Integrated Care for Older Adults: A Struggle for Sustained Implementation in Northern Netherlands

Sander Holterman; Maarten Lahr; Klaske Wynia; Marike Hettinga; Erik Buskens

doi:10.5334/ijic.5434

Integrated Care for Older Adults: A Struggle for Sustained Implementation in Northern Netherlands

Int J Integr Care. 2020 Jul 13;20(3):1. doi: 10.5334/ijic.5434.

Authors

Sander Holterman^{1

2}, Maarten Lahr¹, Klaske Wynia^{3

4}, Marike Hettinga², Erik Buskens^{1

5}

Affiliations

¹ University Medical Centre Groningen, Department of Epidemiology, Unit Health Technology Assessment, Groningen, NL.
² Windesheim University of Applied Sciences, Research Group IT Innovations in Healthcare, Zwolle, NL.
³ University of Groningen, University Medical Centre Groningen, Department of Health Sciences, Community and Occupational Medicine, Groningen, NL.
⁴ University of Groningen, University Medical Centre Groningen, Department of Neurology, Groningen, NL.
⁵ University of Groningen, Department of Operations, Faculty of Economics and Business, Groningen, NL.

Abstract

Introduction: Integrated care has been suggested as a promising solution to the disparities in access and sustained high quality long-term care emerging in Europe's ageing population. We aim to gain a better understanding of context-specific barriers to and facilitators of implementation of integrated care by doing a retrospective assessment of seven years of Embrace. This Dutch integrated person-centred health service for older adults was based on two evidence-based models (the Chronic Care Model and the Kaiser Permanente Triangle). Despite successful deployment the programme ended in 2018. In this case study we assess the impact of the programme based on past evaluations, reflect on why it ended, lessons learned and ideas to take forward.

Discussion: The majority of health outcomes were positive and the perceived quality of care improved, albeit no clear-cut savings were observed, and the costs were not balanced across stakeholders. The Embrace payment model did not support the integration of health services, despite reforms in long-term care in 2015.

Key lessons: Enabling policy and funding are crucial to the sustained implementation of integrated person-centred health services. The payment model should incentivize the integration of care before the necessary changes can be made at organizational and clinical levels towards providing proactive and preventive health services.

Keywords: implementation; integrated care; payment models; sustainability; transformation.

Grants and funding

This study is an offshoot of 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 up to these results was 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.