Value Based HIV Care
Since 2014, at OLVG, we have successfully set important steps towards increasing value of care for our HIV population (20% of all Dutch Hiv patients). We have created an HIV care structure that facilitates continuous monitoring and improvement of care outcomes and costs, through:
- development of an hiv outcome indicator set in close collaboration with professional HIV experts, and our patients
- incorporation of this set, including PROMS, in a redefined hiv care path, built into our electronic patient record (EPR)
- Building a working group of OLVG HIV professionals who monthly monitor and discuss outcome indicators to ensue continuous improvement
- Implementation of PROMS in our in-clinic consultation, to support the shared decision making process
- Development and implementation of an additional HIV mental care path, the need of which became clear thanks to our outcome transparency
- Development and implementation of the VBHC app “Happi App”, connected to the OLVG EPR, as a tool to further facilitate the patient to be in optimal control over his health
- a shared-savings VBHC HIV contract with a large Dutch health insurer (January 2018). Together we 3 monthly monitor outcome and cost indicators.
Effects include less overall consultations and less overall laboratory expenditure despite a yearly growing number of patients (number of patients 2014: 2800, 2017: 3150; overall laboratory costs 2014: 2.3 million euro, 2017: 1.6 million euro; number of doctors consultations 2014: 10.000; 2017: 6000) ; a 30% reduction of no show percentages; extremely low lost to follow up percentage (<1%) despite no shows; a rising percentage of consultations where cardiovascular risk was shown (45% in 2016, 58% in 2017, 73% in 2018) and discussed resulting in lower percentages of smokers (40% in 2016, 36% in 2017, 34% in 2018). Other hiv centres have started implementing our way of working and we have international collaborations for example with the hiv outcome initiative and the progress steering committee facilitating introduction of PROMS in routine hiv clinical care.