moving the vbhc needle · 1. specialized clinic providing comprehensive and individualized care for...

MOVING THE VBHC NEEDLE

P R O F. D R . F R E D VA N E E N E N N A A M

1 | THE DECISION INSTITUTE | 1 | PROF. DR. VAN EENENNAAM| 2019 |

“I want to congratulate Prof. Fred van Eenennaam for his pioneering work in this area.”

Harvard Prof. Michael Porter, PhD, founder of VBHC

“I appreciate your work and your recognition of the work of people implementing

value-based strategies.”

Prof. Elizabeth Teisberg, PhD, founder of VBHC

Copyright – The Decision Institute 2019

2 | THE DECISION INSTITUTE | PROF. DR. F. VAN EENENNAAM | 2019 | MOVING THE VBHC NEEDLE

A. Booklet VBHC Prize 2019

I. Flyer Intensive VBHC Green Belt Track

II. Flyer VBHC Green Belt Blended Learning

III. Flyer VBHC Center Europe Membership

IV. Flyer VBHC Prize 2020

Download the pioneering VBHC Thinkers Magazine:

https://www.vbhc.nl/vbhc-thinkers-magazine

Received Materials

Prior to the event, some interesting VBHC material was shared with you. Download also

the VHBC Thinkers Magazine for more interesting VBHC content.


https://www.vbhc.nl/vbhc-thinkers-magazine


Background: VBHC Community

An extensive international network of pioneers in VBHC education and implementation has been built over

the past 10 years. Value-Based Health Care Center Europe acts as a HUB, sharing implementation

practices among its members.

More than 28,000 academic

experts in healthcare;

VBHC tours in and outside

Europe since 2003;

International network of 120

universities.

Experience: >10 years with >110

implementation projects

Loyalty: Loyal to the VBHC

concept

First: a pioneer in VBHC

implementation and methodology

since 2008

Recognize

Celebrate

Inspire


Value-Based Health Care is growing. There are a lot of inspiring VBHC Initiatives 1

across the world focusing on different medical conditions

• Hereditary angio-odemia

• Dental Health

• Peritoneal Neoplasms

• Cardiology• Oncology

• HIV• Osteoarthritis• Diabetes• Oncology• Cardiology

• Epilepsy

• Pelvic pain

Selection of VBHC examples over the world

1. Value-Based Health Care Center EuropeCopyright – The Decision Institute 2019


LETS ZOOM IN: The Netherlands

Winner VBHC Prize 2017



Diabeter

1. Specialized clinic providing comprehensive and

individualized care for children and young adults

with type 1 diabetes

2. Diabeter is organized in IPUs (clinical and non-

clinical)

3. Measuring outcomes:

• Tier 1: Mortality rates, QOL, Psychosocial parameters

• Tier 2: Time to enroll the patient in the program, time to

return to normal life.

• Tier 3: Long-term parameters

4. Bundled payment method for the entire diabetes

care cycle

In the Netherlands there was a huge clinical problem regarding to diabetes, the pediatric facilities were full. Diabeter came with the solution

Diabeter outperforming other Dutch diabetes clinics 2

2. DIABETER VALUE-BASED HEALTHCARE DELIVERY IN DIABETES DIABETER. By: Jens Deerberg-Wittram and Laura Lüdtke from The Boston

Consulting Group, 2016Copyright – The Decision Institute 2019


LETS ZOOM IN: Denmark

Winner VBHC Prize 2019



Good Life With Osteoarthritis (GLA:D)

1. Great example of using therapeutic care rather than drugs

or surgery for treating joint, and – potentially – back pain

2. Patients are highly involved in the program

3. Started in Denmark and is now already scaled up to:

• China

• Australia

• Canada

• Switzerland

4. Planning to scale up to new medical condition: Back pain.

GLA:D implemented VBHC for people with knee and hip osteoarthritis nationwide

through education, exercise and patient-reported outcomes that empower people to

experience a better quality of life

Results GLA:D Program 3

3. GLA:D annual Report 2018 by: Dorte Thalund Grønne, Ewa Roos and Søren Thorgaard Skou, 2019 Copyright – The Decision Institute 2019


