‘Flevoland healthcare landscape has all ingredients to continue to deliver high-quality and accessible healthcare’

By | Health, News

The current Dutch Flevoland healthcare landscape has all the ingredients to continue to deliver high-quality and accessible healthcare – now and in the future. That’s the main conclusion from a report by Bas Leerink, explorer of the future and partner at IG&H.

Download the full report here (in Dutch).

In the past few months, Leerink and his team of IG&H consultants have defined a vision of healthcare in the Dutch province Flevoland from 2020 onwards. To this end, they’ve had extensive talks with residents, healthcare providers, health insurers, and the local government. They’ve also made extensive calculations and analyses of all scenarios. Moreover, regulators NZA (Dutch Healthcare Authority) and IGJ (Health and Youth Care Inspectorate) have been actively involved and have responded to the report. They don’t have any objections.

As an explorer of the future, Leerink recommends a step-by-step improvement of the current healthcare provision as the best approach for Flevoland. The province shouldn’t seek to restore the situation that existed before the bankruptcy. Therefore, the emergency room and acute obstetrics will not be reopened in Lelystad.

This is a difficult matter for many parties involved, but restoring the situation that existed before the bankruptcy doesn’t offer a solution for future demand. Furthermore, it’s neither realistic nor feasible in the short term. In the report, Leerink makes several recommendations. If this Agenda for Healthcare is realized, it will turn Flevoland into a leading region in the sector.

Importance of close collaboration

The bankruptcy of the former MC IJsselmeer hospitals has damaged the citizen’s trust in healthcare (parties) and the extent to which they’re able to really put the public interest in available, accessible, and good healthcare first. Now, researchers observe that healthcare (particularly the networks of healthcare professionals) is being restored in terms of content. The trust of citizens – reflected in local governments, the Flevoland Patient Federation (FPF), and Stichting Actie Behoud Ziekenhuis Lelystad (foundation to promote the preservation of a general hospital in Lelystad) – is still fragile.

Therefore, the explorer of the future proposes to keep analyzing and monitoring the situation carefully, and to continue consulting with all parties involved through Zorgtafel Flevoland (healthcare table Flevoland) in the coming year. The latter is supported by a progress meeting, chaired by the Ministry of Health, Welfare, and Sport. It also offers the option of addressing bottlenecks and escalating progress-related problems. The Ministry of Health, Welfare, and Sport can use the outcomes of the meeting to inform the Dutch Lower House of Parliament.

Acute healthcare

One of the issues that damaged trust encompasses concerns about accessible emergency care. Before the bankruptcy, patients with an acute, life-threatening condition, such as a heart attack, were sent to the Zwolle-based hospital. This procedure will be maintained. Because of the emergency outpatient department in Lelystad and the local emergency room in Emmeloord, it’s possible to provide care in the area in the case of low-complex emergency conditions.

To relieve pressure on these surrounding hospitals, it’s important to set up an acute care data science team in Flevoland. The team can contribute to the improvement of processes, which can increase the availability and effectiveness of emergency rooms. Currently, the St Jansdal hospital provides the emergency outpatient department at the Lelystad location and the emergency room at the Harderwijk location, which means it’s logical to start with this hospital.

By deploying data and new technology in the right way, ambulance care in Flevoland can take the lead in data-driven process improvement in the short term. This may serve as an example for other regional ambulance facilities in the Netherlands in the long term.

Obstetric care

The disappearance of acute obstetrics in Lelystad means that part of the people in Flevoland need to travel a longer distance in acute obstetric situations. The increase in travel distance means it’s easier to use an ambulance.

A new type of collaboration is needed to keep providing good birth care. Carefully organizing the unchanged demand for care within the context of the altered care provision – both primary and secondary care – is a priority. Recently, new partnerships have already been established between all care providers involved. They have given tremendous effort to reach additional agreements, which has strengthened cooperation and mutual trust.The explorer of the future also recommends that birth care in Lelystad is supported for one year.

The starting point is to offer birth care in the pregnant woman’s area if possible, and to provide it in a clinical setting as quickly as possible if the case in question so requires. Birth care providers are obstetricians or obstetrically active primary care physicians, secondary and tertiary care obstetricians and gynecologists, the regional ambulance facility (only in the case of acute obstetrics), and maternity care.

