Financing Care Integration: A conceptual framework of payment models that support integrated care

Worldwide more and more patients need integrated care. Although the medical conditions and social circumstances differ between patient groups, they all have in common that funding of health and social care is often a barrier to integrated care that meets their needs. Reimbursement and contracting by payers and commissioners are generally fragmented and limit integrated care at the patient level, because health care and social support are financed and organised in silo’s and commissioning historically focuses on providers of care instead of patient needs.

There are in general three types of issues around funding. The first is that the cost of coordinating care activities is not funded. The second is that funding models may not cover the time and resources needed to invest in new forms of care that match the need of patients. The third is that funding models tend to specify in some detail the care they fund and thus limit providers to what type of care they can deliver.

This chapter provides a framework for providers to understand the different payment models and to select the best fitting payment or reimbursement model to overcome the barriers they perceive in funding a program for integrated care for a specified patient group. The aim is to inform senior leaders of health and social care providers about their strategic funding options. Although actual options for funding may vary between countries, our framework can be a source of inspiration and a starting point to discuss models with the local commissioning group or collaborators when building integrated care solutions.