Integrated Care Experiences And Outcomes In Germany, The Netherlands, And England

Abstract

Care for people with chronic conditions is an issue of increasing importance in industrialized countries. This article examines three recent efforts at care coordination that have been evaluated but not yet included in systematic reviews. The first is Germany's Gesundes Kinzigtal, a population-based approach that organizes care across all health service sectors and indications in a targeted region. The second is a program in the Netherlands that bundles payments for patients with certain chronic conditions. The third is England's integrated care pilots, which take a variety of approaches to care integration for a range of target populations. Results have been mixed. Some intermediate clinical outcomes, process indicators, and indicators of provider satisfaction improved; patient experience improved in some cases and was unchanged or worse in others. Across the English pilots, emergency hospital admissions increased compared to controls in a difference-in-difference analysis, but planned admissions declined. Using the same methods to study all three programs, we observed savings in Germany and England. However, the disease-oriented Dutch approach resulted in significantly increased costs. The Kinzigtal model, including its shared-savings incentive, may well deserve more attention both in Europe and in the United States because it combines addressing a large population and different conditions with clear but simple financial incentives for providers, the management company, and the insurer.

From programme theory to logic models for multispecialty community providers: a realist evidence synthesis

“…In the Netherlands, bundled payments result in a principal contracting entity (provider) being lead contractor for numerous other subcontractors. 64 Billings and de Weger 11 describe and distinguish three other contract-based structures: (1) outcomes-based commissioning (an existing NHS approach), (2) the ACO model and (3) an alliance model of a network STEP 2 FINDINGS: COMPARING IDENTIFIED EVIDENCE TO THE INITIAL PROGRAMME THEORY NIHR Journals Library www.journalslibrary.nihr.ac.uk of providers making a joint contract with a payer (in that respect, closer to the NHS idea of an ACO). However, some ACOs themselves use joint payment contracts.…”

“…81 In the Netherlands, care standards with a modular structure (general and disease-specific elements) were jointly negotiated among providers, an arrangement that routinised collaboration among doctors. 64 The HealthOne Mount Druitt project (in Australia) used case conferences to co-ordinate services at patient level, in particular with non-health-care services, such as social care. 62 …”

“…In comparative case studies of a German scheme (Kinzigtal), a Netherlands-wide programme (one care group) and 16 English pilot schemes, Busse and Stahl 64 report that, in the Kinzigtal care model, multisectoral collaboration had, after 2.5 years, reduced mortality rates by half (from 3.74% to 1.76%) for those enrolled in the programme compared with those who were not. Although the network had voluntary sector input, these results are attributed to the network as a whole, leaving it uncertain whether or not the voluntary sector input contributed to these mortality improvements and, if so, to what extent and through what mechanisms and contexts.…”

“…Although the network had voluntary sector input, these results are attributed to the network as a whole, leaving it uncertain whether or not the voluntary sector input contributed to these mortality improvements and, if so, to what extent and through what mechanisms and contexts. 64 …”

“…The project relied on sharing an EHR system across providers to co-ordinate care. 64 Buutzorg used a simple, web-based solution designed by nursing assistants, nurses and back-office employees to communicate and share information in real time between locations such as the patient's home, in the office or on the road. 21 However, in many cases, HIT systems that had not been carefully designed and implemented hindered health professionals in communicating and sharing information.…”