Care and support for vulnerable groups of people

The growing number of vulnerable elderly people with a complex, often cross-domain demand for care and the increasing health differences between socio-economic groups require far-reaching cooperation between care and welfare organizations and municipalities.

An adapted form of the neighborhood clinic in Amsterdam would be an interesting initiative for Lelystad. This clinic’s target group consists of patients with a combination of geriatric problems and, for example, pneumonia, COPD, heart failure, a bladder infection, or neurological symptoms. The results are positive – patients experience less loss of function, and the number of readmissions and emergency room visits is reduced, among other things. Several parties have now entered into discussions, and the first plans for such an initiative in Lelystad are being developed.

There is also a demand for primary care plus in the Noordoostpolder. Chain partners have signed a letter of intent for the new health plaza to be built in Emmeloord. This care concept will offer room for day treatments, convalescence, and observation beds, among other things. The various parties’ involvement enables far-reaching cooperation.

Furthermore, the number of residents with a chronic condition, which is already relatively high in Lelystad, is expected to increase sharply. One of the numerous action points that should be implemented according to the explorer of the future is the deployment of e-health initiatives. However, it is essential to pay attention to the limited digital and health literacy among part of the population. Finally, it is important for health insurers to support these initiatives – that is, if they don’t already.

Vision for the future of healthcare in Flevoland

In January, after the sudden bankruptcy of the IJsselmeer hospitals last fall, minister Bruno Bruins appointed Leerink. The disappearance of the emergency room and obstetric care caused much unrest in Flevoland. As an explorer of the future, it was Leerink’s job to make a thorough inventory of the healthcare market in Flevoland and to subsequently outline both short-term and long-term needs.

Healthcare vendors want less market and more cooperation

By | Health, News

Purchasing and selling between healthcare providers and insurers is increasingly a strategic activity. New mutual agreements do not merely consist of budgeting and enabling expense claims. On the contrary, both parties contribute their strategic intentions. As a result, healthcare contracting becomes the starting point for joint projects. IG&H conducted a research among hospital healthcare vendors and found that healthcare contracting is increasingly at the heart of the healthcare system. To cope with core healthcare issues, however, more cooperation is required.

Download the Zorgverkoopmonitor 2019 (healthcare vendor monitor 2019) here (in Dutch).

In the Zorgverkoopmonitor 2019, IG&H takes stock with healthcare vendors and looks at the future. Nearly 25 healthcare vendors and finance managers at hospitals and clinics participated in the research. Together, they represent a total revenue of approximately €8 billion.

It turns out healthcare vendors want to set aside twice as much time to discuss policy themes and quality with insurers. Currently, price and volume still dominate more than 60% of all meetings. If it is up to healthcare vendors, 50% rather than 25% of meetings will be about substantive themes, such as the right care in the right place, meaningful care, and a vision of the region.

Approximately half of the respondents have concluded long-range agreements with the largest insurer – and a quarter of them with nearly all insurers – laying a solid foundation for a different type of meeting. ‘Unfortunately,’ not all of these are cooperations between providers and insurers. Part of the long-range agreements are simply concluded because banks require financial security. However, these long-range agreements provide peace of mind and room for a different type of meeting.

There’s a reason why healthcare vendors appreciate insurers bringing their own vision of healthcare to the table. You may disagree on this vision, but it is the main reason why 45% of healthcare vendors consider Zilveren Kruis the most professional of healthcare purchasers, and 25% believe it to be VGZ. According to healthcare vendors, they have set up a proper foundation for healthcare purchasing, and it is now time to give healthcare purchasers more authority and room for customization.

Ultimately, 30% of healthcare vendors consider the affordability of healthcare as the main challenge – especially the gradual transition (25%) to a different healthcare landscape (25%).

Healthcare vendors mainly want realistic financing, and they are willing to contribute to a financial transition. They, too, realize that healthcare should remain affordable for everyone. At the same time, they also need to deal with fixed accommodation and staff expenses, which means they can’t rush into cutting costs.

