Unique Value Based Heartcare community introduces new healthcare purchasing model and improves outcomes by sharing and learning
In the current Dutch situation health insurance companies pay for volume and not patient value. As a result, interests between providers, payers, and patients are not aligned and parties scuffle about finances. It’s time to make a change. As a solution we present the bundled payment initiative of the community of Netherlands Heart Registration (NHR), Menzis (health insurance company) and 10 Dutch heart centers.
The initiative focuses on the treatment of the 20.000 patients with Coronary Artery Disease (CAD) with PCI or CABG in the 10 participating centers.
The model incentivizes better value performance; if outcomes are better than expected, the hospital is rewarded. When worse, the hospital gets less. The starting point for this model is based on historical relevant outcome data for PCI and CABG, which is already available within the NHR. From historical data the expected performance on patient relevant outcomes is calculated. Instead of paying for the volume of care, Menzis pays for the difference in realized versus expected outcomes of care, with a bonus for better than expected performance. In the project the same methodology will be explored and applied for important cost drivers.
In our community heart centers share best practices and use insights in outcomes and costs to improve patient value. The information on outcomes and costs is provided by the NHR, the Trusted Third Party in this initiative. The heart centers develop and implement at least one improvement initiative each year. Patients are involved in the initiative as member of the improvement teams for the outcome measures used for the NHR medical set, evolution of the model and through meetings with patient associations.
This initiative is unique because it is the first time that a payer, a national registry and providers jointly participate in a community along with a bundled payment model based on predicted outcomes. The goal is that in the next years more Dutch health care insurance companies and all Dutch hearth centers are going to join. The pilot aims to continuously improve patient outcomes and reduce 20% costs of PCI and CABG. Creating focus on patient outcomes by all parties involved in the care process including the higher board of the hospital is a key part of the pilot, as is including professionals from all relevant disciplines.