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Introduction Chronic conditions are related to 60% of disability adjusted life years and account for 75% of total health care expenditure worldwide. The economic burden of chronic conditions is much larger when considering the costs of productivity loss and informal care. The threat that chronic conditions pose to population health and economies increase because of increasing prevalence and multi-morbidity, which multiplies the burden of chronic conditions. Integrated care is seen as the means to tackle this threat by improving population health and patient experience with care, and reducing costs. It includes initiatives that seek to improve outcomes for those with (complex) chronic health problems and needs by overcoming issues of fragmentation through linkage or coordination of services of different providers along the continuum of care. In the era of personalized medicine and genomics, integrated care may be characterized by the recently suggested term ‘humanomics’ because it incorporates treatment based on personal need, preferences and capacity, it interacts with the context in which it is implemented, and its success depends highly on human behaviour [1]. Financial incentives are one of the main prerequisites for integrating care [2].

Background In the Netherlands, disease management programs (DMPs) are used to treat chronic diseases. Their aim is to improve care and to control the rising expenditures related to chronic diseases. A bundled payment was introduced to facilitate the implementation of DMPs. This payment is an all-inclusive price per patient per year for a pre-specified care package. However, it is unclear to which extent the costs of developing and implementing DMPs are included in this price. Consequently, the organizations providing DMPs bear financial risk because the development and implementation (D&I) costs may be substantial. The aim of this paper is to investigate the variability in and drivers of D&I costs among 22 DMPs and highlight characteristics that impact these. Methods The data was analyzed using a mixed methods approach. Descriptive statistical analysis explored the variability in D&I costs as measured by a self-developed costing instrument and investigated the drivers. In addition, qualitative research, including document analysis and interviews, was conducted to explain the possible underlying reasons of cost variability. Results The development costs varied from €5,891 to €274,783 and the implementation costs varied from €7,278 to €387,879 across DMPs. Personnel costs were the main component of development. Development costs were strongly correlated with the implementation costs (ρ = 0.55), development duration (ρ = 0.74), and number of FTEs dedicated DMP development. Organizations with large size and high level of care prior to the implementation of a DMP had relatively low development costs. These findings were in line with the cross-case qualitative comparison where programs with a longer history, more experienced project leadership, previously established ICT systems, and less complex patient populations had lower D&I costs. Conclusions There is wide variation in D&I costs of DMPs, which is driven primarily by the duration of the development phase and the staff needed to develop and implement a DMP. These drivers are influenced by the attributes of the DMP, characteristics of the target population, project leadership, and ICT involved. There are indications of economies of scale and economies of scope, which may reduce D&I costs. Electronic supplementary material The online version of this article (doi:10.1186/s12913-014-0518-0) contains supplementary material, which is available to authorized users.

Objectives: Different payment schemes have been implemented in Europe to stimulate integrated chronic care and to reduce health care expenditure. We aimed to investigate the impact of different payment schemes on national total health care expenditures. Methods: We first identified European countries with payment reforms directed at integrated chronic care. Then, we conducted 15 interviews with chronic care experts in England, the Netherlands, Germany, Denmark, Austria, and France to get detailed information about the reforms and the facilitators and barriers for implementation. Last, we used difference-in-differences (DID) models to estimate differences in health care expenditure growth before and after the introduction of a payment scheme between intervention and control countries. Intervention countries included countries with a pay-for-coordination (PFC), pay-for-performance (PFP), and all-inclusive payments for integrated chronic care. We used OECD and WHO data from 1996 to 2010. Results: The interviews showed that adequate financial to care providers, flexible task allocation between care providers, and stakeholder cooperation facilitate the success of payment schemes. However, misaligned incentives across stakeholders and gaming of the system by care providers constitute the most frequent barriers to their implementation. The results from the main DID models showed that PFC increased the growth of medication (12.43 US$ per capita) and administrative (9.55 US$ per capita) expenses while PFP and all-inclusive payment schemes reduced the growth of hospital expenditure by 26.30 and 59.54 US$ per capita, respectively. Further, the growth of medication expenses was increased in the countries with PFP (by 9.30 US$ per capita) and decreased (by 20.91 US$ per capita ) in countries with all-inclusive payments. Considering the cumulative impact of the payments on all expenses categories in the four years following their implementation, PFP, PFC, and all-inclusive payments reduced the growth of health care expenditure by 164.88, 143.09, and 72.4 US$ per capita, respectively.

