Management principles and financial results of a population-based integrative care approach in Germany

PURPOSE AND CONTEXT: ‘Gesundes Kinzigtal’ is one of the few population-based integrative care approaches in Germany, organising care across all health service sectors and indications. The system is run by a regional health management company (Gesundes Kinzigtal GmbH) in cooperation with the physicians' network in the region and with two statutory health insurers (among them is the biggest health insurer in Southwest Germany: AOK Baden-Württemberg). Membership is optional for insured persons in the Kinzigtal area. The management company and its partners strive for a higher organisational quality (as concerns management and interaction processes among the cooperating physicians, physiotherapists, pharmacists, hospitals, patients and health insurers) at lower overall cost as compared with the German standard. Very recently first financial results of the Kinzigtal system during its first two years of operation have been presented—they are surprisingly positive. This contribution will discuss which principles of inter-professional cooperation and which management strategies have proven to be effective and thus have probably led to these results. CASE DESCRIPTION AND DATA SOURCES: In our presentation, we will describe the principles of strategic management of the integrated care system. Among these are – the construction process of the management company itself, comprising both medical/therapeutic expertise by physicians and other health professions and management expertise, – the development and prioritization of integrated health programmes, – the structure of economic incentives, and – the cooperation between management company and health insurers. The financial results of the Kinzigtal integrated care system are measured in the context of a shared-savings contract. The calculation model resembles health insurers' calculation of the contribution margin difference of a given population. The calculation model will be described in greater detail during the presentation, as well as the actual financial results of 2006 and 2007. CONCLUSIONS AND DISCUSSION: The management and cooperation principles which have been implemented in the Kinzigtal integrated care system seem to have led to a higher efficiency in the organisation of population health services—obviously without losses in quality of care and at lower overall cost compared to the German standard. In our presentation, the Kinzigtal experience will be related to similar projects in Germany and other European countries. If the success of the Kinzigtal model should prove to be sustainable during the years to come, it could even become an example for other similar regions in Germany and Europe.