Two principles can spell success for integrated care (IC) in Europe. First, integrated care programmes need to address entire population groups rather than single medical conditions.
Second, integrated care should be implemented via incentives, not via regulation. Those major messages from the 13th International Conference on Integrated Care, we passed on to 220 international experts in Berlin this April, an event co-funded by the Robert Bosch Foundation and hosted by the International Foundation for Integrated Care, the AOK Federal Association and the German Managed Care Association (BMC).
Almost all European countries struggle with the same problem: the healthcare system is fragmented and isolated from other support systems with reimbursement models and cost pressure exacerbating this fragmentation.
IC experts have been searching for innovative responses to the key issue for some time. How can the different providers in the healthcare systems and beyond cooperate with other actors in social security systems to be able to offer uninterrupted and reliable care to patients with multiple or chronic diseases?
Professor Chris Ham, head of the non-profit foundation The King’s Fund in Great Britain and a key speaker at the IC conference, recommends a step-by-step approach to IC projects. A common objective to which the partners commit, he emphasised, is an absolute must. The increasing number of patients with chronic diseases and the concomitant increasing need for coordinated measures require regional and population-focused programmes.
The professor presented the approach of the Knowsley district, where representatives of different professions and organisations cooperate intensively every day to ensure flexible and need-oriented care. ‘That means everybody has to give up his independence to some extent and make compromises, which is not always easy,’ he said.
Tighter integration of social security and healthcare systems
President of the International Foundation for Integrated Care, Professor Guus Schrijvers from Utrecht, uses three terms to describe the successful implementation of IC structures – local leadership, vision, and commitment – and observes ‘useful approaches in many countries – the UK, Spain, the Netherlands and Germany, among others’. Nevertheless he warns: ‘There is no “one size fits all” solution in healthcare since the conditions are far too heterogeneous.’
Prof. Schrijvers is like the incarnation of success in the Netherlands. Economist by profession and professor for Public Health, he helped establish new care structures in Almere, Leidsche Rijn and Zwolle. No doubt he had a major advantage, being familiar with the municipal structures in his home country: for 10 years he was a Utrecht City Council member. His approach: ‘Create a network member of different partners in a town, for example a hospital, and several office-based healthcare providers, and then take this model to other towns.’
The professor also demands better education for members of non-medical health professions and urged their tighter integration in the IC programmes. The incentive system, he suggests, should be developed in the course of the cooperation and should consider the different points of view of the professions involved.
Share success – share gain
Helmut Hildebrandt, managing director of Gesundes Kinzigtal GmbH and co-organiser of the symposium, emphasises that the participants in IC need to agree on three objectives: to achieve a healthier population, create positive experiences with the care system and handle funds responsibly. In his organisation, based in south-west Germany, he tries to find answers to what he considers the key issue: how can we ensure that healthcare actors direct their intelligence towards these objectives? While Gesundes Kinzigtal GmbH has gained a reputation beyond German borders, Hildebrandt founded another company: OptiMedis AG Hamburg. Here he built a regional network with a local physicians’ net for the clients of two health insurers. Other partners are, for example, care services, hospitals and physiotherapists.
The network not only aims to improve care but also to offer prevention services, such as weight control programmes designed to reach risk groups before a disease can develop. In Kinzigtal, he reports, some objectives have already been reached: the mortality rate decreased, there is less fluctuation among the insured between insurance companies and last but not least the income situation of the health insurers has improved.
Based on the ‘shared gain’ principle, health insurers and Gesundes Kinzigtal GmbH share the funds generated. A unique feature of Gesundes Kinzigtal: 80% of physicians participating in the network are also shareholders in this limited liability company and thus participate in its economic success.