Background: Disease management programmes are increasingly used to improve the efficacy and effectiveness of chronic care delivery.But, disease management programme development and implementation is a complex undertaking that requires effective decision-making.Choices made in the earliest phases of programme development are crucial, as they ultimately impact costs, outcomes and sustainability.Methods: To increase our understanding of the choices that primary healthcare practices face when implementing such programmes and to stimulate successful implementation and sustainability, we compared the early implementation of eight cardiovascular disease management programmes initiated and managed by healthcare practices in various regions of the Netherlands. Using a mixed-methods design, we identified differences in and challenges to programme implementation in terms of context, patient characteristics, disease management level, healthcare utilisation costs, development costs and health-related quality of life.Results: Shifting to a multidisciplinary, patient-centred care pathway approach to disease management is demanding for organisations, professionals and patients, and is especially vulnerable when sustainable change is the goal. Funding is an important barrier to sustainable implementation of cardiovascular disease management programmes, although development costs of the individual programmes varied considerably in relation to the length of the development period. The large number of professionals involved in combination with duration of programme development was the largest cost drivers. While Information and Communication Technology systems to support the new care pathways did not directly contribute to higher costs, delays in implementation indirectly did.Conclusions: Developing and implementing cardiovascular disease management programmes is time-consuming and challenging. Multidisciplinary, patient-centred care demands multifaceted changes in routine care. As care pathways become more complex, they also become more expensive. Better preparedness and training can prevent unnecessary delays during the implementation period and are crucial to reducing costs.

The health, social and economic impact of chronic diseases is well documented in Europe. However, chronic diseases threaten relatively more the ‘memorandum and peripheral’ Eurozone countries (i.e., Greece, Spain, Portugal and Ireland), which were under heavy recession after the economic crisis in 2009. Especially in Greece, where the crisis was the most severe across Europe, the austerity measures affected mainly people with chronic diseases. As a result, the urgency to tackle the threat of chronic diseases in Greece by promoting public health and providing effective chronic care while flattening the rising health care expenditure is eminent. In many European countries, integrated care is seen as a means to achieve this.The aim of this paper was to support Greek health policy makers to develop an action plan from 2015 onwards, to integrate care by bridging local policy context and needs with knowledge and experience from other European countries. To achieve this aim, we adopted a conceptual framework developed by the World Health Organization on one hand to analyse the status of integrated care in Greece, and on the other to develop an action plan for reform. The action plan was based on an analysis of the Greek health care system regarding prerequisite conditions to integrate care, a clear understanding of its context and successful examples of integrated care from other European countries. This study showed that chronic diseases are poorly addressed in Greece and integrated care is in embryonic stage.Greek policy makers have to realise that this is the opportunity to make substantial reforms in chronic care. Failing to reform towards integrated care would lead to the significant risk of collapse of the Greek health care system with all associated negative consequences. The action plan provided in this paper could support policy makers to make the first serious step to face this challenge. The details and specifications of the action plan can only be decided by Greek policy makers in close cooperation with other health and social care partners. This is the appropriate time for doing so.

