Comparing sustainability and business models of scaling up care programmes within EU regions

• Published in: International journal of integrated care 2018-10, Vol.18 (s2), p.150
• Main Authors: Holterman, Sander, Lahr, Maarten M.H., Hettinga, Marike, Buskens, Erik
• Format: Article
• Language: English
• Subjects: Budgets; Business models; Funding; Integrated delivery systems; Reimbursement; Sustainability; Telemedicine
• ISSN: 1568-4156; 1568-4156
• DOI: 10.5334/ijic.s2150

Introduction: The aim of this study is to compare sustainability and business models of fourteen programmes scaling up after successful regional implementation, between EU regions. This study arises from the ACT@Scale Advancing Care Coordination and Telehealth deployment at Scale Programme which has received funding from the European Union, in the framework of the Health Programme. The work leading to these results is funded by the European Community’s Health Programme under grant agreement 709770. The ACT@Scale programme is fully aligned with the European Innovation Partnership in Active and Healthy Ageing objectives to deploy integrated care for chronically ill patients.Methods: This study used a mixed-methods approach: 1 semi-structured online surveys directed at programme leaders and managers were used for information on reimbursement methods, financial flows and drivers for scaling up; 2 documentation on the progress of scaling up was studied including Key Performance Indicators KPIs as programme costs; 3 expert interviews and workshops were held with programme managers to discuss barriers and plans for improvement.Results: The survey showed that the fourteen programmes vary regarding health care system, reimbursement and business model. The majority have established a ”medium maturity” on sustainability. Eight programmes expect a change in funding within three years and explore alternative business models.Regarding the KPI’s, programme costs vary considerably even between programmes with many comparable elements of their business models as their target group, key resources, partners and activities.The workshops and interviews showed that also programmes that are clinically effective struggle with sustainability.Discussion: The differences in maturity on sustainability may be influenced by the number of years a programme has been running, the allocated staff capacity and the funding model.Comparing the characteristics of the programmes with the outcomes of the expert interviews and workshops, they coincide in two considerations. Programmes in a taxed based health system, experience barriers like resistance due to top down decisions of scaling up the programme, fixed budgets with limited capacity, and uncertainty by changing health policies and budgets. Programmes in health systems based on compulsory social insurance and voluntary insurance, experience barriers as tight and yearly budgets and fragmentated funding.Conclusions: The studied integrated ca