The art of concluding contracts in a new era

Even though they seem to have conflicting interests at times, healthcare providers and insurers face the same task. Of course, it can be completed through harsh negotiations, but lowering revenues and costs together requires a substantive cooperation.

The latter starts with mutual trust, which is created by truly empathizing with the other party.

The next step is for both parties to define a shared ambition that serves each party’s interests. Develop a vision of the region or certain types of healthcare, look beyond your own organization, and determine what it is you want to achieve together. Set up a joint project group, allow each other access to data, and perform the analysis together. Joining forces will automatically eliminate old behavioral habits. Discussions will no longer be about each letter in the contract but about what is good for the patient, the policy holder, and society. This will ultimately benefit insurers and healthcare providers, too.

By Walter Kien, Senior Manager Healthcare

IG&H and GroupLife combine forces

By | Banking, Health, Insurance, News, Pensions, Retail

Consultancy firms IG&H and GroupLife are moving forward together under the name IG&H, resulting in a specialized consulting group that is able to help realize business and technology transformations from start to finish.

Both companies have in-depth sectoral knowledge, close customer relationships, high quality people and service. By combining their expertise in strategy, organizational transformation, data analytics and technology, they will be able to more effectively help organizations with transformative matters. The new consortium includes more than 220 specialized professionals.

Execution of strategy requires integral approach

Jan van Hasenbroek, managing partner IG&H: “The rapid developments in the technology sector have an enormous impact on the business models of our clients. In order to remain successful in the future, our vision must include addressing organization and technology together. This will lead to corporate strategies being immediately operable, providing concrete results and sustainable organizational transformation. GroupLife has an impressive track record and a proven methodology in business modelling, implementation of technological platforms, and data management. That’s why a collaboration fits well within IG&H’s strategy to continually strengthen its technological ecosystem.”

Wim Groenen and Tom Bottinga, co-founders of GroupLife: “In previous projects with joint clients, we discovered that we had similar ideas about how to address complex business transformations. IG&H knows how to combine its expertise in strategy, data analytics, technology and organizational transformation with sector knowledge. We are delighted with the collaboration and together with IG&H we can make an even greater contribution to the success of our clients.”

About IG&H

IG&H is committed to help leading organisations in the financial services, retail and healthcare sectors. With 160 involved and enterprising professionals, the consultancy and implementation firm, based in Utrecht, helps organizations take steps towards radical customer centricity. They set high standards for themselves and their way of working. With in-depth knowledge and a personal approach, they aid their clients to help them improve the sector. IG&H is recognized as a ‘Great Place to Work’ and puts a lot of emphasis on a high net promotor score.

Are we in the Dutch healthcare market looking forward to Amazon?

By | Health, Healthcare, News

Last year, Amazon entered into a partnership with Berkshire Hathaway and JPMorgan Chase & Co. The company also bought Pillpack, an online pharmacy. Both initiatives aim to offer good care at a low price. This step arouses unrest: the share prices of several companies in the med tech and pharmaceutical industries fell. Has a new disruptive healthcare player emerged? And what will the effect be on the Netherlands?

By entering into a partnership with Berkshire Hathaway and JPMorgan Chase, Amazon is circumventing the health insurer. The purchase of Pillpack and the plans to open clinics indicate that the ambitions of the web giant go beyond just financing care. If Amazon interferes with technological developments in the healthcare market, the impact will be vast. It fits in with the strength and motivation with which the company has also entered the supermarket sector, for example.

Opportunities for digital platforms in the Netherlands

In other markets, we see tech parties that bring supply and demand together on a single digital platform emerge. This excludes intermediaries, as Airbnb and Netflix are already doing.

Does Amazon have this healthcare role in mind and is their plan to take it outside the US? There are many intermediaries active in the Dutch healthcare sector, for example in health insurance, pharmacy or medical devices. For Amazon and other online disruptive players, there are plenty of opportunities to integrate and digitise the role of these intermediaries.

Exciting, because they will significantly increase the competitive pressure in the healthcare market. A platform offers many advantages in terms of ease of use and experience. It also makes the offer transparent, which lowers prices. And that is the – so far only – goal communicated by Amazon, Berkshire Hathaway and JPMorgan Chase.

