What is DMP

Disease Management Programs

Disease Management Programs (DMP) are structured treatment programs for chronically ill people. Patients with certain chronic diseases can sign up for such a treatment program with their health insurance company. This means that they are treated in line with the latest medical research across all facilities. A coordinated approach should help prevent unnecessary complications, hospital stays and consequential damage.

The G-BA's task is to select chronic diseases that are suitable for a DMP and to determine the content-related requirements for such programs more precisely. In doing so, it is based on the current state of medical science, which is determined in accordance with the principles of evidence-based medicine from the existing clinical treatment guidelines. The G-BA updates and evaluates existing DMPs according to the current status of the guidelines at regular intervals.

The DMP is run by the statutory health insurances that they offer for their chronically ill insured persons: They conclude regional contracts with contract doctors and / or hospitals. The Federal Social Security Office (BAS) first checks whether the requirements for a DMP set out in the G-BA guidelines are being met - only then can they be approved by the Federal Social Security Office. According to BAS, 7.2 million insured persons were enrolled in one or more DMPs by mid-June 2020 and 8,955 programs were approved by the Federal Social Security Office (as of June 30, 2020).

Requirements for DMP

There are currently requirements for DMP for the following chronic diseases:

  • bronchial asthma
  • Breast cancer
  • Chronic heart failure
  • Chronic back pain
  • COPD
  • depressions
  • Type 1 and type 2 diabetes mellitus
  • Coronary heart disease
  • osteoporosis
  • Rheumatoid Arthritis (not yet in force)

The content requirements for the DMP and documentation requirements are regulated in the DMP requirements guideline. This is particularly about medical treatment based on the current state of science, but also about quality assurance measures, requirements for the insured person's enrollment in a program, training courses for doctors and patients. In addition, specifications for the documentation and the evaluation are specified.

Requirements for the design of DMPs and the contracts to be concluded for their implementation are also regulated in the Risk Structure Compensation Ordinance (RSAV). The background to this is the fact that the Federal Ministry of Health had laid down the DMP requirements in the RSAV by 2011.

Update of DMP requirements

In 2021, the G-BA will begin deliberations to update the DMP breast cancer and DMP bronchial asthma. The aim is to adapt the programs to new medical knowledge.

Opportunities to comment on the DMP requirements

The opportunity to comment on the guidelines of the G-BA is given to those responsible for safeguarding the interests of outpatient and inpatient preventive and rehabilitation facilities and self-help as well as the central organizations relevant for other service providers at the federal level, insofar as their concerns are affected, as well as the Federal Social Security Office and to give to the relevant scientific specialist societies.

In order to determine which are the relevant top organizations for the protection of the interests of outpatient and inpatient preventive and rehabilitation facilities and self-help as well as those for other service providers at federal level, these were determined by the G-BA through public announcements on the Internet and in the Federal Gazette. Organizations that responded to the announcements were checked by the G-BA to determine whether they were to be regarded as the relevant umbrella organizations on the basis of the criteria of the G-BA's rules of procedure. The organizations entitled to comment resulting from the legal basis and the specific G-BA resolutions are shown in the following table:

General information on the comment procedure can be found in the section on the comment procedure.

Statements on DMP regardless of the statutory opinion procedure

Unsolicited statements on DMP can also be submitted to the G-BA at any time regardless of the statutory statement procedure: