Crossing the boundaries from individual medical care to regional public health outcomes: The triple aim of “Gesundes Kinzigtal” – better health + improved care + affordable costs

Abstract

Introduction: With the increasing health burden of non-communicable diseases, especially in low- and middle-income countries, it is vital to better integrate and coordinate public health care delivery across health professions. Yet, most health care systems are not well equipped or designed to meet the rapidly increasing needs in order to deal with the problem. "Gesundes Kinzigtal", a small company, based in Germany, is owned by a regional physician's network and OptiMedis, a health science company. It is implementing a pilot integrated health care initiative for region in Germany with 70,000 inhabitants. "Gesundes Kinzigtal receives all administrative and medical data from the insurance companies which are partners in the initiative. This data is vital to monitor successes as well as failures and to frequently improve the interventions. Aims: The "Gesundes Kinzigtal" initiative seeks to simultaneously achieve three health outcomes: a) targeting the most problematic diseases and risk behaviours, b) integrating care, and, c) keeping costs low. Interventions: Starting in 2006, the initiative has built a motivated and dedicated network including health care professionals, sports clubs, municipalities, schools, nursing homes, and businesses. Approximately 10,000 enrolled members are insured by two health insurance providers who are partners in the initiative. Patients receive access to free self-managed and self-paced health promotion trainings. Physicians are able to better manage coordination of patients' care using a joint electronic patient record. People belonging to high-risk or groups particularly vulnerable to a disease receive tailored case management. "Gesundes Kinzigtal" is financed on the basis of the actual "health outcome" via a "shared savings approach" - a very new and innovative approach. The project receives money only when it shows better health outcomes among patients within the project compared to the health status of patients not participating. Technically this means it is getting a share of the improved morbidity-adjusted financial outcome from the health insurances. Results: Results show that "Gesundes Kinzigtal" patients are in better health. An 18-month increase in life expectancy for 4,600 enrolled members over two and a half years was recorded, compared to a propensity score matched control group. Overall health care costs are lower, while health insurance costs decreased, leading to savings of 151 Euros per member during a two-year period, compared to a control group. Conclusion: Discussions at the conference in Bucharest showed that the financial mechanism, adapted management methods, and the interventions of "Gesundes Kinzigtal" may be of interest to regions not only in Western Europe but also in Eastern European countries regardless of the health system in place in those regions. For instance, "Gesundes Kinzigtal" and community health initiatives throughout Romania have shown several similar and overlapping results to the one in Germany. "Gesundes Kinzigtal" is interested in cooperating with other initiatives and offers a Health Academy for such training purposes. [ABSTRACT FROM AUTHOR]