Introduction: Psychosis is a common and severe mental illness, with a large health and economic impact on societies worldwide. The earlier the illness is treated the better the long term outcomes. In England, Early Intervention in Psychosis (EIP) services have been introduced over the last 15 years to address this problem and they are included in the new Access and Waiting time standard in England published in April 2015. This standard mandates that all those with first episode psychosis should be treated within an EIP service within 2 weeks. They differ from standard community care in that they provide continuity across child and adult services, cognitive behavioural therapy, family interventions, assertive community treatment and vocational and educational support for early recovery. However, evidence about the effectiveness and cost-effectiveness of EIP services in England is inconclusive and their implementation is variable. We therefore undertook a health economic evaluation of EIP services to demonstrate the costs and outcomes associated with these services.Methods: We used routinely collected data (pseudonymised physical and mental health data licensed from the HSCIC – HES and MHMDS) of 4,104 patients with psychosis to compare the costs and effects of EIP services with other community mental health teams over a 3-year period (Apr 2010 – Mar 2013) in Thames Valley. Psychosis patients were identified using a combination of ICD-10 diagnosis codes, Mental Health Payment by Results Clusters and Health of the Nation Outcome Scales. The sample consisted of 923 patients were treated under EIP service and 3,181 patients were under standard community care. The analysis included the costs of acute hospital emergency (A&E) visits, length of stay in mental health hospital ward and acute care hospital wards, and community care services. Outcomes were measured in terms of getting employed and moving to mainstream housing during the follow-up period. Generalised Estimating Equations and Generalised Linear Models were used in the analysis and Propensity Score Matching was used to correct for confounding between the compared services.Results: EIP services resulted in on average saving of £1,761 (13%) in healthcare costs (p=0.059) compared to standard community care. This annual saving is translated into £32 (32%) less A&E costs (p

Introduction: SELFIE is a new EU-Horizon2020 funded project, which started on September 1st 2015 and is entitled “Sustainable intEgrated care modeLs for multi-morbidity: delivery, FInancing and performance”. SELFIE stands out from other EU-funded projects on integrated care by adopting a broad health economic approach. SELFIE will perform empirical research of promising integrated care models which specifically target individuals with multi-morbidity. It will conduct policy evaluations of financing/payments schemes with different incentives to support integration of care within and across the health care, long-term care and social care sectors. It will develop methods for price-setting, tools for performance monitoring, and strategies for implementation of integrated care in different healthcare systems and contexts including Central and Eastern European Countries. But the first stream of research in SELFIE consists of the development of a conceptual framework on integrated care for multi-morbidity, the identification of specific programs in developed countries, and qualitative research on these programs. Methods: To inform the conceptual framework, scientific literature was searched in online databases (i.e. Pubmed, Embase, Scopus, Web of Science, Cochrane, PsycInfo, and sociological & Social Services Abstracts via ProQuest) and combined with grey literature from OECD, WHO and EU. Studies and reports concerning frameworks/models, integrated care, and multi-morbidity were selected. These sources were also used to identify implemented integrated care programs in the EU. In later phases of SELFIE, these programs will be scored and rank-ordered on a number of criteria in order to select the most promising ones. The latter will be included in the qualitative and quantitative empirical evaluation using Multi-Criteria Decision Analyses (MCDA). MCDA assesses the performance of different integrated care programs on a number of criteria related to the Triple Aim of integrated care (i.e. patient experience, health/wellbeing and costs) and combines them with relative weights that Patients, their Partners, the Professionals, the Payers and the Policy makers (5 Ps) assign to the importance of the criteria. Weights will be obtained o.a. via Discrete Choice Experiments. As little is known about the dynamics, success factors and obstacles for ICC programs dealing with multi-morbidity, a research approach from the qualitative paradigm, the thick description, is used to gain more insight in their social fabric. Results: The literature search resulted in x unique studies of which y were included in our selection. At the time this abstract was written, information from the studies was being retrieved and the identification of implemented integrated care programs for multi-morbidity was in progress. At the conference we will present the first results, including the conceptual framework, the approach for the qualitative in-depth study of specific programs and the methods developed for the MCDA. The focus of the results will be on elements of integrated care particularly relevant for individuals with multi-morbidity. Examples of such elements are a holistic assessment of an individual’s needs, preferences, skills, life-style and illness-perceptions across the entire spectrum of diseases that the individual has, and person-centred care that accounts for overlap and interaction between clinical guidelines/protocols for different diseases and avoids polypharmacy. Discussion and conclusion: The ICIC-16 will be an ideal conference to present the SELFIE study for the first time to a large and broad audience and the results will be interesting to many attendees. The discussion will include the need to develop integrated care approaches for multi-morbidity, the elements that constitute integrated care suitable for people with multi-morbidity and the potential of using MCDA to facilitate a broad evaluation of integrated care. This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 634288. The content of this abstract reflects only the SELFIE groups’ views and the European Commission is not liable for any use that may be made of the information contained herein.

