Germany: Evolution and Scaling Up of the Population-Based Integrated Health Care System “Healthy Kinzigtal”

‘Gesundes Kinzigtal’ is the flagship model of an Integrated Health Care System and the only fully population-based system in Germany that has been subject to rigorous external evaluation. It is based on the IHI Triple-Aim model, simultaneously pursuing to improve patient experience of care, population health and reducing per capita cost of health care. At its core is a value-oriented population-based shared savings contract. Two central evaluation studies demonstrate the success of ‘Gesundes Kinzigtal’, (i) a survey amongst the insured regarding their perceived health, satisfaction, and health behaviour and (ii) an analysis of the over-, under- and misutilisation of health services, based on an analysis of routinely available health claims data from the Social Health Insurance. The general approach, interventions and evaluation frameworks are widely applicable and deeply rooted in the scientific literature and in models that have proven effective elsewhere. However, a number of conditions need to be met to ensure that the results can be replicated elsewhere, which are being presented here to inform successful scaling-up of the experience.