Getting a foothold is difficult

Before a digital player like Amazon gets a foothold in the Netherlands, it will have to overcome many hurdles. Our complex financing structure leaves little space for new business models. The patient is not or hardly willing to pay extra for new services, on top of the premium. This is a major entry barrier for new initiatives.

Health care systems across the globe vary considerably, making it more difficult for platforms to scale up across borders. Crucial to the success of digital platforms is the low cost of an additional user. With different systems, this success factor does not seem to work. Truly successful digital players need a minimum scale that is larger than the Dutch market alone.

To be successful, digital disruptive parties use data and algorithms. In Dutch healthcare, mass data and especially medical data are well protected by laws and regulations. Previously, the national EPD had already failed in the Senate for privacy reasons. Technological innovations in data exchange offer a solution, but are still in pilot phase and not widely implemented.

Finally, healthcare is a service par excellence for which human contact is essential. There is a relationship of trust between doctors, pharmacists and their patients. This can be supported, but it is difficult to replace it entirely by a digital platform of an American tech giant.

Pressure on these barriers is increasing: breakthroughs are imminent

However, we cannot assume that a party like Amazon will be held back by this. Health insurers are increasingly looking for innovative ways to reduce healthcare costs. This may change the payment culture among patients, making them more sensitive to the supply of new parties. Progress is also being made on digital data exchange. This will hopefully be further accelerated by the obligation to share patient data digitally, recently announced by Minister Bruins.

As a result of these developments, the aforementioned stumbling blocks for tech players are becoming less threatening. The current healthcare market can see this as an opportunity for further development. Tech players are successful because in their business operations, they put their customers first. They offer more convenience and excellent service. Ask yourself whether your organisation still meets the needs of the patient or customer to the maximum. Identify the steps you can take to match this level, perhaps in collaboration with successful tech players.

Wondering how (digital) disruptions can take your organization to the next level? At IG&H we are happy to think along with you.

By: Roos Blankena (r.blankena@igh.nl) and Linda de Jong (l.dejong@igh.nl).

Bas Leerink new Health partner at IG&H

By | Health, News

On January 1, Bas Leerink will join IG&H as a partner. Leerink has in-depth sector knowledge about healthcare and wants to use his knowledge for the benefit of the patient.

Leerink previously worked as a director at health insurer Menzis, and afterwards as chairman of the board at top clinical hospital Medisch Spectrum Twente. At the time of his appointment in 2013, the hospital was facing difficult times; it came under strict supervision, while at the same time a new hospital was being built. In the last six years, Leerink focused on more transparency and received a lot of praise for doing so. Presumably, the organization is currently doing very well financially. Leerink has also put Value-Based Health Care on the agenda, together with the other Santeon Hospitals.

He wants to apply this knowledge to healthcare institutions and insurers in a broad sense. On his move to IG&H, Leerink says: “There is a lot to do in healthcare. Society expects better services, continuous introduction of new medical techniques and medicines, more “joint decision”, and more possibilities for healthcare at home, at the same cost. For me, the continuous focus IG&H places on the end-user of healthcare or health insurance is an important reason to make this transition. Besides of course the team of people with whom I will be working. “

Princess Máxima Centre: Providing a path for medical technology

By | Health, News

The run-up to the opening of the Princess Máxima Centre was a special time. Today, the third blog of a series in which we discuss the following question with the experts involved: how did the centre so quickly go from dream to reality in no more than 8 months?

“What do you need to put into what type of medical situation?”

“We only just began tackling the question of medical technology this past December 2017. Only a half year before the opening”, says Wilco Kleine, healthcare technology and innovation manager. At that time, there had not yet been a single thought about what the centre would need in this area. “What demands do we have to put into place regarding equipment? Which brands do we choose? How do we get the ultimately 3000 different types of medical devices delivered on time? Which healthcare professionals need what type of training to be able to work safely and efficiently with the equipment involved? And what if a device breaks down during use? These kinds of questions had not been answered until that moment. Which is why we had to go through the entire process quickly. “This was not easy, because it involves a lot of regulations and medical technology that directly affects patient care. For example, you can not just go out and buy a hospital device and install and use it.” Kleine: “You have to think carefully about what you need to do exactly for any medical situation that may arise. So we first determined which devices would fit in the new care processes, such as patient monitors. Afterwards, together with the healthcare professionals, we looked at the requirements that were set, which providers could supply the right equipment, and which configuration was best suited for our centre.”

