outcome based healthcare 2018-2022 - nhg · kees molenaar program manager nico zijnstra workstream...

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


Agenda Introduction

Healthcare in the Netherlands

A brief history

Outcome based healthcare

Healthcare in the Netherlands...


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


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


A brief history


...20192018201720162015


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


A brief history



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?


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)


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


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


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


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


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.


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…


outcome based healthcare 2018-2022 - nhg · kees molenaar program manager nico zijnstra workstream...

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