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Final Program


Final Congress Guide

Health Policy and Systems

700 Section - Proactive Outreach to Insured Individuals at Risk of Work Disability: Process Modeling, Implementation, and Evaluation

Wednesday, May 20, 2026
6:00 PM - 7:30 PM PT

    Presenting Author/Autor expositor(s)

  • PJ

    Prehn Johanna, MS

    Research assistant
    University of Lübeck, Institute of Social Medicine and Epidemiology
    Lübeck, Schleswig-Holstein, Germany

    • Co-Author/Coautor(s)

  • RA

    Richard Albers, MS

    Research assistant
    University of Lübeck, Institute of Social Medicine and Epidemiology
    Lübeck, Schleswig-Holstein, Germany

  • MB

    Matthias Bethge, PhD

    Professor
    University of Lübeck, Institute of Social Medicine and Epidemiology
    Lübeck, Schleswig-Holstein, Germany

Objectives : German social law offers rehabilitation services to support work ability, but needs are often identified late. Access depends on the insured person’s initiative and knowledge, often leaving opportunities underutilized. Therefore, the German Pension Insurance piloted the nationwide use of a standardized risk score, based on routine administrative data, to proactively identify individuals at higher risk of receiving a disability pension. Those with a risk score of ≥60 were contacted by postal mail, provided with information about rehabilitation services, and invited to counseling if needed. Our study (DRKS00034737) examined the implementation of this proactive outreach through process modeling and identified barriers and success factors to develop a transferable approach for routine care.

Design: A mixed-methods process evaluation assessed implementation within real administrative structures of eleven pension insurance providers. Standardized process documentation and semi-structured interviews with process managers were collected at two time points. Administrative workflows were modeled using Business Process Model and Notation (BPMN) to visualize and analyze adaptations. Qualitative data were analyzed using Mayring’s content analysis to identify implementation experiences, challenges, and facilitators.

Results:

The approach was successfully implemented across eleven pension insurance providers, with BPMN models of planned and actual workflows generated for each. Core processes were consistent, differences arose in digitalization and team coordination. Modeling highlighted discrepancies between planned and implemented procedures and quantified adaptations. Key success factors included interdepartmental coordination, pilot testing, clear internal communication and inter-provider exchange. Challenges arose from low response rates, time-consuming processes and complex interface coordination.

Conclusion:

Process modeling provided actionable insights into implementation, including facilitators and barriers. A flexible, provider-specific approach proved practical, suggesting a uniform procedure is unnecessary. For further dissemination, we recommend standardizing processes, strengthening internal coordination, ensuring implementation quality through systematic documentation, and maintaining inter-provider exchange. BPMN, a rarely used tool in rehabilitation research, proved useful for analyzing complex processes.