Value Based Healthcare (in Erasmus MC)

Transcription

1 Value Based Healthcare (in Erasmus MC) Jan A Hazelzet, MD PhD CMIO and Professor Health Care Quality & Outcome

2 Sophia Children's Hospital Erasmus University Medical Center NYT JUNE 15, 2017

3 Desiderius ERASMUS Born in Rotterdam Humanist 1 st European Rotterdam 1466 Basel 1536

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7 These are our aims! More information: Ambition 1: Continually adding Value Our guiding principle for research, education, and health care is creating added value for patients Understanding the health, diseases, and wishes of patients Personalized medicine (individualized treatment) Prevention Translating knowledge into useful, innovative products and health care concepts

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9 The effect size Benefit Harm Resources necessary appropriate inappropriate futile Zero Adapted from: Gray M. How to Get Better Value Healthcare. 2nd edition. Oxford: Offox Press Ltd.; 2011

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12 VBHC: value based healthcare Health Care Quality: Effective Patient centered Safe Efficient Timely Equitable Outcomes + Experiences that matter to patients + energy needed to achieve the outcomes Focus on Disease / Individual Team based approach Care Path / Integrated Care Measurement of outcome & costs in every patient == Culture / Organizational change Fee for volume performance VALUE

13 Focus on the outcomes that matter most to patients

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15 Why PRO (patient reported outcome) Biomarkers fail to correspond with how patients actually feel Patients value biomarkers differently PROM s provide a key component to understand burden of disease Especially important in diseases with morbidity (and low mortality) Starting point for improvement of therapy Better communication and shared decision making Detecting adverse effects of therapy PRO PROM PRO-PM o Depression HADS - % pts wit initial HADS > 8, and < 8 at 6m

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17 Erasmus MC Blueprint Facilitate the teams on their journey towards VBHC Intake Preparation Develop & Design Building Implement Evaluate & Innovate Change management Expertise team VBHC Collab. agreement Preparation Care path & Outcome set Building IT configuration Building dashboard Facilitate benchmark Disease team Signing up Preparation Optimize path & set Implement & measure Continuous improvement Benchmark & innovate Patient participation in the sessions

18 Breast Cancer CTCAE v4.0 EORTC QLQ-C30 EORTC QLQ-C30 EORTC QLQ-BR23 FACT-ES EORTC QLQ-LMC21 EORTC QLQ-C30 BREAST-Q BREAST-Q EORTC QLQ- BR23

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21 Patient Reported Outcome Measures (PROMs) en Provider Reported Measures

22 PROM-learning 2,5 years registration (at outpatient clinic or by phone/ post) PROMs No response Reminder PROMs No response Data registration in waiting room prior to/after clinic Patient response PROMs data visible to clinican Patient reponse Including feedback by health care professional Need for normscores : What is to be expected? When to intervene?

23 Results are discussed in the consultation room

24 Hands on Prospective data collection (since 2015) including feedback Benchmarking with 8 regional partner hospitals Summer 2018; Albert Schweitzer, Amphia, SFG and Vlietland, Ikazia, Maasstad, van Weel Bethesda, Spijkenisse Medisch Centrum) Dataplatform and dashboard: Dutch Hospital Data (DHD) (initiated by NVZ & NFU) International benchmarking European University Hospital Alliance; Dana Farber Cancer Centre, Boston; OECD National initiative to measure PROMs in other UMCs

25 Lagendijk, M., van Egdom, L.S.E., van Veen, F.E.E. et al. Ann Surg Oncol (2018).

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28 The Timeline of VBHC in Erasmus MC Starting: Head and Neck cancer Starting: Bladder cancer Starting: Macula degeneration (T) Starting: Cataract (T) Starting: Starting: Subarachnoid hemorrhage Pregnancy & Birth Breast cancer Sickle-cell disease Craniofacial GIST Esophageal and anorectal Stroke Cervical cancer Microsomia malformations Cleft lip & palate Pediatric thoracic surgery Functional bladder *Start: Pilot Value Based Reproductive medicine: Turner syndrome Pediatric brain tumors disorders Payment (Testicular sperm extraction Brain tumors Obstructive Jaundice Larynx cancer *First VBHC course and IVF) Obesity (T) Lung cancer Peripheral vascular (Erasmus Summer School) Autoimmune inflammatory Liver tumors disease *Start: Pilot Value Based disease (incl. biologicals) Liver transplantations Skin cancer (T) Healthcare Medical Multiple myeloma Kidney transplantations Sarcoma Curriculum Congenital hand Familial hypercholesterolemia malformations 1 st Erasmus MC and ICHOM strategic partnership *HBR: A Blueprint for Measuring Health Care Outcomes Overall health *2nd VBHC course (Erasmus Summer School) = Erasmus participation in ICHOM set

29 Work in Progress: Overall Health Adult Overall Health Pediatric Hand and Wrist Conditions Congenital Heart Disease Head & Neck Oncology

30 Patient as a Partner

31 Evidence vs Value Based Health Care JAMA 2014; 312:

32 Patient Reported Experience Measure: Picker Principles of Person-Centred Care Involvement of and support for family and Carers Picker Institute Europe

33 Transforming the current system in several ways Current system Focus on specialty Clinician based approach Organized in hospital Measurement of process and charges Fee-for-service payments based on volume/services IT systems for services and departments New model Focus on individual with disease(s) Team based approach Integrated Care Measurement of outcome & costs in every patient Performance based payments Integrated IT platfrom Adapted from Michael Porter

34 Improvement is teambased

35 Towards Continuous Team-based Redesign based on Value Organizational Support Change Support Performance Data Set PROM s PREM s Clinical Outcome Disease Team United, responsible, accountable Care Proposition Preventable Complications..clinical leadership, team collaboration, personal commitment Data Support Patient Support Key Process Measures Finance Team Culture

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37 VBHC Collaboration Erasmus MC Zilveren Kruis 2 year follow-up for outcomes 2 year claims data (total costs) Integrated Care: Erasmus Rehab Nursing Home Physio Homecare Long-term project for shared savings/risk contracting &VB bundled payment

38 Corporate entity One Management Combined Contract Uniform Budget Joint consensus Multiple Separate Different Separate

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40 SNOMED CT & LOINC

41 Perlo J et al. IHI Framework for Improving Joy in Work. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2017

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43 VALUE BASED HEALTHCARE (VBHC) Value = Outcomes & experiences that matter to patients Costs and energy needed Focus on disease / individual Team based approach Care Path Integrated Care Shared decisionmaking Measurement of outcome & costs in patient Culture / Organizational change Fee for volume performance

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45 2019 August, every day 13-16hr