Value-Based Health Care in Europe. What’s Next? · PDF file6/18/2016 · Value-Based Health Care in Europe. ... Value-Based Health Care increasingly becomes the norm, ... De Schön

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

1 | THE DECISION GROUP | PROF. DR. FRED VAN EENENNAAM | JUNE 18 , 2016

Leadership and Management in Cardiovascular Medicine Forum

Value-Based Health Care in Europe.

What’s Next?

2 | THE DECISION GROUP | PROF. DR. FRED VAN EENENNAAM | JUNE 18, 2016

1. The fundamental challenge in health care

2. Value Based Health Care addressing the issuea. Value is …?

b. Who creates value and how?

c. How do we measure and improve Value Creation?

3. Three classic VBHC examples

4. The Dutch Meetbaar Beter in Heart Diseases

5. Wrap up and closure

PROGRAM


Value-Based Health Care Delivery

Introduction and background

Prof. Dr. Fred van Eenennaam

• Affiliated to George Washington University, Erasmus University, St. Gallen University and The Decision Institute

• Included in the Harvard Business School, Microeconomics of Competitiveness Affiliate Hall of Fame

• Managing partner of The Decision Group

• Incoming Chairman of the Value-Based Health Care Center Europe

1994 2006 2011 2013

4 | THE DECISION GROUP | V 1 | PROF. DR. FRED VAN EENENNAAM | JUNE 18, 2016

Michael Porter - Value-Based Health Care

The root cause of why we have difficulty in creating patient value and capturing the

value for providers and industry…

Value-Based Health Care – Healthcare Problems and Solutions

https://www.youtube.com/watch?v=6vuiYFtK2wo


Unexplained, unmeasured, unmanaged variations

…has led to FEE FOR SERVICE instead of FEE FOR VALUE … which has contributed

to increasing healthcare costs and over and under treatment of patients.

Doctors performing C-sections varies from 15 to

71,4% of births without case mix difference ???

Who is getting paid for or is paying for value?

Standardized death rates and charges

per admission have no correlation.

Source: NHS Confederation 2004, Brian Jarman, nhsconfed.orgSource: PBGH report: Variation in NTSV C-section rates among California hospitals (2014)


Balance of power of stakeholders (patients vs. payer)

Are Patient(groups)/Physicians in terms of joint decision making, bargaining power,

and influence, able to drive healthcare decisions or are the payers/ insurers dominant?

Payers,

Insurers

Facilities

(Primary) Care Physicians

Patients

Patients

(Primary) Care Physicians

Facilities

Payers,

Insurers

Where will the dominant power be?


Patient value is at the core of VBHC

Patient Value is the balance between patient relevant health outcomes and the costs of

delivering these outcomes. Patient-centered – doctor-driven.

Porter, M.E. (2013) The strategy that will fix healthcare? The New England Journal of Medicine, 363;26

“Doing the right things”

“Doing the right thingsat the right place, at the right costs”

Effectiveness

Efficiency

Value-Based Health Care is about creating value

for patients throughout the full cycle of care. It

is about maximizing the health outcome per

Euro spent (cost).


Value-Based Health Care: Change is on its way

Value-Based Health Care increasingly becomes the norm, placing the interaction between

patient and family & physician and team at the center of care.

Patient and Family

Physician and Team

- More informed (apps, internet)- Active role decision making (palliative)- Voting by feet (go to best care&cure)

- Care around Medical Condition (e.g. diabetes, prostate cancer)

- Improvement of Outcome Measures (Meetbaar Beter, Santeon)

- Transparency (ParkinsonNet)


Stop inflation of measurements and data

For many years, healthcare providers have been trying to measure performance in numerous

ways following different trends. Health outcomes are measured by outcome measures.

1950 1960 1970 1980 1990 2000 2005 2010 2014

Medical

Measures

Process &

Structure

Measures

Quality

Manage-

ment

(process

focus)

Followed by

Lean & Six

Sigma

Patient

Perception

Measures

(& patient

reported

outcomes)

Family

perception

Outcome

Measures

Historical development of measurement in health care over the past 60+ years


Health Outcomes

A limited set of outcome measures and initial patient conditions provides medically relevant

and usable data for each stakeholder.

Source: Porter, M.E. &

Teisberg, E. Redefining

Health Care (2006)


Care Delivery Value Chain

All activities over the full cycle of care are described by the Care Delivery Value Chain:

procedures, visits, treatments, communication and measures related to a patients medical

condition.

Example of a Care Delivery Value Chain for breast cancer

Source: Porter, Redefining Healthcare


How does the CDVC translate to outcome measures?

Every outcome measure is directly related to a step in the Care Delivery Value Chain that

adds value for the patient.

Example of the Outcome Measures HierarchyExample CDVC for breast cancer

Source: Porter, Redefining Healthcare

Nausea due to

Anaesthesia

Time to functional

status

2-year survival


VBHC: Why outcome measures?

Patient relevant outcome measures result in one common language for a transparent dialogue

plus the dissemination of best practices on four essential Value-Based Health Care topics.


