Lower health care cost by superior (integrated) care management? Evaluation of a population-based integrated care system in Germany—first results

PURPOSE AND CONTEXT: ‘Gesundes Kinzigtal’ is one of the few population-based integrated 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 regional physicians' network 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 maintain to reach a higher quality of organisational, coordination and interaction processes (among the concerned physicians, therapists, pharmacists, hospitals, patients and health insurers) at a lower overall cost as compared with the German standard. During its first two years of operation (2006–2007), the Kinzigtal project actually achieved positive financial results as compared with its reference value. To gain independent evidence on the quality aspects of the system, the management company and the two cooperating health insurers provided a remarkable budget for the evaluation of the system by independent scientific institutions. Since 2006–2007 several evaluation projects have started, investigating different quality aspects of the Kinzigtal system. In our presentation we will outline the overall evaluation concept and report some preliminary results. CASE DESCRIPTION AND DATA SOURCES: Preliminary results of the following studies will be presented. A controlled cohort study, beginning in 2007, investigates the assureds' attitudes towards quality of care, shared-decision-making and overall patient satisfaction both in the Kinzigtal region as well as in a control region. In a second controlled cohort study the quality of care is checked by relying on health insurers' administrative data which are routinely collected on all reimbursed health care services. A third study, pursuing a simple cohort study design, investigates the attitudes of the cooperating physicians, physiotherapists, psychotherapists as well as pharmacists. PRELIMINARY CONCLUSIONS AND DISCUSSION: The evaluation of the integrated care system in the Kinzigtal area in Germany is still in progress. Up until now, there is no evidence that the positive financial results of the Kinzigtal system have been achieved at the expense of the quality of care. If these results were confirmed at the time of study completion (or if an even improved quality of care in the Kinzigtal region were demonstrated), the Kinzigtal integrated care system could become a role model for many other similar regions in Germany and Europe.