 November 201134Prepared for Novo Nordisk27
Delaying complications saves medical costs – despite occasionalskepticismILLUSTRATIVE16.3NPV12.4Illustration: calculation, the value of 3year delay of complicationsNPV, annual costs EUR ‘000-24%42Illustration is for a 60 yearold male patient alreadydiagnosed060 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75AgePatient of 60 years old diagnosed with Type 2 diabetes.assuming complications will occur after 5 yearsCost if we would be able to delay complications with3 years with an intervention, less complications occurringafter 8 yearsCost per year (based on average costs oftreatment and complications, excl. other medical costsEUR ‘000105010%5%0%10%5%0%60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75AgeAttrition%60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75AgeMortality%60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75AgeDetails• Given that patient is aliveand remains withininsurance plan• Complications assumedto occur after 5 years• Assumed thatintervention can delaycomplications for 3 years• Attrition level assumedconstant at 5%• Mortality % of diabetespatients estimated 2.2times as high as personwithout diabetes (sourceinterview medicalspecialist)Booz Source: & Company Booz 14 & November Company 2011 analysisPrepared for Novo Nordisk2835
Page 6 and 7: SummaryDiabetes is a serious and de
Page 8: diabetes care. Extra compensation w
Page 11 and 12: ContentsSummarized findings and rec
Page 13 and 14: 11Diabetes is a major and underesti
Page 15 and 16: 33Further improving health of of di
Page 17 and 18: 22Recommendation 2: Engage employer
Page 19 and 20: 44Recommendation 4: Introduce condi
Page 21 and 22: Already more than 1M diabetes patie
Page 23 and 24: Costs of of complications and treat
Page 25 and 26: Number of patients reaches ~1.4M in
Page 27 and 28: Increase in lost productivity is dr
Page 29 and 30: Diabetes care clearly improved in t
Page 31 and 32: Better compliance can be stimulated
Page 35: ContentsSummarized findings and rec
Page 39 and 40: LimitedLimitedcollaborationcollabor
Page 41 and 42: Individual quality incentives are l
Page 43 and 44: Recommendation 1: Insurer should in
Page 47 and 48: Labour shortage from late nineties
Page 49 and 50: However, curative and participative
Page 53 and 54: Non-compliance leads to severe comp
Page 55: Facilitated patient networks are su
Page 58 and 59: Recommendation 3:Facilitate network
Page 62 and 63: But new medication could add a lot
Page 66: Booz & Company is a global manageme

Diabetes Care in The Netherlands: - Novo Nordisk

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