Value-based healthcare: the road to success

By Healthcare, News

It has been more than a decade since the book Redefining Health Care by Prof. Michael E. Porter was published. Since then, the attention of the Dutch healthcare sector for value-based healthcare (VBHC) has increased every year.

We know that value-based healthcare is about maximizing the value of patient care and reducing healthcare costs. Porter describes the transformation of care into value-based healthcare using six sub agendas:

Last year, during a working session with Michael Porter, 25 decision-makers from the Dutch health care sector identified the first two sub-agenda’s as most relevant and urgent: the design of the IPUs and the measurement of the results.

We do see a number of themes that need attention:

  • Healthcare organisations are often organised around specialisms and it requires leadership to break through this. In order to set up integrated practice units, walls must be broken and existing interests (including budgets) must be abandoned.
  • The lack of funding is an often heard excuse. Reforming the DOT-system is the only way to make Value-based Healthcare possible. Fortunately, practical examples show many opportunities within the current system.
  • The required (outcome) indicators are not or only available to a limited extent. Although the available control information in care institutions is often not yet at the desired level, however this does not mean that you can’t do anything with it.

Although these are complex themes, they are already being tackled by a number of Dutch healthcare organisations. For example, we are seeing the emergence of integrated practices units more and more often. For example, in Diabeter for type 1 diabetes care and within the Dutch Obesity Clinic (NOK) for patients with morbid obesity. The number of cases in which value is purchased has also increased in recent years in terms of funding. Menzis is the leader in this field and applies this for a large number of providers of cataract operations and hip and knee osteoarthritis treatments. As a hospital, Santeon has taken a leading role in the value-based healthcare philosophy. For example, by starting with what is already measured, instead of waiting until the entire set of indicators is available. With a manageable scope and a pragmatic approach, Santeon hospitals are able to achieve their first successes. We believe that these are the crucial factors for a successful implementation of value-based healthcare.

How do you increase the chance of success?

A limited scope and organisation at program level and in the care area are important success factors for a successful start. The focus of many organizations is mainly on the, often ambitious, final goal and not on the road to it. Some examples to start pragmatically:

  • The entire organisation does not have to change, you can start per medical condition.
  • Develop a roadmap and systematically do one or few medical conditions at a time. Start with the information that is available and expand these indicators step by step.
  • Introduce activity-based costing step by step, starting with the largest cost items. Also take a good look at what’s in-house. It does not have to be extremely accurate. Estimates are also just fine.

Good leadership is essential

To start small, there must be room to change, to make mistakes and to learn from them. Good leadership is essential. Give employees a safe environment to experiment in by radiating ambition and believing in the ultimate goal. But how do we ensure good leadership, a healthy ambition and a safe culture of improvement? And how can we make optimal use of this to make value-based healthcare really work? It is our ambition to help the healthcare sector by sharing our vision and experiences with you. In the coming period we will discuss the following topics in a series of blogs.

Blog 1: The Pragmatic Start

Starting small and pragmatic is important to create momentum. Give the enthusiastic healthcare professionals and existing initiatives a platform. We describe three steps to start with, to organize for success. What makes this start pragmatic and therefore feasible?

Blog 2: The Data driven Performance Dialogue

How do you get from insight to action? What type of conversation should be held between professionals in value-based healthcare? How do you do so? And what is needed for this?

Blog 3: Data and Insight

Data and insight: an important factor in value-based healthcare. Not for nothing one of the most important strategic sub-agenda’s and at the same time a big threshold. What is needed to unlock the necessary data? And how do we present the data in an intelligent way so that it facilitates the performance dialogue? How can data-analytics support this to the maximum?

Blog 4: Our vision for the future

How beautiful it would be …

… if the patient can take part in the care process and is in control of his own health?

… if technology is used to the maximum and doctors and managers are supported by predictive (or even prescriptive) analytics?

… if knowledge sharing is the norm, among doctors, among care providers and between research and the clinic?

Value-based healthcare: the pragmatic start

By Healthcare, News

Despite the many initiatives, few value-based healthcare programs at institutional level have been launched. What is the reason? IG&H lists the three main causes (and solutions).

Healthcare organisations are often organised around specialisms. Breaking through this structure requires leadership. In order to set up ‘integrated practice units’, walls must be broken and existing interests (including budgets) must be abandoned. Few healthcare institutions in the world are given the opportunity to implement value-based healthcare completely, including organisational changes, in one go.

The Karolinska Institute in Sweden has gone down this road. The university hospital made this decision after careful deliberation. Within the Swedish system of registries, the organisation first gained years of experience in managing the outcomes of care.

After the institute decided to tilt the organisation, it turned out to be even more difficult in practice than had previously been estimated. A ‘big bang’ was chosen in which all divisions and departments were abolished. The introduction of the extensive new structure with hundreds of patient groups and new management methods met a great deal of resistance from medical specialists and nurses.

If you want to roll out value-based healthcare programs in a broad sense, you need to be pragmatic.

1. Scope determination

Make sure that it is clear in advance what the scope of the project will be. Take into account the feasibility, impact and make the right decision.

For example, do you join an existing initiative or start a new one? Both have advantages and disadvantages that need to be weighed against each other. In this way, you can build on the lessons learned from an existing initiative, but your own contribution will be smaller.

Do you start your own initiative or do you start working together immediately? An important question that needs to be asked is whether the benefits outweigh the complexity of starting together. Examples are the added value of being able to benchmark externally and sharing investments in information management.

Finally, there are many hard and soft criteria that need to be considered: for example, what is the size of the care areas you start with? What data is already available? What is the support base among healthcare professionals?

2. Organise for success at program level

Perhaps the most important precondition for success is that the leadership of an institution is committed to the implementation of an institution-wide program. It is essential that the (care) professionals feel supported by the top of the organisation.

A value-based healthcare program as a change process that requires a lot of time, energy and perseverance is the right approach. It must be a priority on the long-term policy agenda and should be guided for a longer period by means of tight program management.

Finally, a prominent place on the investment agenda is also necessary; value-based healthcare requires investments in both people and systems, which pays off later.

3. Organise for success per care area

Another decisive precondition for a successful implementation within a healthcare area is that the healthcare professionals involved support the initiative. This goes hand in hand with the need for strong leadership at institutional level.

The professionals involved are the driving force in setting up the multidisciplinary team. This group then determines which indicators should be used as a basis for steering and how the continuous improvement cycle should be set up. All this, of course, with the support of the program that is set up at institutional level.

Conclusion and follow-up

Starting small and pragmatic is important to create momentum. However, for a successful roll-out at institution level, more is needed. A well thought out delineation of the scope and organising for success at institution level and per care area are essential. The above questions can help. Do you want to know more? Please contact us, we will be happy to help you.

This series of blogs on value-based healthcare will soon be followed up with the topic “data-driven performance dialogue”. What type of conversation should be conducted between professionals? How do you do so? And what do you need for this?