Gesundes Kinzigtal (meaning ‘healthy Kinzigtal’) is a joint venture between a network of physicians in Kinzigtal and a Hamburg-based health care management company, OptiMedis AG. Gesundes Kinzigtal is responsible for organising care and improving the health of nearly half of the 71,000 population in Kinzigtal in southwest Germany.
Since 2006, Gesundes Kinzigtal has held long-term contracts with two German non-profit sickness funds to integrate health and care services for their insured populations, covering all age groups and care settings. Around a third of this population has actively enrolled in Gesundes Kinzigtal – free to all those insured – which allows access to a number of health improvement programmes offered by the organisation.
Health care providers in Kinzigtal are directly reimbursed by the sickness funds for their services, but Gesundes Kinzigtal holds ‘virtual accountability’ for the health care budget for this population group. If the sickness funds spend less on health care than the population budget, Gesundes Kinzigtal shares the benefits.
Keeping the population healthy
To help keep the population of Kinzigtal healthy and reduce care costs, Gesundes Kinzigtal contracts with traditional health and care providers as well as collaborating with a range of community groups including gyms, sports clubs, education centres, self-help groups and local government agencies. Through these collaborations, Gesundes Kinzigtal offers gym vouchers to encourage people to stay active as well as dance classes, glee clubs and aqua-aerobics courses.
It also runs health promotion programmes in schools and workplaces and for unemployed people, and ‘patient university’ classes to offer health advice to support prevention and self-management.
Targeted care management and shared decision-making
As with many other integrated care systems, Gesundes Kinzigtal has developed targeted care management and prevention programmes for particular high-risk population groups, such as older people, those living in nursing homes, people with specific conditions, and those with high body mass index. Health professionals are trained in shared decision-making to ensure that patients are actively involved in their own care when they do require input from health services.
Professionals also benefit from the availability of a system-wide electronic health record to ensure that information about patients is available across providers and care settings to support effective co-ordination of care.
External and internal evaluation has shown that this approach is improving health outcomes – most notably, reducing mortality rates for those enrolled in Gesundes Kinzigtal compared with those not enrolled. There have been improvements in the efficiency of services, as well as people’s experience of care. Gesundes Kinzigtal has also been successful in slowing the rise in health care costs for the population it serves (not simply those who have actively enrolled in Gesundes Kinzigtal).
Between 2006 and 2010, it generated a saving of 16.9 per cent against the population budget for members of one of the sickness funds, compared with a group of its members from a different region. One of the main drivers of this saving related to emergency hospital admissions. Between 2005 and 2010, emergency hospital admissions increased by 10.2 per cent for patients in Kinzigtal, compared with a 33.1 per cent increase in the comparator group.