Promoting integrated care is a key concern of CSS Insurance. 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. CSS sees the introduction of a uniform system of financing for outpatient and inpatient services (EFAS) as a further way in which to promote integrated care. Such a system would allow additional discounts to be offered for integrated care models, thus making them more attractive. Conversely, the law must not arrive at too narrow a definition of integrated care as this could hinder the implementation of innovative ideas.
CSS welcomes the Federal Council's determination to further promote integrated care through its second package of measures. However, a mandatory gatekeeper system, as proposed by the Federal Council, is not fit for purpose. There are enough alternative insurance models on the market capable of performing this gatekeeper role. Prescribing an additional cantonal gatekeeper by law would both make the system even more complicated and minimise the desired savings effect. Around 70% 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. This is already possible within the current legal framework, but the supervisory authority does not insist on its application strongly enough. It goes without saying that the traditional managed care models are slowly becoming outdated. They do not offer service providers enough financial incentives to coordinate the entire care pathway. Digitalisation especially provides new opportunities to bypass the primary care providers and connect. To give a specific example: via an online platform such as WELL that ensures digitally supported integrated care.
CSS's integrated care offering includes alternative forms of insurance and a variety of programmes and services.