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Transitioning to high value care: think big, start small and don’t reinvent the wheel

27 November 2020

 

The transition to high value care (HVC) models doesn’t demand a new system, but instead refocusing resources already available and harnessing the passion of healthcare professionals (HCPs) to make a difference to patients, experts explained on the second day of EIT Health’s Summit Series. 

In the session, High-Value Care: Evidence-based Transformation in Patient Care, chaired by leading HVC expert, Christina Åkerman, affiliate faculty at Dell Medical School, delegates heard from the leaders of three successful HVC systems based in the Netherlands, who challenged healthcare professionals to rethink what’s possible.

Director of Santeon, Pieter de Bey, operates a network of seven hospitals delivering healthcare nationally across the Netherlands through HVC.

He said: “[The most important advice is to] define value outcomes together with patients and use what’s already out there - you don’t need to reinvent the wheel.”

Santeon set up patient groups across 15 different diseases to work with medical professionals, defining the outcomes that matter the most to them. Treatment decisions and the data being monitored is then based on those outcomes. 

Overcoming the barriers

In an online survey delegates in the session believed interoperable data platforms were the biggest barrier to HVC but de Bey disagreed.

“You don’t need sophisticated technology”, he said. “When we started, it was about getting data from existing systems. Our patients all had electronic medical records but they were not all the same. We put our data managers and analysts in charge who collected meaningful data and started benchmarking and comparing.”

While it was agreed that improvements in standardising data capture would significantly enhance data quality, speakers recognised the foundations were already available they just need to be agreed and enforced.

Speakers also agreed that a major incentive to the success of HVC is the ability for HCPs to fulfil the reason they entered the healthcare profession in the first place – to make a difference to patients.

Jan Hazelzet, professor health care quality and outcome of Erasmus MC, a university medical centre based in Rotteridam, said the formula for success is, “starting with enthusiastic people. They are the pioneers.”

He explained that an HVC organisation develops by gradually inviting investors, support teams, IT expertise and then finally, support from the board executives. But he added: “This joint effort creates enthusiasm and culture change.”

Rethinking payment models

HVC puts patients at the centre of care with payment models designed around the outcomes that matter most to them. In another survey question during the session, delegates felt payment models were also a barrier to overcome. Implementing HVC will likely require a step-change from conventional payment systems centred around delivery of care to models of payment for outcomes as a result of that care.

However, Diabeter Nederland, which operates health facilities focused on patients with type 1 diabetes through remote monitoring and treatment of patients, explained it had attracted more interest from insurers as a result of its transparent, data-driven approach and long-term contracts.

Henk Veeze its senior international medical director said: “We know exact cost per patient and that together with outcome has the HVC construction. With all this knowledge we can try to predict future outcomes and look at how much we can reduce costs attributed to complications in the future. So it is worthwhile for insurance companies to invest in us because we can really do our best to get to a level where we reach a normal life expectancy and a life without complications for the type 1 patient.”

Both Diabeter and Erasmus explained that their models works by sharing profits and losses with insurers based on agreed value outcomes.

Delivering the right care

In his opening remarks, EIT Health CEO, Jan Philipp explained: “Currently, European healthcare systems are unsustainable. The cost of delivering healthcare is rising faster than GDP.

Evidence suggests that not all healthcare spending is contributing to better outcomes for patients, in fact it is estimated that around 30 per cent of all resources are spent on avoidable costs, unnecessary treatment or simply administrative efficiencies.” 

EIT Health has created the HVC forum to support the transformation of healthcare systems to HVC, to bring together key stakeholders, provide education and training, and share best practice via real-life case studies.

Pieter explained: “You cannot measure patient outcomes from a procedure perspective or from a speciality perspective, you have to do it from a patient perspective and therefore it’s multidisciplinary, it’s the result of the entire care pathway. In hospitals, traditionally we are very much focused on speciality but that is not what determines the outcomes.”

Ultimately, HVC provides a healthcare system that can cope with the future demands on our healthcare services across Europe by putting patients at the centre and delivering better care, not more care.

Don’t worry if you missed the live session, you can watch the recording here.