Key messages

• The growing prevalence of people with multimorbidity will increasingly require new payment mechanism that better account for the presence of multiple chronic diseases and promote better coordination and integration of care.
• Payment mechanisms can provide key incentives for providers to collaborate. Well-designed approaches encourage multiple providers to work together and enable better care, while mechanisms that pay individual providers separately can block effective integration.
• Payment mechanisms need to adequately account for the complexity of cases treated and will inevitably be relatively complex themselves.
• Evaluations of several integrated care programmes suggest that these can lead to savings particularly through, increased multi-professional collaboration, polypharmacy management and innovative, integrative technologies – all of which can be stimulated by payments.
• Innovative payment mechanisms can be combined with more traditional payment (e.g. budget, capitation, Fee For Service and DRGs) and include:
  • Pay for coordination (P4C) which rewards the provider coordinating care.
  • Shared-savings models which divide savings (against historical or other benchmarks) between payers and providers.
  • Bundled payments where the onus is on providers to combine suitable services for patients’ needs.
  • Pay for performance (P4P) which can also be adapted to reflect multimorbidity and incentivize better quality care.
• Complex payment mechanisms do not work without extensive data on cost but also on quality.
• Policy makers introducing financing mechanisms to support integrated care must therefore:
  • Improve information systems so that they can support complex payments.
  • Carefully assess the local context and whether the system in place will be able to cope.
  • Make sure that new payment systems do not overburden local provision and management structures
  • Take an incremental approach to introducing new, more complex systems.
• Policy makers should also put in place funding guarantees (short- and long-term) for start up programmes or ensure a real prospect of rapid inclusion in ‘mainstream’ funding, so that providers are not deterred from innovating.
• Other pre-requisites for the successful implementation of new financing mechanisms are:
  • Strong leadership and
  • Supportive governance structures at national and programme level.
  • Providers with sufficient reserves to assume financial risks (especially in case of broader payments)
• Policy-makers should also ensure continuous long-term evaluation of effectiveness to inform future policy.

Contents

• What is ICARE4EU?
• How do Policy Briefs bring the evidence together?
• Acronyms
• Key terms
• Executive summary
• Policy brief
  • Introduction
  • Findings
  • Discussion
  • Conclusions
• References
• Appendix 1
• Appendix 2
• ICARE4EU Policy Briefs

This report arises from the Innovating care for people with multiple chronic conditions in Europe (ICARE4EU) project, which has received funding from the European Union (EU), in the framework of the Health Programme. The authors wish to thank all country expert organizations and the programmes that participated in the ICARE4EU project. The authors are grateful to the programme managers for sharing information on their programmes.

The authors and editors are also grateful to Søren Rud Kristensen (Manchester University) and Apostolos Tsiachristas (University of Oxford) for reviewing this publication and contributing their expertise.

All rights reserved. NIVEL and TU Berlin have granted the European Observatory on Health Systems and Policies permission for the reproduction of this Policy Brief.

The content of this Policy Brief represents the views of the authors only and is their sole responsibility; it cannot be considered to reflect the views of the European Commission and/or the Consumers, Health, Agriculture and Food Executive Agency or any other body of the European Union. The European Commission and the Agency do not accept any responsibility for use that may be made of the information it contains.

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