Ten-Year Evaluation of the Population-Based Integrated Health Care System “Gesundes Kinzigtal”

Abstract

ealth care in Germany is provided-historically grown-in sectors that are largely distinct from one another, at the interfaces of which recurrent losses of information and "breaks in care" occur, leading to negative effects on the quality and cost of care (1, 2). One approach to improving the effectiveness and efficiency of health care is seen in "integrated care" with horizontal and vertical networks of actors. A concept of this kind was developed for a rural area by Optimedis AG and the "Kinzigtal Medical Quality Network Medical Initiative" (MQNK), which undertook a joint venture to form "Gesundes Kinzigtal GmbH." The selective contract "Gesundes [healthy] Kinzigtal Integrated Care" (Integrierte Versorgung Gesundes Kinzigtal, IVGK) was entered into with two health insurance companies (Box).The population-based IVGK is considered to be a best-practice example of integrated care in Germany as well as internationally (3-6). The early years saw extensive accompanying research and process evaluation, for example, by means of surveys among members (e1), as well as surveys among service partners regarding satisfaction, cooperation, and their commitment to integrated care (e2), health promotion among the elderly (e3), patient satisfaction, and preference of insured persons in terms of their participation in decision-making (e4). Based on routine data, a survey on underuse, overuse, and misuse of care was conducted, involving four authors of the study reported here. The survey investigated the quality of care only for the period 2005-2011 compared to care in Baden-Württemberg (random sample)-using 18 indicators for selected diseases that formed the focus of the IVGK (7).No external outcome evaluation based on routine statutory health insurance data for the period after 2011 has been carried out as yet. This represents a serious gap in evidence-especially if one assumes that undesirable trends such as underuse, for example, as a result of managed care elements like the shared savings contract (e5, 8), would only become demonstrably evident after a number of years. It also appears conceivable that unintended side effects as a result of focusing integrated care management on specific programs only emerge after years. Although evaluation studies, albeit with inconsistent results, from other countries are available (4, 9-17), the differences in health care as well as in the understanding of SummaryBackground: The population-based integrated health care system called "Gesundes Kinzigtal" (Integrierte Versorgung Gesundes Kinzigtal, IVGK) was initiated more than 10 years ago in the Kinzig River Valley region, which is located in the Black Forest in the German state of Baden-Württemberg. IVGK is intended to optimize health care while maximizing cost-effectiveness. It consists of programs for promoting health and for enabling cooperation among service providers, as well as of a shared-savings contract that has enabled resources to be saved every year. The goal of the present study was to investigate trends in the quality of care p...

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