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Integrated care models have shown to deliver efficient healthcare, but implementation has proven to be difficult. The Support Consultation is an integrated care model, which enables full integration by bundled payment, insurer involvement, predefined care pathways and strengthening of primary care. The purpose of this paper is to provide an indication of the improvements in healthcare delivery after implementation of this proposed model and to create a base for extension to similar interfaces between primary and secondary care.

A retrospective study was used to compare the effect on the number of referred patients with non-acute cardiac complaints and the cost effectiveness before and after implementation of the Support Consultation. Patients who previously would have been referred to the cardiologist were now discussed between general practitioner and cardiologist in a primary care setting.

The first consecutive 100 patients (age 55±16 years, male 48 percent), discussed in the Support Consultation, were analyzed. Implementation of the Support Consultation resulted in a net costs (program costs and referral costs) reduction of 61 percent compared with usual care. All involved parties were positive about the program.

The Support Consultation has the ability to provide more effective healthcare delivery and to reduce net costs. The setting of the current study can be used as example for other specialties in countries with a similar healthcare system.

This study provides the potential cost savings after implementation of an integrated care model, based on real-life data.

This paper explores the building blocks of risk governance systems that are equipped to manage systemic risk in the 21st century. Whilst approaches to risk governance have been evolving for more than a decade, recent disasters have shown that conventional risk management solutions need to be complemented with a multidimensional risk approach to govern complex risks and prevent major, often simultaneous, crises with cascading and knock-on effects on multiple, interrelated systems at scale. The paper explores which risk governance innovations will be essential to provide the enabling environment for sustainable development that is resilient to interrelated shocks and risks.

This interdisciplinary literature review-based thought piece highlights how systemic risk is socially constructed and identifies guiding principles for systemic risk governance that could be actionable by and provide entry points for local and national governments, civil society and the private sector. particularly in low- and middle-income countries (LMIC), in a way that is relevant to the achievement of the 2030 Agenda for Sustainable Development. This considers preparedness, response and resilience, but more importantly prospective and corrective risk control and reduction strategies and mechanisms. Only when systemic risk is framed in a way that is relevant to the political agendas of countries will it be possible to begin a dialogue for its governance.

The paper identifies opportunities at the global, national and local levels, which together draw up a viable framework for systemic risk governance that (1) embraces the governance of sustainability and resilience through a strengthened holistic governance framework for social, economic, territorial and environmental development; (2) improves managing conventional risk to ultimately manage systemic risks; (3) fosters the understanding of vulnerability and exposure to gain insight into systemic risk; (4) places a greater focus on prospective risk management; (5) manages systemic risk in local infrastructure systems, supply chains and ecosystems; (6) shifts the focus from protecting privatized gains to managing socialized risk.

The choices and actions that societies take on the path of their development are contributing intentionally or unintentionally to the construction of systemic risks, which result in knock-on effects among interconnected social, environmental, political and economic systems. These risks are manifesting in major crises with cascading effects and a real potential to undermine the achievement of the SDGs, as COVID-19 is a stark reminder of. This paper offers the contours of a new risk governance paradigm that is able to navigate the new normal in a post-COVID world and is equipped to manage systemic risk.