Towards incentivising integration: A typology of payments for integrated care

Abstract

Traditional provider payment mechanisms may not create appropriate incentives for integrating care. Alternative payment mechanisms, such as bundled payments, have been introduced without uniform definitions, and existing payment typologies are not suitable for describing them. We use a systematic review combined with example integrated care programmes identified from practice in the Horizon2020 SELFIE project to inform a new typology of payment mechanisms for integrated care. The typology describes payments in terms of the scope of payment (Target population, Time, Sectors), the participation of providers (Provider coverage, Financial pooling/sharing), and the single provider/patient involvement (Income, Multiple disease/needs focus, and Quality measurement). There is a gap between rhetoric on the need for new payment mechanisms and those implemented in practice. Current payments for integrated care are mostly sector- and disease-specific, with questionable impact on those with the most need for integrated care. The typology provides a basis to improve financial incentives supporting more effective and efficient integrated care systems.

Economic incentives and survival probabilities for chronic and multimorbidity patients - Do the relationships depend on patient pathways?

“…During our study period, there were roughly 3.18 million in-patient admissions with length of hospital stay (LOS) greater than or equal to one day, and where 67 per cent of admissions were emergencies and the rest were planned. This study considers 30 important chronic and long-term conditions for which administrative data are available, and these conditions are also used in the previous literature [9,26]. These 30 diagnoses consist of, for example, alcohol abuse, asthma, atrial brillation, cancer, lymphoma cancer, metastatic cancer, chronic heart failure, chronic kidney disease, chronic pain, chronic pulmonary disease, chronic viral hepatitis B and cirrhosis (see Appendix for the 30 chronic conditions with their ICD-10 codes; [26], Table 1, p 31).…”

“…Ideally, treatment of patients with chronic conditions and multimorbidity should occur through some kind of bundled payment [8,9]. In reality, an e cient form of bundled payment is di cult to implement because it will require expensive data and sophisticated systems of income sharing between units and independent systems, over time.…”

Economic incentives and survival probability for chronic and multimorbidity patients - Do the relationships depend on patient pathways?

“…Ideally, treatment of patients with chronic conditions and multimorbidities should occur through some kind of bundled payment (Quinn, 2015;Stokes et al, 2018). In reality, an efficient form of bundled payment is difficult to implement because it will require expensive data and sophisticated systems of income sharing between units and independent systems, over time.…”

“…In reality, an efficient form of bundled payment is difficult to implement because it will require expensive data and sophisticated systems of income sharing between units and independent systems, over time. However, as illustrated by Stokes et al (2018), in practice there are different payment systems that incorporate elements of bundling, for example, income sharing between treatment levels (primary care, social care, specialist care) and a specific time horizon that a particular remuneration covers.…”

Primary health and emergency care network: interfaces in health regions in Brazil and Canada

“…Although the Ontario reform changed the payment to family doctors and access to primary care, it has not yet addressed the fragmentation of the health system and how that can be overcome . Stokes et al (2018) developed a typology to describe traditional and alternative payment mechanisms in terms of their expected impact on integration. This typology describes the mechanism in eight dimensions of the whole health system: the scope of payment (1) target population, (2) time, (3) sectors; participation of providers 4provider coverage, (5) financial pooling/sharing; single provider/patient involvement (6) income, 7 (3) high mortality in emergency departments.…”