Type of Project: Funded project Model project Study
SERVE - Cross-sectoral preventive identification, counseling and support for insured persons with special job-related problems

Initial situation: Chronic illnesses are among the most common and economically significant health problems in Germany and have a particular impact on quality of life, ability to work and mortality. Serious illnesses in working age have extensive consequences not only for the person affected (loss of workplace, risk of poverty), but also for the community of insured persons (lost contributions to social insurance). As a result, society has to bear the costs of health care, absenteeism due to illness and premature reduction in earning capacity. To date, the share of pension additions due to reduced earning capacity in Germany is over 20% of all insured pension additions. In turn, around 40% of new pension recipients received unemployment benefits or basic social security benefits (ALG II) in the year prior to receiving benefits. Model project: The "SERVE" model project specifically addresses the above-mentioned needs. Patients with certain health risk factors are identified at an earlier stage than before with the help of a screening by the family doctor / DRV / job center / employment agency. With the help of a virtual, multidisciplinary "Social Medical Colloquium" (SMK), these patients are to be provided with targeted measures that, if necessary, go beyond the statutory benefits catalog. In the SMK, the members of the colloquium who are spatially distant from each other (family doctor, social physician, job center, employment agency and DRV Hessen) consult in virtual space (with the help of telematic concepts "eCollaboration") about precisely fitting services for the patient brought into the case conference. Innovation: SERVE is intended to test whether the above-mentioned modules can reduce the risk of premature reduction in earning capacity due to illness. In daily practice, the problem arises that the patient only comes to the attention of the social benefits agency when he or she applies for a reduced earning capacity pension. At this stage, however, many forms of assistance come too late because the clinical picture has already become chronic or patients have lost confidence in their own ability to work. From the patient's point of view, the decision to apply for a reduced earning capacity pension has usually been made. Another problem with current care is that the patient does not receive the necessary assistance in making an application and the feedback in the application proceedings for rehabilitation benefits is sometimes very lengthy. This discourages many patients, but also family physicians, to initiate this procedure constructively and early. The SERVE model procedure presented here makes it possible to offer patients cross-professional support long before they submit an application for a reduced earning capacity pension. These reach the patient in a sensitive transitional phase, even before chronification occurs and in which, due to his personal context, a better acceptance and adherence to the offered services can be expected. In this early phase, sustainable measures ranging from primary prevention to rehabilitation can be initiated to counteract the reduction in earning capacity. In this project, the relevant patients are identified at an earlier stage than in the past by, among others, family physicians, who are particularly suitable for the early detection of a risk of reduction in earning capacity due to their experienced medical history, their relationship of trust with the patient and as coordinators of health care. Accordingly, in the planned pilot project, they act as pilots through the health care system. A particularly innovative feature is that they establish contact with the social medical colloquium (virtual case conference), which is one of the special innovations of SERVE. In addition, patients can be detected via job centers and/or the employment agency. As a further innovative aspect of SERVE, patients in particular need of treatment (e.g. severely depressed patients who are often unable to actively accept assistance) are assigned a "SERVicEperson" throughout the entire care process. The "SERVicEperson" has a mediating function and links the patient's needs with suitable care offers (broker function and creation of health awareness in the patient). For the area of job centers, a support of the patients, due to the characteristics or special problems, by a SERVE staff member seems generally reasonable. In summary, the social medical colloquium has the following significance for the health care system and the patients themselves: - Earlier and thus more effective help for affected persons - Increase of intersectoral and interdisciplinary cooperation of social insurance providers and service providers - And thus uncomplicated and interdisciplinary exchange of information between several service providers and social insurance providers, which should enable improved care for patients - High quality second opinion procedure, which should improve the quality of care - Release of organizational and economic synergy effects between the service providers and the sectors - Scope for prescribing scientifically tested rehabilitation services that have not yet been included in the general catalog - Individual support by SERVicEPerson possible if required; thus support and guidance throughout the entire process before, during and after the rehabilitation measure Prevention before rehab before pension: In this way, patients are informed about their impairments and needs at an early stage. In this way, patients are identified at an early stage with their impairments or needs in the sense of "prevention before rehabilitation before retirement" and are provided with appropriate support measures. In addition, targeted measures facilitate the official application proceedings. Nevertheless, the family doctor / job center / employment agency remains the first point of contact for the patient, which is likely to be beneficial to the acceptance and continuation of assistance. Furthermore, the close cooperation of the service providers offers the possibility to optimize their cooperation across legal entities and sectors. Target group: As a target group, SERVE focuses on people aged 40 and older with musculoskeletal, psychiatric and oncological health problems. The target group definition is based on DRV Hessen's own analyses and empirical values with regard to the indication and age structure of patients who have filed an application for a reduced earning capacity pension in Hessen. In these analyses, we see an increase in EM pension applications of 40% in the age group of patients < 50 years compared to patients < 40 years. Project partners: In view of the high prognostic significance of previous payments of unemployment benefits or basic security (ALG II), ALG II recipients represent an important target group of the model project here. The cooperation with the job centers / employment agencies in Marburg and Frankfurt, among others, improves the DRV Hessen's ability to approach the above-mentioned target group in a targeted manner in the sense of equal health opportunities and to provide them with tailored assistance at an early stage in order to counteract a reduction in earning capacity. It links the competences of service providers in the sense of the project objective and promotes the cooperative collaboration required by the legislator in the Prevention Act. It can be deduced from the figures on the utilization of rehabilitation services before a reduction in earning capacity pension that there is an access problem to rehabilitation and prevention measures in this context. SERVE is testing new access routes in which, in addition to general practitioners, the medical service of the job centers and employment agencies screen the relevant group of insured persons at an early stage for the presence of a risk of reduced earning capacity and, if necessary (conspicuous screening result), refer them to the socio-medical colloquium. The latter, in turn, provides interdisciplinary advice on the best possible and most effective assistance for the insured in terms of patient-oriented care. Cross-jurisdictional approach: SERVE aims to improve interface management and information exchange between the sectors of the social insurance providers (SHI, GRV, Jobcenter, etc.) as well as the service providers (e.g. general practitioners, etc.) through the Social Medical Colloquium (SMK). The colloquium's collegial decision on the holistic treatment concept, taking into account the preferences of the insured person (participation), is more "accurate and effective" than the individual decision of a practitioner and should enable the quality of care for the insured person to be improved and synergies to be leveraged. Based on a resolution of the Social Medical Colloquium, an interlocking, seamless care process will be initiated with partly new, but above all needs-based and tailored and innovative services. Long-term objective/hypothesis: The early case discussion in the socio-medical colloquium and the measures initiated as a result will reduce the number of applications for reduced earning capacity in the following 5 years among those affected by the disease areas studied more than among a control group of patients treated within the framework of the current standard offer (therapy as usual). This long-term hypothesis cannot be answered conclusively within the time frame of the model project and is subject to further analysis after a period of 5 and 10 years, provided that the study participants give their consent to be followed, in the above-mentioned period. These analyses are carried out and financed independently by DRV Hessen. Scientific support: The SERVE project is scientifically supported by the Phillips University Marburg and the Technical University of Central Hesse in Giessen as well as the Goethe University Frankfurt. The detailed SERVE project description can be accessed here (PDF | 22 pages | 297 KB): https://www.rehadat-forschung.de/export/sites/forschung-2021/lokale-downloads/BMAS/FO125952_SERVE_Projektbeschreibung.pdf