By NextBestFitPhase 3: Waves 2 & 3: working-age adults · Step 3.6
Create integrated care organizations (ICOs)
Years 2–4 · UHADiscuss this step
How other countries handled this same piece of implementation, what happened, and what it means for this plan.
Side by side
| Country | Approach | Result | Lesson for this plan |
|---|---|---|---|
| This plan (U.S.) | Provider-run integrated systems can accept a single risk-adjusted global budget for patients who choose them. This preserves the Kaiser/Geisinger model without an insurance layer. | ||
| Spain (Valencia) | 'Alzira model': private operators received capitated budgets for regional populations. | Lower cost but controversy over profit; reverted to public management (2018+). | Capitation for private operators needs strict oversight. |
| Germany | Gesundes Kinzigtal integrated care contract with shared savings. | Reported savings and better outcomes for enrolled population. | Provider-led integration with shared savings can work within a public system. |
Spain (Valencia)
- What they did
- 'Alzira model': private operators received capitated budgets for regional populations.
- What happened
- Lower cost but controversy over profit; reverted to public management (2018+).
- Lesson for this plan
- Capitation for private operators needs strict oversight.
Germany
- What they did
- Gesundes Kinzigtal integrated care contract with shared savings.
- What happened
- Reported savings and better outcomes for enrolled population.
- Lesson for this plan
- Provider-led integration with shared savings can work within a public system.
More precedent
- Kaiser Permanente; Medicare ACOs; Germany's integrated care contracts.