Belgium contracted 12 pilots for implementing quadruple aim in social and health care. ‘more value for the same money’ is supported by a guarantee that benefits for the health insurance are available for financing higher value services not yet covered by health insurance. Observed expenditure is compared with risk adjusted expected expenditure for a predefined population in each project. The paper explains theoretical background and practical consequences.Fragmentation in health and social care goes with avoidable costs and suboptimal quality of care. Belgian authorities started a journey towards integrated care through pilots in 12 locoregional territories, covering 2,5 million inhabitants. Pilots commit to realise quadruple aim. Consortia of local communities, authorities, social and health care and insurers have defined action plans. They contracted from 2018 with the National Health Insurance (NHI) for implementation. Except for integrator function,projects do not get additional money. A budget guarantee warrants health insurance expenditure for the pilot population to be maintained for 4 years at its predicted level when real expenditure is lower by avoiding low value care. These ‘efficiency gains’ can be reinvested in high value activities not yet covered bij NHI. This 100% shared saving will support innovation including shifting from fee for service to population based financing. Not for profit insurers administrate reimbursment of claims. A national database contains detailed information at individual level, both on characteristics of the insured as on service utilisation. Yearly calculation is made of the expected expenditure at pilot population level, derived from national observed expenditure. By regression, for each pilot, the mean expenditure per individual in a national reference population is calculated taking into account a set of individual characteristics (age group, sex, morbidity, …) and applied to the size of population in the pilot region. Outlier individuals and expenditures are excluded ...