“It was like shooting at moving targets”

The fact that everyone took care of a specific task during the transition period, especially within their own domain, did not always make it easier. “Everything had to be done quickly and therefore run simultaneously”, says Kleine. “In this context, it is very difficult to keep the various disciplines well-managed. IG & H participated in all program lines and monitored the coordination within the organisation, which was fully ensconced in the construction and set-up phase. There was a great added value in that.”

Arvid Glerum, consultant at IG&H, adds: “For us it was one of the biggest challenges to get everything done in time. At the organisational level, all sorts of things are so new and interesting that you want to share them, but we always had to weigh up: when is something just interesting to know and when is it critical?” Because everyone at the Prinses Máxima Centre was making choices at the same time in order to organise everything properly, there were a lot of mutual dependencies. For example, when something changed in the building, this had consequences for the technology needed, and vice versa. “It was like shooting at moving targets”, says Arvid. And Kleine agrees with this: “We have managed to keep a good grip on things by putting together a multidisciplinary group with which we have managed the whole process. This included representatives from all areas: from care to purchasing to technology. This made it easier to discuss developments with each other on a weekly basis. Arvid informed us about all the relevant developments in the other programs and provided us with progress reports with which we kept the entire transition organisation up-to-date.”

“Everything had to work out and everything had to be safe”

Because the subject of medical technology came relatively late on the agenda, the team encountered the necessary problems. That often required making swift decisions. “Once you have ordered a monitor, for example, there’s not much you can change”, says Kleine. “So there were times when we had to tell the organisation that it was really time for a final decision. In this way, we have also been able to set the framework.”

“Because some decisions were postponed, we often had to join forces with the suppliers”, says Arvid. “We once had a supplier show up at the door, having driven in his own car during the weekend, with equipment in the boot of his car.” Kleine thought it was nice to see that everyone came together in this success mode: “Everything had to work out and everything had to be safe. The equipment not only had to arrive on time, but also comply with all the regulations. The quality of care is indeed a precondition for the centre.”

The balance that was established provided a solid framework. We mapped the risks and determined how we would tackle them. “We opted for a more pragmatic approach for less risky systems, while we used very detailed procedures for high-risk systems”, Kleine explains. “We have done everything neatly and meticulously, but without the stagnating bureaucracy that you often encounter in existing hospitals.”

“Hands-on, a-typical, successful: the process was unique”

The Princess Máxima Centre attaches great importance to keeping patients mobile. This was the mentality throughout the entire process. Kleine: “The patient must go through the care process smoothly. For children, it is very important for them to be able to move around and get out of their room. The centre works with innovative care concepts, which we had to design technologically during the transition.” Because the opening date of 18 May was rapidly approaching and medical equipment normally had delivery periods of a few months, the team had to act quickly: “We have organised the medical technology in such a way that the centre is ready for innovative care concepts, now and in the future. For example, we have ensured that nurses can monitor all the vital parameters of patients remotely, via smartphones, and even watch them live on monitors. But perhaps the most important thing is that patients are actually mobile now!”

Another important and complex part of the project was the training of health care professionals. Starting up with a completely new organisation has had its share of challenges, but also unique opportunities. For example, through transition meetings we have been able to train all doctors’ assistants, nurses, and medical specialists on all the risky equipment and critical work processes. Even before they started working in patient care. Super-users have also been given extra training and brought into the position for providing support at the workplace, as well as training new colleagues in the future. In fully operational hospitals this is often difficult to manage.

Both Kleine and Arvid proudly look back on a fantastic process. Because of the hands-on mentality and solidarity within the collaboration, but also because it has been a very a-typical experience in hospital care. “Within a ‘pressure cooker setting’ we achieved a solid, final result in a very short time”, says Arvid. “The entire centre, from the doctors to the employees, really came together in the final weeks. Together we rolled up our sleeves. It was very special to see and experience that.”

