Innovating in payment models to support the adoption of innovative technologies in integrated care: A Delphi study

• Delphi explored payment models for innovation in IC, where evidence was lacking • Principles were identified to qualify innovations for innovative payment schemes • Technologies with significant therapeutic value should access novel payment models • HTA bodies should guide pricing negotiations and value-based use of innovations • DRG plus P4P was the only model achieving high consensus for technology uptake Payment’s mechanisms that facilitate the uptake of innovative technologies embedded in integrated care (IC) systems have not been described. This study aims to identify the principles that qualify innovations for inclusion in innovative payment schemes, as well as those that facilitate their uptake in IC. A two-round web-based Delphi was conducted to gather consensus among healthcare professionals, health economists, health technology assessment (HTA) professionals, payers, and managers. Statements were rated on a 6-point Likert scale, and consensus was classified as high, moderate, or low based on proportion of agreement-level responses and median score for each statement. Statements with moderate consensus were revised and re-evaluated in round 2. The first-round response rate was 51% (n=92/181); the second was 88% (n=80/92). The involvement of HTA in pricing negotiations along with the identification of the best-value scenarios for the innovation was the principle with the highest level of consensus and agreement. Among the payment models considered, only the combination of diagnostic-related-groups (DRG) and pay for performance (P4P) achieved high consensus. All the others reached moderate consensus (94%, n=15/16); however, most showed a high proportion of agreement-level responses (≥90%). The combination of DRG and P4P emerges as the most accepted pathway to accelerate innovation adoption. Establishing clear preconditions and guidance remains essential for successful implementation and high-quality patient care. Six additional novel schemes may also facilitate adoption. While some have been tested in real-world settings, further cases are required to assess feasibility and effectiveness across diverse healthcare contexts.