Sustainable Integrated Care Models For Multi-Morbidity: Delivery, Financing and Performance (SELFIE)


SELFIE is a Horizon2020 EU project that will contribute to the current state of knowledge on integrated chronic care (ICC) for persons with multi-morbidity and provide applicable policy advice. We particularly aim to generate evidence on the impact of promising ICC models and supporting financing/payment schemes on patient experience, health outcomes, and costs. Specific ICC projects for multi-morbidity will be empirically evaluated using multi-criteria decision analyses (MCDA).


Currently, over 50 million persons in Europe have more than one chronic disease. As populations age and continue unhealthy lifestyles, this number will increase dramatically in the near future. Multi-morbidity will become the number one threat to population health and economic sustainability of health care systems. Persons with multi-morbidity have been found to have a higher mortality, worse health status, worse quality of life and wellbeing as compared to persons with a single disease. From the patient perspective, frequent visits to multiple caregivers for different chronic diseases, who do not collaborate and may provide conflicting advice, is inconvenient, confusing, costly, and discourages compliance. From a professional perspective, treatment of multi-morbidity is a challenge, as evidence-based clinical guidelines are followed that are commonly written by specialists in a specific disease, drawing on research in selected patients without co-morbidities. From the societal perspective, multi-morbidity increases production loss and healthcare costs. Part of these costs can be avoided because they result from inefficiencies in health care organization and delivery, little substitution of expensive care, and harmful effects of interfering treatments.

What's needed

To respond to these challenges, new models of care for multi-morbid patients are needed that are supported by adequate payment systems. Specifically, what is needed is a holistic assessment of patient’s needs, capabilities, and preferences, person-centered integrated chronic care, and a supportive network of effectively collaborating professionals that account for possible interference between simultaneous treatments. This means that shared-decision making, the promotion of self-management, and partnerships across the health and social care sector are essential.


  • Taxonomy and ‘intervention toolkit’ of most promising ICC models for multi-morbid patients. The toolkit will allow ICC models to be built in specific health and social care systems.
  • List of financing/payment schemes that details the options that can support the implementation of ICC for multi-morbidity.
  • Price-setting technical document for ICC models.
  • Performance assessment tool to monitor the goal achievement of ICC models, this tool will include new indicators that specifically address the quality of care for patients with multi-morbidity.
  • Strategies for implementation and change management.

For and with whom

In SELFIE five stakeholder groups play an important role (5P’s):
  1. Patients with multi-morbidity,
  2. Partners and family members of patients with multi-morbidity who often take the role of informal caregivers,
  3. Professionals and organizations who provide health and social care, and professionals who conduct research in this field,
  4. Payers, such as health care budget holders and health insurers, and
  5. Policy makers.
The importance of the various outcomes will be measured from the viewpoint of the 5P’s. They are included in the international stakeholder advisory board and will be invited to national workshops.


The SELFIE project started in September 2015, and will continue for four years, until September 2019.

Project Website