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.
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?