How to strengthen financing mechanisms to promote care for people with multimorbidity in Europe?

Verena Struckmann, Wilm Quentin, Reinhard Busse, Ewout van Ginneken. On behalf of the ICARE4EU consortium

Payment mechanisms that take multiple chronic conditions into account and actually promote better integration of care are sadly lacking. This policy brief examines the steps policy makers must take if they are to adapt financing systems to support people with multimorbidity better. It looks at securing sustainable funding; options for upgrading payment mechanisms; and how financing mechanisms can stimulate good quality integrated care for people with multimorbidity. Key messages include that:

• Payment mechanisms can provide key incentives for providers to collaborate, enable better care and create efficiency savings (while paying individual providers separately tends to block integration).
• Innovative payment mechanisms (shared savings models, bundled payments, pay for performance) can be combined with more traditional models (budget, capitation, fee for service) but are inevitably complex. They need to adequately account for the complexity of cases treated which means drawing on very extensive data on cost and quality and considerable technical expertise.
• Policy makers, who are working to make financing support integrated care, need to give a strong leadership signal and create supportive national and programme structures. They must: 
  • Put in place information and support systems to deal with the complexity
  • Give proper thought to local conditions (and local capacity to cope)
  • Consider funding guarantees and other strategies for mainstreaming new approaches so that providers are encouraged to innovate, and
  • Take an incremental and long-term approach to change (including ongoing evaluation).