Value-based Healthcare

The incidence of type 1 diabetes (T1D) is placing an increasing burden on the healthcare system. With the aim to improve outcomes for patients (i.e. fewer hospitalisations by fewer complications and better quality of life) and contain costs, Dr Henk Veeze and Dr Henk-Jan Aanstoot founded Diabeter in 2006 in the Netherlands. It is now a Dutch-certified clinic with more than 2000 patients in 5 locations, specializing in providing comprehensive and individualized care for children and adolescents with T1D. They are pioneering diabetes care, founded on value-based e-health solutions and a unique patient experience.

Their concept resembles the value-based healthcare (VBHC) model as put forward by Professor Porter of Harvard Business school. He stressed the need for transforming healthcare systems by improving the value of healthcare for patients without raising costs and/or maintain high-standard care at lower costs. VBHC is based on 5 pivotal pillars: 1) Integrated practice units (IPU: healthcare providers organized around the patient’s medical condition; 2) Measuring outcomes and costs of the entire care cycle, and improve value; 3) Bundled payment for care cycles, to prevent volume over quality; 4) Integrate care delivery (dedicated facilities); 5) Expansion across regions. These should be interconnected by information and communications technology (ICT) platforms for data collection, decision support and coupling technology with big data and analytics.

Diabeter operates outside of the traditional hospital setting and with dedicated personnel (medical doctors, nurses, dieticians, psychologists, administrative staff). As T1D is a chronic disease, the practised care cycle is geared towards intensifying contacts between patient and healthcare provider (visits, phone, e-mail, Skype), leading to more active patient participation. Each patient has a care manager who is responsible for the entire care cycle and contact person for all concerned (i.e. patients and care givers). ICT is indispensable: using VCare, a custom-built patient record system, data from glucose meters and/or insulin pumps can automatically be uploaded, allowing patients to monitor their own data in real-time on a dashboard. Vcare provides care managers with e-mails on patients’ status and after analysis, patients receive a ‘Ther@py mail’ with info on trends, target setting, treatment plans and follow-up appointments. In case of large deviations in the data, automatic alerts are sent to the treating physician.

"Nurses can take on twice the patient load,”. “This also means our staff get twice as much experience, helping them to become highly specialised – which further improves outcomes." - Dr Veeze

Outcomes in 3 categories are continuously monitored (health status achieved, care process and complications, sustainability of health), as well as costs. More than half of Diabeter patients are at target (55% of children < 18 years reach HbA1c < 7.5% [58 mmol/mol]) and fewer patients are hospitalized (1-3%)  compared with most other clinics (10%), with yearly costs staying constant (65-70% personnel; remainder for laboratory tests, admin, IT, accounting, marketing and rent).

Summarizing, using value-based solutions, Diabeter is shifting from spending on acute interventions to improving chronic disease management, with patients enjoying greater freedom and better health. Please find our white paper here.

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