Table 5.

Level and type of integration, contracting and partnership arrangements.

Initiative, Country	Level of integration	Type of integration	Contracting model
Torbay, UK	Full	Organizational Functional Service Clinical System	Alliance Contracting Model Contract between Torbay Care Trust (now Torbay and Southern Devon Health and Care NHS Trust) and alliance of parties who deliver integrated care and services. All parties share risk and collectively own opportunities and responsibilities to deliver care and services
SIPA, Canada	Full	Organizational Service Clinical	Lead provider/Prime contractor model Two community-based multidisciplinary teams in two areas in Montreal took full clinical responsibility for delivering integrated care through provision of community health and social services and coordination of hospital and long term care
Nuka, USA	Full	Organizational Service Clinical Normative System	Alliance Contracting Model Co-ownership and co-management agreement between Southcentral Foundation and the Alaska Native Tribal Health Consortium (ANTHC); Provision of care is based on integration among the providers and types of care/services and inter-provider and -agency referrals. Financial risk and benefits from efficiencies, better coordination or better population management are shared across the system.
NW London ICP, UK	Coordination	Organizational Functional Service Clinical	Alliance Contracting Model Alliance partnership of commissioners (clinical groups and local authorities), voluntary sector and providers from social care and other sectors governed b the Integrated Management Board. Funding surplus from efficiencies is shared across the partnership and a flexible resource envelope is made available to each multidisciplinary group for care planning, case conferences, and performance reviews.
Embrace, the Netherlands	Coordination	Organizational Service	Alliance Contracting Model University of Groningen in partnership with health insurance company Menzis and health care organization Meander initiated Embrace (public-private partnership); Formal cooperation agreement was struck between community organisations (welfare organizations and municipalities) and health care organisations (general practitioner practices), home health care organisations, homes for the elderly, nursing homes and hospitals, and elderly associations to leverage the unique skills and expertise of each organization
Healthy Housing, NZ	Coordination	Organizational Service	Alliance Contracting Model Joint initiative between Housing New Zealand Corporation (provider of government- funded housing) and District Health Boards that includes other tiers of care (primary care, hospitals) and social service agencies Alliance agreements are used to share responsibility between partners and Healthy Housing program
Hennepin, USA	Coordination	Organizational Functional Service Clinical	Accountable Care Organisations Four partner affiliates of the Hennepin County government (Hennepin County Medical Center, North-Point Health and Wellness Center, Hennepin County Human Services and Public Health Department) created Hennepin Health ACO by signing a business agreement to share full financial risk for newly enrolled Medicaid beneficiaries.
Hartberg, Austria	Coordination	Organizational Service Clinical Normative	Alliance Contracting Model Initially established as a network of social care and health organizations, including Red Cross, Caritas and Volkshilfe; district hospital added later to assure a full continuum of care for patients within the network. Principal task is to coordinate the network between the different social and health care providers in a district.
KAPI, Greece	Coordination	Organizational Service Clinical	Alliance Contracting Model Ministry of Health and Welfare and Association of Volunteer Workers set up a pilot KAPI; Since their institutionalisation, state transferred the responsibility of their management and operation to local municipalities and KAPI have been operating with the contribution of volunteer organisations, the Greek Red Cross and the Christian Youth Organisation. There is a cross-country network of KAPI, each KAPI is a legal entity with a board of directors and a network of local partners to support provision of health care and social assistance. KAPI are also part of the National Social Care System cooperating with Day Protection Centres for the Aged and Health Units.
Zijloever, ND	Coordination	Organizational Service Clinical	Alliance Contracting Model Based on co-operation between health care (general practitioners and hospitals), care (home care, institutions for psychiatric patients, the handicapped and the elderly) and prevention. Operates as care-friendly district characterized by the provision of residential care outside an institution, small-scale community-based care and services, co-location of all providers, and incorporation of welfare facilities.
Gesundes Kinzigtal, Germany	Coordination	Organizational Functional Service Clinical Normative System	Outcome-based Contracting and Commissioning A joint venture between a network of physicians in Kinzigtal and a care management company, OptiMedis AG; An outcome-based contract is set up and through this contract clinical and financial incentives are aligned in the management of integrated care; Holds contracts with statutory health insurers (“sickness funds”) to integrate health and care services for their insured populations, covering all age groups and care settings. Collaborates with community groups including gyms, sports clubs, education centres, self-help groups and local government agencies.
Jönköping County Council, Sweden	Coordination	Organizational Service Clinical Normative System	Alliance Contracting Model Governed by the county council, Esther organizing committee and small networks of Esther coaches in each municipality Provision of care is based on integration among the providers and types of care/services and inter-provider and -agency referrals. Cost savings are reinvested across the continuum of care.
Kaiser Permanente (Southern California)	Coordination	Organizational Functional Service Clinical Normative	Alliance Contracting Model Formal contractual agreements among Kaiser Foundation Health Plan (insurance company), Kaiser Foundation Hospitals (KFH), and Southern California Permanente Medical Group.
Maternal and Child Health, USA	Linkage	Organizational Service Clinical	Alliance Contracting Model Two local health departments, Spokane Regional Health District and Clark County Public Health initiated transition to place-based integrated care and maintained funding. Stakeholders included local boards of health, school partners, advisory boards, and non-profit agency leaders.
Healthy Homes, UK	Linkage	Organizational Service	Alliance Contracting Model Alliance between Liverpool City Council and Partners in public health, primary care, community-level care that includes a range of services, e.g., social care agencies, specialized care (mental health), hospitals, etc.; Provision of care is based on inert-agency referrals.