Context, aims and objectives: Health economics is concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and health care. Health economics can contribute valuable insights to the debate on integrated care, mainly in two areas: 1) economic evaluation and 2) financing, payment and incentive structures. Regarding the first area, we witness that economic evaluation is increasingly used as a basis for reimbursing, contracting, and commissioning integrated care models. However, standard methods of economic evaluation fall short in incorporating the several types of outcomes and costs of integrated care models. As a result, outcomes such as patient experience and satisfaction, self-management skills, wellbeing as well as costs related to the integration of health and social care or services provided by other sectors are not accounted for adequately. Overall, little is known about the cost-effectiveness of integrated care, partly due to the fact that adequate methods are lacking, partly due to a failure to include economic evaluation in the design, planning and implementation of integrated care. Therefore, existing evidence is contradictory and inconclusive. Concerning the second area, integration of services within and between sectors is often hampered by financial disincentives, budgetary restrictions, incompatible funding structures or inadequate price setting. This holds true for both tax-based and insurance-based systems, though to varying degrees. There are relatively few systematic evaluations of reforms in the funding and payment systems that aim to stimulate integrated care and even less is known on how to design financial structures which ensure its sustainability. In order to overcome the shortcomings in these two areas and accommodate the better integration of health economics in integrated care practice, a Special Interest Group Health Economics in Integrated Care (SIG HEIC) was initiated under the auspices of IFIC. Primarily, the SIG HEIC is striving to reconcile existing health economic evaluation methods with the complexities of evaluating and analyzing integrated care models. This necessitates a systematic appraisal of economic evaluation methods and their suitability for evaluating integrated care. Based on this analysis new approaches need to be developed and existing methods to be adapted to facilitate a thorough economic evaluation of integrated care. A first set of relevant research questions is currently addressed in a discussion paper, which outlines shortcomings of standard economic evaluation methods and proposes areas for future research. In order to foster discussion and involve an international pool of experts with interest in health economics, a SIG HEIC workshop is envisaged to take place at the ICIC16. This workshop aims to give participants the possibility of critiquing the discussion paper as well as to pool knowledge and expertise to establish a research agenda for the SIG HEIC. The proposed workshop will be the kick-off meeting for the SIG HEIC to refine research questions, prioritize research activities and form a working group to drive the agenda forward. The basis for the workshop will be the discussion paper, which will be published before ICIC16. The objectives for the workshop will be specifically to: - discuss existing health economic evaluation methods and their adaptability for integrated care research as outlined in the discussion paper and refine resulting research questions; - connect interested researchers in health economics and integrated care to collaborate on research projects, grant proposals, and other activities to answer the outlined research questions; - refine the discussion paper and develop it into a position paper on health economic research for integrated care; - establish further the SIG HEIC as a working group within IFIC, which will be responsible for the further development of the research agenda as agreed upon during the workshop. Participants: The target audience consists of the participants of the workshop on health economic evaluation in integrated care during the ICIC14 in Brussels; researchers and professionals who are interested in health economics in integrated care and decision-makers and insurers who are willing to get a better understanding of health economic issues.