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Introduction: Implementing integrated care is inherently challenging due to the number of actors to engage, the long-term realization of benefits, and assessing intervention effectiveness. Thus, policymakers often rely on transferring best-practices from existing integrated care systems to inform the design of regional initiatives. However, the implementation challenges of simply transferring best practices from other contexts is increasingly acknowledged. SCIROCCO Exchange is an EU-funded consortium that aims to scale-up integrated care initiatives within respective health system contexts through facilitating knowledge transfers and providing personalized improvement support. Aims Objectives Theory or Methods: Here we demonstrate how logic models can serve integrated care implementation by identifying gaps in causal links between desired outcomes and planned activities, and as a communication tool for stakeholder engagement. We collaborate with 9 regions across Europe at varying stages of integrated care journey to cocreate logic models. Participating regions utilize a validated selfassessment tool that includes twelve dimensions found to be integral in successfully implementing integrated care to identify goals of improvement with patient involvement. We then work with regional leadership and staff to create a high-level model, then proceed to validate the model with wider stakeholders. Highlights or Results or Key Findings: - Early engagement with regional actors was key to building the trust required for cocreation of a representative logic model - While regional leaders were initially unfamiliar with the use and purpose of logic models, adoption and acceptability increased after its demonstrated value in clarifying goals, and thinking through the causal chain of events that link planned/implemented activities and anticipated outcomes - Regions at earlier stages of their integrated care journey focused more on activities and direct outputs while those at later stages focused more on outcomes. Across participating regions, thoughtful work was required to iteratively define the causal links between activities and outcomes - The process of logic model development adds value to the process of implementing integrated care systems by challenging stakeholders to think through the causal mechanisms that links activities that are invested and the desired outcomes within the regional context. Conclusions: One of the reasons that integrated care systems are not scaled up is due to the lack of transparent communication and shared understanding between different actors regarding the causal linkages between invested activities and the desired outcome. Logic models can be a useful tool to close this gap among stakeholders. Implications for applicability/transferability sustainability and limitations: Logic model is a highly adaptable and sustainable tool to support integrated care system at different stages of implementation. We are limited to our initial experiences engaging regional leadership in this work. The next step will be to validate and further refine the logic model with stakeholders on the ground. [ABSTRACT FROM AUTHOR]

Background: Studies from different countries have shown that a small number of insured persons (high-cost patients) are responsible for a large portion of health care spending. At the same time, it is assumed that some of these costs could be saved by a better management of this group of people. The aim of this article is to analyze the performance and cost profiles of high-cost patients, to put them in an international comparison, and to derive a better management approach., Methods: Retrospective observation study based on statutory health insurance data from two statutory health insurances for the year 2013., Study Population: top 5 %, as well as top 1 % of the most expensive insured persons. Identification of characteristics of high-cost patients and international comparison with the Netherlands, the USA, Canada, Spain, England and Japan., Results: 5 % of insured persons account for almost half of the total costs and the most expensive 1 % of 22 %. These high-cost patients in Germany are, on average, 20 years older than the general population. Almost every person of the high-cost population was prescribed at least one medication during the study period (99.2 %), and 85.8 % had at least one hospital stay. Hospital care accounts for the biggest part of total costs: 75 % together with drugs. The average per capita costs caused by one of the 5 % most expensive insured persons in the year under review are 20 times higher than that of the other 95 % of insured persons. High-cost patients are generally more multimorbid and have higher mortality rates. The most common diagnoses of these patients are hypertension, lipoprotein metabolism disorder and back pain., Conclusion: Similar to other developed countries, Germany faces the challenge to develop and implement adequate intervention approaches addressing the special requirements of high-cost insured persons. This paper provides a first basis. The analogies of high-cost patients in Germany and other countries illustrate the need for transnational research and intervention approaches on this specific issue. More in-depth work is needed to investigate the potentials of Predictive Modelling and integrated care approaches to the management of this group of insured persons., (Copyright © 2020. Published by Elsevier GmbH.)