Outcome basedhealthcare2018-202225 September 2019 | VBHC Conference Finland
225 September 2019 | VBHC Conference Finland
Kees MolenaarProgram manager
Nico ZijnstraWorkstream lead
Your speakers today
› Provide insights in Dutch National Outcome Based Healthcare program
› Exchange perspectives on a nationwide approach› Discuss practical challenges of moving a system towards value
Objectives for today
325 September 2019 | VBHC Conference Finland
Agenda Introduction
Healthcare in the Netherlands
A brief history
Outcome based healthcare
Healthcare in the Netherlands...
25 September 2019 | VBHC Conference Finland
Main principles
• Access to healthcare for all• Solidarity through medical
insuranceHigh quality healthcare services
Public requirements
• Private individuals are required to purchase basic health insurance
• Insurers have to accept all clients
• Premiums are equal to all insured individuals
• Insurers have duty of care• The contents of the insures
basic health coverage is provided for under law.
5
...is a system of managed competition
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Insured individuals are free in their choice of insurer; possibility to
change every year
Providers compete for contracts with insurers on price & quality of
care
Insurers compete for insured on premium, quality, service level
Insured individual
Provider InsurerHealthcare purchase market
Government are responsible for organising accessibility, defining basic package and supervising
market and quality
Public private partnership
Agenda Introduction
Healthcare in the Netherlands
A brief history
Outcome based healthcare
...20192018201720162015
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Shared-decision making
Letter to Parliament
on Outcome transparency
(minister Schippers)
Board meeting
CA-partners
Collaboration agreement1 (CA)
specialist medical care
Year of transparency
Coalition agreement Rutte III
1 Four-year deal with CA-partners:• Dutch Hospital Association• Federation of University Medical Centers• Patient Federation• Association of medical specialist• Professional nurse practioner organisation• Umbrella organisation for health insurers• Umbrella organisation of private clinics
Professional associations jointly emphasize ambition to develop outcome information that is relevant for patients for 50% of the national burden of disease and to use this type of information for:• Performance improvement and learning• Usage of outcome information for shared-
decision making• Healthcare purchasing that
supports patient needs
Agenda Introduction
Healthcare in the Netherlands
A brief history
Outcome based healthcare
1025 September 2019 | VBHC Conference Finland
Step1
No striving for 100%certainty• No longer striving for removal of all
barriers and 100% certainty, but to startquickly and develop while learning.
Outcome basedhealthcare• Improving patient quality of life.• Increasing job satisfaction for
healthcare providers.
Getting startedlocally• 10% pioneers as leverage• Dutch Health Care Institute
(ZiNL) and Ministry of Health,Welfare and Sport (VWS)createroom for pioneers
• Patients as driving force toactivate demand
Show that it is possible!
Organise:from 10% to 100%
Outcome based healthcare= the new norm(al)
Front runners
Master plan
ICTstandards / € / privacy
Regulatory pressureexperienced difficulty
Rewardsfinances / funding
Along a four-pronged approach:
1. More insight into outcomes
2. More shared decision-making
3. More outcome based organisation and payment
4. Better access to relevant and up-to-date outcomes information
How to prepare for a ride on a winding road?
1125 September 2019 | VBHC Conference Finland
BEST OUTCOMEFOR THE PATIENT
4. ICT & information
3. Payment &organisation
1.Outcomeinformation
2. SharedDecision-making
Initiative 1
Initiative 1
A national steering group to coordinate program
National Outcome Healthcare
Steering group
Working group ‘Outcome
information’
Initiative 1
Working group ‘Shared-decision
making’
Working group ‘Payments and organization’
Working group ‘IT and data’
Program Management Office (MoH)
Group of all CA-partners to refine and detail the ambition and jointly initiate program activities (convened and chaired by MoH)
PMO to provide day-to-day steering and coordination
Every working group is chaired by one of the CA-partners.
Individual initiatives contribute to progress towards the vision (and generate learnings / insights)
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Workstream 1More insight intooutcomes
• Patients and healthcare providers know which conditions are part of the approach.
• Patients and healthcare providers know which outcomes are relevant.
• Healthcare providers are given room to use these outcomes as they see fit.
• Parties are familiar with agreements about use of outcomes and validation of said use.
• Governance of quality registries increases efficiency.
3.1 More insight into outcomes
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Workstream 2More shareddecision-making
• Patients know that they can share in the decision and are supported better than before.
• Healthcare providers and health insurers are now more focused on shareddecision-making
3.2 More shared decision-making
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Workstream 3More outcome basedorganisation andpayment
• Outcomes play a substantial role in healthcare contracting.
• Organisation of care is based on the patient’s entire chain of care.
3.3 More outcome based organisation and payment
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Workstream 4Better access to relevantand up-to-date outcomesinformation
• All patients are able to report their outcomes.
• Data management (collection, management and processing) is well organised and can be scaled up.
• All persons and organisations involved in patient care have access to outcome information.
• Outcome information is safely available for other purposes, taking privacy guidelines into account.
3.4 Better access to relevant and up-to-date outcomes information
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1 2
3
INVOLVEMENT&PROMOTION
AWARENESS
INTERNALISATION
4. Change management approach1 Awareness
• Communication ambitions and creating expectations.• Attention for pioneers and followers, both within and between
care organisations.
2 Involvement & promotion• Learning from each other in daily practice.• Exploring organisation of regional support with parties
including NFU, NVZ and ZKN, using existing care networks and bottom-up implementation of best practices where possible.
• Connecting to (existing) local and regional care networkstogether with patients.
• Connecting to existing initiatives and projects, such as BeslistSamen, Linnean, Santeon, VIPP and Zorgladder.
• Immediately addressing organisational bottlenecks in localinitiatives; make structural solutions available.
• Improving quality registry landscape.• Invite pioneers as ambassadors.• Stimulate regional meetings.
3 Internalisation• Create location(s) for knowledge, experience
and implementation support.• Address administrative bottlenecks via evaluation of Administrative
Meeting on Transparency.
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Time
START GROWTH MATURE
2022
- Linnean initiative- Santeon- CA funds
- Outline agreement- Administrative meeting on
Transparency- Information deliberation
Peer pressure - IGJ- NZa
Activ
epa
rtic
ipan
ts
A snowball effect with impact…
2225 September 2019 | VBHC Conference Finland