Case examples

The Martini Klinik (outcomes), Schön Klinik (cost) and Meetbaar Beter (First Dutch

Initiative) are the three most inspiring European initiatives in Value-Based Health Care.

Martini Klinik:

Prostate Cancer Care

• Application of outcome measures in

prostate cancer

• Outcome measures analysis and

continued reflection with the staff led

to:

• Higher continence rates

(96,7% as opposed to 56,7

German average)

• Adoption of multiple best

practices and new techniques

Meetbaar Beter

Measuring outcomes in Cardiology

• Implementation of outcome measures

for 10 key heart centers in The

Netherlands

• Using outcome measures for a group

of hospitals created:

• Change in patient flows

• Transparency on patient

outcomes

• Health quality improvements

Schön Klinik

Measuring Cost and Value

• Patient Value through Time Driven

Activity Based Costing (TDABC) for

total knee replacements

• TDABC over the full cycle of care

and elaborate outcome measures

resulted in:

• Reinvestment in profitable

rehabilitation facilities

• Empowerment of doctors,

nurses and hospital


Continuous learning has led to improved health outcomes for prostate cancer

resulting in being the best prostate cancer clinic in Germany and the world.

Martini Klinik

Results - A short overview:

Source: Harvard Business Case: Martini Klinik


Schön Klinik

De Schön Klinik is the best example for Time Driven Activity Based Costing. Insight in real

costs are a valuable source for improvement.

Health outcomes:Measured by an extensive list of outcome measures such as: • Womac scale: 23.7 points (measuring pain and functional limitation

for osteoarthritis of the knee. 0 is best status, 96 is worst)

• EQ-5D scale: 77.9 points (measuring baseline health and

functionality: 0 is the worst, 100 is best)

Cost:Measured by Time Driven Activity Based Costing:Through a combination of data-analysis and interviews with clinical and

support staff the Schön Klinik team was able to create:

• Process maps: sequence of processes the patient encounters through

the full cycle of care.

• Cost assessments: the costs and practical capacity are calculated per

resource type

Schön Klinik:

Measuring Cost and Value

Patient Value through Time Driven Activity Based

Costing (TDABC) for total knee replacements.

TDABC on the full cycle of care and elaborate

outcome measures resulted in:

• Reinvestment in profitable rehabilitation

facilities

• Empowerment of doctors, nurses and

hospital

• Cooperation between different Schön

Kliniks and other institutions are central

to the success. Based on HBS cases: Kaplan et. all, 2012, 112085-PDF-ENG


Cost saving

Time Driven Activity Based Costing is relevant for improving the health outcomes for

patients and to secure the quality of care delivered.

Time Driven Activity BasedCosting (TDABC)

Interviews and data-analysis resulted in control over:

- Cut-to-next-cut for operation room turnover

- Labor time allocation- Costs of supplies (eg. drugs,

implants, etc.)- Indirect costs (eg. radiology)- Depreciation of instruments- Facility costs

Reassessment of real costs

Acute care:

- Costs dropped from $9300 to $8000. - Ebitda profit margins raised 6%-points (19%)

Rehabilitation:

- Costs dropped from $4600 to $3300.- Ebitda profit margins raised 13%-points (7%)

Reinvestment in rehabilitation

Restructured care process

Comparability of best practises

Schön KliniksPhysical therapy: not

individually but in groups

Internationally: US + Denmark

3 pilots to reduce coststhrough length of stay:

- 2 days Copenhagen University Hospital

- 3 days average US- 4 days Denmark- 10 days Schön Klinik


About Meetbaar Beter


Meetbaar Beter in numbers

Source: Meetbaar Beter Outcome Book 2015.


Meetbaar Beter: Participating Centers

Source: Meetbaar Beter Outcome Book 2015.


Meetbaar Beter: The Program


VBHC: The coming years

1. Value-Based Purchasing – moving from volume towards value

2. Data / IT integration and digitalization

3. Patient engagement

4. Creation of (systematic) learning loops for improvement purposes

5. Cultural and transformation change and leadership

6. Moving towards integrated practice units

7. Industry engagement

8. Primary care engagement

Various topics and challenges in Value-Based Health Care will become

increasingly important in Europe as well as internationally in the near future.


Save the date!

May 11

VBHC Prize 2017

Pre-applications will be accepted as of September 1st, 2016

Contact us via [email protected]

@VBHCEuropeValue-Based Health Care Center Europe

VBHCPrize.com

VBHC.nl

2017 ?

Want to become the

mailto:[email protected]



26 | THE DECISION GROUP | VERSION 1 | PROF. DR. FRED VAN EENENNAAM | JUNE 18, 2016 |

Contact:

The Decision Group

Buitenveldertselaan 106

1081 AB Amsterdam

(t) + 31 (0) 20 40 40 111

(e) [email protected]

www.thedecisiongroup.nl

www.thedecisioninstitute.org

www.vbhcprize.com

www.vbhc.nl

Thank you

Documents

Value-Based Health Care in Europe. What’s Next? · PDF file6/18/2016 · Value-Based Health Care in Europe. ... Value-Based Health Care increasingly becomes the norm, ... De Schön