gms | German Medical Science

Background: The Covid-19 pandemic and the discount agreements had a not inconsiderable impact on the target agreement and the MRG (Morbidity Related Groups) agreement on pharmaceuticals in Schleswig-Holstein in terms of conception and contract controlling. Due to the remote work regulations of the insured in varying degrees, there were shifts in patient flows with regard to medical practices, with an accumulation in some specialties.

Materials and Methods: The analysis of all drug prescription data from the last four available quarters in Schleswig-Holstein for all statutory insured persons is used to design an MRG (Morbidity Related Groups) agreement and a target agreement between the contractual partners. The MRG system is used to prospectively provide each doctor with a financial guarantee volume for drugs that can be increased through retrospective consideration. The MRG system has the following basic elements: Quarterly each patient of every physician is assigned to a unique basic MRG defined by the third level of the ATC (four characters= therapeutic/ pharmacological subgroup) with the highest cost. In analogy to the DRG system in the hospital setting this basic MRG will be extended by a severity level depending on age group (five year steps), polypharmacy and prescription intensity separated by medical specialist groups. In the target agreement, standard values for the prescription costs per day and a proportion for which the target is to be at least achieved are agreed for groups of active substances with a high prescription rate. Another block of the target agreement defines lead substances that are to be prescribed with a minimum proportion.

Results: The Covid-19 pandemic and the discount agreements have a significant impact on the MRG guarantee volumes, which affect both the changes that have taken place and those that are to be expected. One focus of the target agreements in recent years has been on biosimilars. With all positive approaches to controlling the regulations through target agreements, the assessment of potential damage if the targets are not met by the examination body is becoming increasingly difficult, since the financial assessment is subject to considerable restrictions and different legal assessments by the partners in the statutory health insurance regions, e.g. due to the discount agreements. It is advantageous for the statutory health insurance to focus on the benefits for a health insurance region as a whole and not on additional demands from individual doctors. With this approach it is possible to take more account of the positive elements of discount agreements. Existing models in different regions of the statutory health insurance compared in this regard.

Conclusion: An essential design tool in the implementation of drug contracts is given by data-supported individual doctor consultations by the contractual partners who related to Covid-19 in Schleswig-Holstein, which could increasingly be activated again. The selection of the voluntary counseling offers to the practices results from the controlling by the contractual partners.