32 How to improve care coordination for people with chronic conditions in Switzerland?

The research focused on investigating: 1) continuity of care (COC) in the 50+ population in Switzerland, and its association with multimorbidity, healthcare utilization and costs, and 2) preferences of this population for alternative care delivery models aimed at improving coordination.

To reach the first goal, we analyzed health insurance claims data of 200,000 individuals between 2015 and 2018 and measured COC using indices reflecting how often people change provider.

To reach the second goal, we developed a survey in which respondents could choose between new care delivery models described in hypothetical scenarios, or their existing model. This allowed us to investigate the important factors that influence choice and to identify subgroups of the population with similar preferences.

Lack of coordination and care continuity can have a negative impact on the effectiveness, quality and efficiency of care. Elderly people with several chronic conditions are particularly affected, since their complex treatments require the involvement of many different care providers. Federalism, the diverging interests of stakeholders in the healthcare system, fragmented information systems and the complexity of current funding mechanisms are obstacles to the delivery of better coordinated and integrated healthcare in Switzerland.

The aim of the study was to define framework conditions for improved care coordination in Switzerland and to assess the potential value of new healthcare models.

Overall, continuity of care was rather low in Switzerland but comparable to other countries; COC in primary care was very high. COC was higher for people with a gatekeeping insurance model and among complex patients, although it varied widely by specific condition. Higher COC was associated with improved health outcomes (e.g., hospitalizations) and reduced costs. The survey on population preferences showed that 21% of respondents systematically preferred their current model as opposed to any kind of change, reflecting an attachment to the status quo. Policy scenarios providing additional benefits (e.g., a designated care coordinator) could foster acceptance of alternative care delivery models. We distinguished 3 population subgroups: a majority open to some reforms; progressive younger adults open to major reforms, and older conservative individuals strongly attached to the status quo.

The study shows that it is possible to use claims data to analyse healthcare service usage and costs, and that these data can be used in countries that do not have a national register. They can also be used to improve our understanding of multi-morbidity and to identify specific patient profiles. Furthermore, the study shows the potential of improved coordination and continuity of care in Switzerland and proposes specific organisational and financing models that are acceptable to the population. In particular, it makes specific recommendations:

1. Develop a stratification system to allocate care coordination resources for those most likely to benefit.
2. Improve communication about existing insurance models and discuss benefits beyond premium reductions.
3. Improving health and health system literacy in the population.
4. Develop financial incentives encouraging care coordination.

How to improve care integration, coordination and continuity? Designing policy from population needs and preferences