LETS ZOOM IN: Germany



1. Highly Specialized Care• 12 Chief physicians – own specialty

• 200 – 300 operations annually per person

2. Integrated Practice Unit• One clearly defined medical condition

• All care at same place

• Patient and family included

3. Bundled payments• Lower costs

• Reimbursement 0,5% less than standard

• Revenue of over 25 million USD

4. Focus on improving• Outcome measurements

• Publicly publishing results

• Learning from inside and outside

The Martini Klinik is the classical example of successful implementation of a highly specialized surgery based Integrated Practice Unit.

Martini – Klinik

Outcomes Martini Klinik 4

4. Martini Klinik: Prostate Cancer Care by: Michael E. Porter, Jens Deerberg-Wittram, Clifford Marks, 2014Copyright – The Decision Institute 2019


VBHC Prize

The Previous winners of the VBHC Prize and Excellent Awards. All of them creates excellent patient value in an unique and inspiring way.


2020

Apply for the Value-Based Health Care Prize 2020

Applications will be accepted from the 1st of September 2019

The 7th VBHC Prize Event May 14th 2020

For more information, subscribe to the newsletterwww.vbhcprize.com


13 | THE DECISION INSTITUTE | V1 | PROF. DR. F. VAN EENENNAAM | 2019 | MOVING THE VBHC NEEDLE

Appendix VBHC Implementation

I. Core VBHC Starting Tools

Medical Condition

Medical Leadership

14 | THE DECISION INSTITUTE | PROF. DR. F. VAN EENENNAAM | 2019 | VALUE-BASED HEALTH CARE

Copyright 2019 | The Decision Institute

I. Core VBHC Starting Tools

Patient Relevant Medical Outcomes, Patient Initial Conditions and Time-DrivenActivity-Based Costing are the core elements needed for Value-Based Health Care implementation.

4. Patient Initial

Conditions

1. Selection

Medical Condition

2. Define Care

Delivery Value

Chain (CDVC)

3.Patient

Relevant Medical

Outcomes

5. Time-Driven

Activity-Based

Costing

15 | THE DECISION INSTITUTE | PROF. DR. F. VAN EENENNAAM | 2019 | VALUE-BASED HEALTH CARE


2) Start point

Match patient with

available kidney

UCLA defined the Kidney Transplantation medical condition as:

1. Selecting & defining the medical condition (2/2)

Medical Condition

ExcludedExcluded

1

1 Porter, M.E., (2010). The UCLA Medical Center:

Kidney Transplantation. Harvard Business School

3) End point

90 days after transplantation

5) Related medical conditions

Heart / Lung failure

Diabetes

Depression

8) Alternative Treatment Plans

• Dialysis

• Conservative treatment

Example

7) Exclusions

Dialysis

Pre-transplant phase

1) Medical Condition

Kidney Transplantation

Patients with kidney failure

and/or

End stage renal disease (ESRD)

9) Exceptions

Complications

Mortality

6) Hand over to

Local GP / nefrologist management

4) Hand over from

Nefrologist to

transplantation team

Not in medical condition

16 | THE DECISION INSTITUTE | 2019 | VALUE-BASED HEALTH CARE


A. Medical leadership

Medical leadership is showing continuous responsibility to improve the quality of care

delivery.

No. of medical leaders needed

=10√ (total number of personnel)

1 Lee, T. Turning Doctors into Leaders, Harvard Business Review, 2010.2 Lee, T. & Cosgrove, T., Engaging Doctors in the Health Care Revolution, Harvard Business Review, 2014.

Challenges for VBHC Medical Leadership:

1. Articulating vision and values

2. Organizing for performance

3. Developing a measurement system

4. Building effective teams

5. Improving processes

6. Dismantling cultural barriers

7. Showing data

8. Defining strategy around patients’ needs

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