Projects

The inav and the OptiMedis AG are jointly supporting the Swiss health insurance company SWICA in the development of a sustainable, population-oriented health care model. After a literature review, a best practice evaluation and stakeholder interviews, a “big picture” for the possible implementation of value-based care concepts in Switzerland was outlined. The specification was conducted in cooperation with central stakeholders of a selected region in the framework of a business plan for a possible health care ecosystem. Based on existing regional health insurance data, potential analyses were conducted and used as a baseline for the definition of initial integrated care products. In addition, potential financing models were developed and the governance and organizational structures for a pilot implementation with selected service partners were designed.

In Switzerland, there is already extensive experience with new forms of controlling and financing, on the one hand in cooperation with office-based physician groups, and on the other hand through the development of different tariffs with, in part, telemedical access models. Overall, however, these attempts have not yet led to a comprehensive cross-sectoral regional coordination and provision of services that reflects international experience and also rewards the maintenance of a healthy population.

The conclusions from the best practice analysis are relevant for SWICA – just as they are for other parties involved in the development of an innovative care model:

1. New health care delivery systems must be aligned with today’s health care stakeholders’ demands for entrepreneurial activity and work-life balance. Compensation should therefore increasingly reward benefits rather than service volumes.
2. The changes toward integrated care are particularly complex. Therefore, the health care models and their governance structures must relate to larger population collectives, include a variety of professional groups and their partially conflicting interests, and thus be resilient enough to withstand disputes.
3. In predominantly privately organized healthcare systems, regional “healthcare ecosystems” are developing more frequently, becoming contract partners for payers either on the level of a few professional groups and indications or across entire populations and their diseases. It seems reasonable to include some of the regional providers in the governance body structures.
4. The examples show that these types of regional “healthcare ecosystems” experiment with population sizes between 20,000 and 200,000. It appears reasonable to include the largest proportion possible of the region’s total population. It is also important for the participating local healthcare players to care for the largest possible proportion of their patients within the framework of the new integrated healthcare approach, to ensure the processes can be implemented effectively and sustainably.
5. In many best practices, digital innovations such as the introduction of telemedicine or an integrated patient record are the basis for implementing more efficient health care pathways. They support the joint definition of standards and guidelines for communication and collaboration between stakeholders.
6. All best practices under consideration are increasingly focusing on prevention, i.e., on earlier intervention in the outpatient setting, in particular to enhance patient satisfaction, but also to reduce the need for more cost-intensive hospital treatments. Intelligent use of health care data and population risk stratification enable identification of relevant risk groups and thus an earlier and more targeted approach to the affected populations. Interdisciplinary cooperation between the various professional groups and stronger links between the healthcare and social systems are important factors in this context.

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