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Background Many countries are experimenting with new models of care provision and numerous integrated care programmes have been established internationally. However, little information is available on how to implement integrated care. The aim is to provide more in-depth insights in the implementation of integrated care for developers and managers of integrated care programmes, policy makers, health insurers, and researchers. Methods 17 integrated care programmes addressing multi-morbidity were selected and studied in 8 European countries as part of the Horizon 2020-funded project SELFIE (Sustainable intEgrated care modeLs for multi-morbidity: delivery, FInancing and performancE). An overarching analysis with data extraction forms of the Thick Descriptions completed for all 17 programmes in combination with previous insights from the literature was applied. Information about the implementation of integrated care was extracted and coded according to the six components of the SELFIE framework: service delivery, leadership &amp; governance, workforce, financing, technologies &amp; medical products, and, information &amp; research and sub-elements of each component at the micro, meso and macro level. Results The results show the interrelatedness of the six SELFIE framework components and that alignment work between them, different elements and levels is important. The meso-level seems to be the driving force of implementation and that a stepwise approach to change by building upon what is already there (e.g. existing collaborative networks) and gradually expand and broaden the scope of the integrated care programmes was supportive. Conclusions Implementation activities should simultaneously focus at the micro, meso and macro-levels at which integration occurs as they strongly influence each other. Alignment of the integrated care programme and the active influence of the macro-level context by creating an enabling environment facilitates successful implementation. Key messages Integrated care should be implemented with an incremental growth model rather than from a disruptive innovation approach. Integrated care should involve bottom-up and top-down implementation at different levels of the programme.

Implementing integrated care for multi-morbidity: analysis of experiences in 17 European programmes