The Transition towards Integrated Care in Belgium: From locoregional pilot projects to a national policy plan

Introduction/background: In Belgium, several efforts are being concerted in realizing integrated care since the beginning of the 21st century. In 2015, a Joint Plan for people with a chronic disease was launched in which the federal and federated health authorities agreed upon a shared vision on integrated care, aligned with the Quintuple aim . Structured into 4 action lines, the Joint Plan outlines 18 essential components, to support the development of integrated care. One of the action lines was ‘from pilot projects to population oriented care’. Aim: The aim is twofold: (1) set up pilot projects in Belgium to implement innovative integrated care practices, and (2) gather valuable insights to inform Belgian policy for large-scale implementation of integrated care. Project design: In 2018, twelve pilot projects were set up across Belgium, each covering a region of ± 200.000 to 300.000 inhabitants. The projects – which were granted financial support and given a high degree of experimental freedom – had the aim to develop and test innovative integrated care initiatives in a well-defined geographical region over a 4-year period. Results: The development and implementation of integrated care practices proved challenging and time-consuming. A first and crucial step was to build an intersectoral and interdisciplinary network within their region, and define a locoregional action plan, which took longer than expected. Moreover, the COVID-19 pandemic caused some delay. Therefore, the projects were extended with one year (2018 – 2022). However, the projects successfully built a broad, diverse network across all levels of care (e.g., community care, primary care, secondary care) and established solid partnerships with local stakeholders. Each project implemented multiple initiatives (in total more than 150), across different sectors, involving health and social care professionals, and targeting a wide spectrum of patient populations. However, the outcome evaluation of the initiatives was hindered due to several factors (heterogeneity between activities, small sample sizes, short timeframe, limited availability of (base line) data). Therefore, we were unable to prove the impact of the projects on patient outcomes and the Quintuple aim. Despite the challenges in quantitative evaluation, stakeholders unanimously acknowledge the pilot projects as pivotal organizations at the meso-level with significant value in facilitating integrated care. Discussion and conclusion: Insights gained from the projects informed the development of a new Interfederal Plan for Integrated Care, including concrete agreements between all health authorities regarding the large-scale implementation of integrated care in Belgium . The Interfederal Plan is considered as the motor for the transition towards a sustainable and integrated health care system in Belgium. The Plan is currently being translated into an implementation plan, that requires a strong collaboration (including co-financing) between all health authorities for the realization of joint programs for integrated care across Belgium. 1 Interministrial conference. Joint Plan for people with a chronic disease. Integrated Care for Better Health. Available: [https://www.riziv.fgov.be/nl/professionals/info-voor-allen/het-interfederaal-plan-geintegreerde-zorg/geintegreerde-zorg-voor-chronisch-zieken] Brussel;2015 2 Interministrial Conference. Interfederal Plan Integrated Care. Available: [https://www.riziv.fgov.be/nl/professionals/info-voor-allen/het-interfederaal-plan-geintegreerde-zorg]