Integrated care
Promoting integrated care has been a key concern of CSS for many years. Integrated care aims to create binding rules for the management of patients throughout their entire course of treatment, thus optimising the quality of treatment and achieving savings in service costs. The customers benefit from better quality and lower costs, which are achieved through efficient treatment. Implementing the fine-tuned system of risk adjustment will strengthen the incentives to promote integrated care models. The standardised financing of outpatient and inpatient benefits (EFAS), which was approved by the Swiss electorate on 24 November 2024, gives integrated care renewed impetus (see our standpoint on the "Implementation of uniform financing").
As part of the second package of cost-containment measures (MNP2), the Federal Council proposed including integrated care networks in the Federal Health Insurance Act (KVG) as new service providers – a process that would involve a large number of bureaucratic hurdles. At the same time, it planned to reduce the retention fee for network services. Parliament deleted this provision during the final vote on the package on 21 March. Together with prio.swiss and the networks, CSS had advocated for the network article to be dropped and expressly welcomes Parliament's decision. This arrangement would have hindered integrated care rather than promoting it. The necessity of strengthening integrated care, especially for the chronically ill, was emphasised during the parliamentary debate but, at the same time, it was recognised that an article of law was the wrong way to approach this. Instead, even better use should now be made of the scope that exists for shaping cooperation based on tariff partnerships, and that scope should be extended. To achieve this, CSS intends to step up its partnerships with integrated care networks, such as the Ensemble Hospitalier de la Côte (EHC), for example. At the same time, alternative insurance models must be made even more attractive, especially for people with chronic illnesses.
Insured persons already benefit from good agreements with the tariff partners: More than three-quarters of insured persons have already restricted their choice of service provider. As a result, their risk-adjusted costs are lower, i.e. these restrictions actually do cut costs. If we want to strengthen the efficient models, it is important to establish a direct link between coordination and savings in service/benefit costs, and to reflect this link in the discounts that are granted. In other words, the amount of discount granted by a model should be even more dependent on the level of coordination provided. Digital networking has emerged as a key factor in making integrated care a success: The use of digital health records by all actors in the network ensures that service providers share information, thus avoiding duplication. A real-life example is the online platform WELL, which guarantees digitally supported integrated care within the EHC care network.
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