Page 20 - vascular professional 01_2021_eMagazine

vascular professional | issue 01 · 2021 guest contribution

Intergrated Care Stucture MICADO HEALTH CARE GmbH: New management
companies* in the healthcare system in Germany

in a New Way improve integrated care structures for outpatient

operations

BY MATTHIAS HEILMANN,

MICADO HEALTH CARE GmbH, Hamburg, Germany

Among other things, integrated care means MICADO stands for „Minimally Invasive Surgery & Appli-
better networking of medical service provi- cable Outpatient Surgery“. Originally, this was an initia-
ders. To this end, in Germany contracts are tive of contract physicians from Hamburg who had made it
concluded between health insurers and a wide their goal to establish and expand cooperation between
range of service providers, such as primary care health insurance companies and physicians in order to
physicians, specialists in private practice, hos- make hospital-replacing operations possible. The man-
pitals and pharmacies. This concept enables agement company MICADO Health Care GmbH, which
physicians to off er their patients special forms was founded in 2004, is still working up to this day ac-
of treatment and bill them via the health insur- cording to these guidelines. However, MICADO now off ers
ance fund, even though these are not actually much more than simply conclude contracts to ensure sol-
part of the regular list of services provided by id fi nancing for outpatient surgery.
the respective health insurance fund. As a contractual partner of this management compa-
ny, physicians are able to use the available contracts with
However, so called IV contracts (contracts for integrated health insurers of MICADO. MICADO‘s fl at rates, some of
care) or contracts for „special care“ are neither the norm which are similar to diagnosis-based per-case fl at rates
nor available nationwide in Germany, even after 20 years. in hospitals, but some of which have fi xed prices, include
If patients want to take advantage of a certain therapy, around 15,000 OPS (operation and procedure code) num-
they may have to drive hundreds of kilometers to fi nd a bers. Doctors are free to choose which contractual ser-
contract physician. At the same time, doctors are often vices are to be integrated. In addition, billing is signifi cantly
just able to off er many modern therapies to patients with simplifi ed thanks to management companies. MICADO, for
private health insurance or to self-pay patients. This is example, has a so-called online grouper. This system de-
where management companies, such as MICADO Health termines the possible billing method (fi xed price or DRG
Care GmbH (MICADO), come into play. On the one hand, - Diagnosis Related Groups system) for your treatment, as
they conclude contracts with numerous health insurance well as the associated remuneration. In addition, clients
companies, which benefi t from being able to off er their receive all the necessary information there that must be
clients a broader range of services, and on the other hand taken into account when billing for the individual treat-
with physicians, who can bill the management compa- ment case. You only have exclusive access to this online
ny for these treatments on an extrabudgetary basis and grouper as a contractual partner.
without any problems. In the fi eld of phlebology and vas- MICADO currently is running contracts with over 40
cular surgery, MICADO off ers minimally invasive endolu- diff erent company health insurance funds (BKKs), inclu-
minal treatment methods for varicose veins, such as laser ding Siemens Betriebskrankenkasse, pronova BKK, vivda
therapy and radiofrequency therapy. Reimbursement is BKK, BKK MTU, BMW BKK, Continentale BKK, BKK Linde,
made promptly via performance-based fl at rates, which BKK Stadt Augsburg and BKK Pfalz. There are also con-
also include material costs incurred. tracts with the Hanseatische Krankenkasse (HEK) (Han-

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