When thinking of successful international examples of integrated care, Germany may not automatically spring to mind due to the institutional fragmentation of its health and care system. Despite this, a number of local health economies in England have identified Germany’s Gesundes Kinzigtal model as one to look at and draw inspiration from in their development of new models of integrated care.
Located in Baden-Württemberg in southwest Germany, and more precisely in the Kinzig river valley, the Gesundes Kinzigtal system is one of the few population-based integrated care approaches in Germany. The system was developed around ten years ago through a partnership between a network of local physicians and a management company, which decided to create a regional integrated care management company (called Gesundes Kinzigtal GmbH) with the aim of providing better, more integrated and more efficient care for the local population.
In a country which has an insurance-based system (rather than a tax-funded one, as in the NHS), a key pillar of this model is the relationship between the integrated management company and local statutory health insurers (the equivalent of our local commissioners). More specifically, since 2006, Gesundes Kinzigtal GmbH has held long-term contracts with two German non-profit sickness funds (AOK and LKK), offering their members (around 31,000 people) enrolment in the integrated care system.
These contracts are based on a shared health gain approach which focuses on the principle that enhancing patients’ self-management capabilities, in combination with health promotion and prevention programmes, will lead in the mid-term to improved population health in comparison with normal care. In economic terms, this health gain should result in more savings than the German standard, with the resulting benefits being shared between the sickness funds and Gesundes Kinzigtal GmbH.
This approach puts significant emphasis on prevention and health promotion programmes, with the overall objective of improving population health and quality of life. This involves running health literacy and healthy lifestyles programmes for specific groups of the population, with particular emphasis on chronic conditions and specific risk groups, such as residents of nursing homes, the elderly, smokers, people at risk of osteoporosis and people with depression.
Furthermore, the scheme supports active membership in sports and gym clubs through vouchers and membership discounts, programmes for health promotion at work, health promotion activities in schools and ‘patient university’ classes consisting of regular health education and patient counselling presentations by medical experts.
This focus on public health is complemented by a patient-centred approach in the provision of healthcare, with individual treatment plans agreed jointly between doctors and patients, and with a named doctor or other health professional, of patient choice, taking responsibility for ensuring seamless care for the patient, including follow-up care and rehabilitation after hospital discharge.
This integrated care approach has been possible thanks to Gesundes Kinzigtal GmbH holding ‘virtual accountability’ for the healthcare budget for the population group, and through its negotiation of cooperation contracts with a range of local providers that have agreed to adhere to a set of guiding principles, standards and procedures. An integrated IT system supports this collaborative approach allowing electronic access to patient data, with patient consent.
An evaluation of this model has shown it has led to improved health outcomes, better patient experience and reduced costs. If we take, for example, 2012 as a year of reference, the scheme generated a saving of around 7 per cent against the population budget for members of one of the sickness funds, compared with a group of its members from a different region. This equates to a saving of €4.6 million for the 31,000 affiliated in the Kinzigtal region. One of the main drivers of this saving relates to reduced emergency hospital admissions compared to other regions.
The existing contract for the Gesundes Kinzigtal integrated care model will run until the end of 2015, but given its success, one of the two sickness funds has already committed to extend the contract for an unlimited period and to expand it to other regions.
The success of this model relies on its combination of logistical re-engineering of care processes, IT integration, public health and prevention measures, and importantly, on the alignment of the financial interests of payers and providers in the system.
At a time when the NHS is looking at ways to deliver better and more integrated care while reducing costs, this model offers an interesting and innovative approach to look at. This is why the NHS European Office
is holding discussions with Gesundes Kinzigtal GmbH on a programme of peer links and collaborations with NHS leaders who are currently developing new models of care.
Elisabetta Zanon is director of the NHS European Office, part of the NHS Confederation. Follow the organisation on Twitter @NHSConfed_EU
International models of care
Discover more about other international models of care in Elisabetta's series of blogs on international examples:
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