“We have built a centre completely from scratch: a new organisation, in a new building, with new stuff”, adds Kleine. “We had a successful dynamic with each other, throughout the entire transition. And we achieved this through a combination of being able to shift gears quickly when necessary and maintaining an organisation-wide view when making decisions. It was a wonderful, unique, and inspiring experience.”

Healthcare organisations deserve more trust (and must have their business operations in order)

By | Health, News

The bankruptcy of both MC Slotervaart and MC Zuiderzee has dominated the news in recent weeks. Although the care system in the Netherlands is one of the best in the world, the two hospitals are symbolic of the chaotic business operations plaguing this sector. Healthcare organisations are also companies, which should not shy away from healthy competition, and should, in general, implement well-thought-out rationalisation and positioning plans. And this comes with (financial) risks.

Every care manager has to deal with it; health insurers that interfere with substantive procedures in hospitals, authorities that would rather impose extra rules than discuss them, and specialists who want to staunchly defend their crucial position within the hospital. Cooperation is hard to find; everyone seems to be acting out of self-interest. ‘Bubbles’ is what Femke Keijzer calls them. The Healthcare Director at IG&H recently spoke to about 30 different Dutch health care managers on this subject for her book ‘Fit Health Care, the step towards healthy management’.

“Corporate responsibility is a disliked point: it is not at all among everyone’s top three interests to act upon,” she says. The metaphor of an ice hole in the care pond came into being: good concrete plans are there, but who has the courage to take the plunge and really make the transformation. The financial pressure is inadequate and if you jump you take risks. And that while you also get a lot healthier as you come up.

‘We must strive for connection’

Keijzer realises it is not an easy situation to break through. “The rules of the game no longer suffice. As long as we do not change them, we will not solve this problem. If we want to keep our care affordable, we must first repair the roof before we furnish the house. The management must be fit. This is only possible from a basis of trust, instead of just another system change”, she says.

“Regardless of what happens in a sector; the customers must be central. They have no interest in slow internal processes, but want to be helped quickly and effectively. Close to home with as few inconveniences as possible. Therefore, break down the walls between specialists, departments, and external organisations, and only focus on performance”, says Keijzer.

When you do that, you can then make better-informed choices as a healthcare institution. “You also know which ‘buttons’ you have to push, for example, to achieve a shorter walk-through time or to increase patient satisfaction. You also save, because you prevent medicine intake, or surgery is not necessary.”

Playing to win

It requires quite a lot from a care organisation. We often hear now that the business operations must be in order: this is about administrations and ICT, correct information, and your financial risks. It is necessary that the direction of the organisation fits well with this.

“Value-based healthcare sounds great, but if we do not know whether it is profitable from a financial point of view or if the use of, for example, medical specialists and ORs is not optimal, then you should put the priority there first”, says Keijzer. “And then a playing to win mentality can come in handy.” Consistent leadership with a strong dose of guts and the involvement of a leading coalition makes it a success.

No more external pressure

But what should we do with authorities, insurers and regulations that increase the pressure on healthcare institutions in the hope of saving costs? Initially I say: abolish, according to the Health Director. “Research has shown that external parties do not generate a sense of urgency among healthcare administrators. All this pressure only distracts, and costs both time and money. It also makes no sense to point out to managers that they have a social responsibility.” So letting the market operation continue to work is a good plan.

If we want to prevent hospitals from collapsing, health insurers to see their costs rise, and the patient ultimately having to pay for the bill, we need to give hospital administrators more freedom. “They are now ready to change the care landscape, so give them the space and the financial resources. The required margins in healthcare must, for example, be realistic. Within the partnership with the health insurer, a hospital must have time: return does not always come in the first year. That is why long-term vision and planning are crucial.” And then the hospitals choose overturn themselves because care in the region is better organised.

Who should pick up the ball? (And where do they start?)

What is needed is that we appeal to everyone’s social responsibility in combination with a healthy dose of realism. Give healthcare administrators the confidence to take this responsibility and help them to make decisions. Join us if you are a medical specialist and are open to change. We have seen hospitals take the first good steps: follow them, and do not be too arrogant: you can learn something from everyone. And that you yourself can do better than the other is the right goal to have for the next few years, and also the challenge.