Gesundes Kinzigtal Integrated Care: A „flagship project“ among Germany’s integrated care approaches
In the Kinzig valley in Baden-Württemberg, Southwest Germany, an integrated health care system has been founded in late 2005. This new regional health care system is termed Gesundes Kinzigtal Integrated Care or simply Gesundes Kinzigtal.
In general, integrated care systems strive to coordinate the “interfaces” between inpatient and outpatient care as well as between primary and secondary (specialized) care better than “normal care”. This is to be achieved first of all by a more effective inter- and trans-sector cooperation between different providers. In Germany, integrated care contracts have benefited in 2004-08 by a start-up funding that was guaranteed by the Statutory Health Insurance Modernization Act (Modernisierungsgesetz der Gesetzlichen Krankenversicherung - GMG).
Since 2004, thousands of integrated care contracts have been made. The overwhelming majority of these are based on a few specific indications (e.g. hip or knee surgery) and have usually integrated two sectors (e.g. inpatient care and rehabilitation) and occasionally three sectors (e.g. inpatient care, rehabilitation, and pre- and post-surgery ambulatory care). Only a tiny minority of contracts attempted to realize a population-based integrated care system, covering all sectors and indications of care for a given population. Gesundes Kinzigtal Integrated Care is one of these few population-based integrated care systems. As it is a very ambitious project and, at the same, rated a very promising one, some authors call it a “flagship project of integrated care” in Germany (cf. Weatherly et al 2006).
The western and central Kinzig valley – the service area of Gesundes Kinzigtal – has approximately 60.000 inhabitants (see map). About half of these (31.000 people) are insured by statutory health insurers AOK BW (29.000 assureds) or LKK BW (2.000 assureds). The contract between the two health insurers and the management company Gesundes Kinzigtal GmbH is termed until June 30, 2015.
Gesundes Kinzigtal GmbH is a regional health care management company and originates from two different organizations: first, the local physicians’ network MQNK (Medizinisches Qualitätsnetz – Ärzteinitiative Kinzigtal e.V.) which has been operating in the Kinzigtal region since about 15 years, and second, Optimedis AG, a health management company with a background in health care management and health economics.
The management company may be interpreted as the central coordination agency of Gesundes Kinzigtal Integrated Care, thereby closely cooperating with both the physicians’ advisory council and statutory health insurers AOK BW and LKK BW. No decision on medical and professional issues may be taken against the vote of the physicians’ advisory council.
Gesundes Kinzigtal GmbH is confident that a better coordination of health care and enhanced self-management capabilities of patients in combination with more intensive health promotion and preventive programmes will lead – at least in the mid and long term – to considerable comparative savings in relation to normal care.
Correspondingly, the financial results of Gesundes Kinzigtal GmbH are calculated within the framework of the concerned health insurers’ contribution and profitability analysis: If the contribution margin of the Kinzigtal region (i.e. of the assureds living in the region) increases in relation to the time period before the integrated care system started, Gesundes Kinzigtal has achieved a profit which will be distributed between the management company and the concerned health insurers according to an agreement made beforehand.
On the contrary, if the contribution margin of the Kinzigtal region decreases with time, this means a loss for which the management company is liable, at the same time offering the concerned health insurer to contract out.
Gesundes Kinzigtal Integrated Care's profit and loss acounts revealed increasing returns during the first years of the system's existence, i.e. from July 1, 2006, until December 31, 2008. The profit and loss acount of 2009 is forthcoming soon.