Santeon’s VBHC@Santeon initiative is aimed at improving health outcomes for patients in the main disease areas (which are responsible for approximately 40% of volume and costs in our seven hospitals), thereby reducing costs involved. Key of the initiative is to make comparing results and improving care practices part of the daily routine in our hospitals. Santeon and Menzis are partners in this effort, which also aims to develop value based payment methods to stimulate improvement of value in stead of paying for volume.
This initiative started in 2012 with measuring and comparing outcomes in four oncological conditions within the Santeon group (seven top clinical hospitals) and publishing the results. This showed significant variation and resulted in improvements, such as concentration of prostate cancer treatments. Seeing the potential of comparing outcomes, and given the wish to speed up our improvement efforts, we developed a method to implement improvement cycles within each hospital and between the seven hospitals, in which outcome for all the major conditions in our hospitals are regularly measured, compared, variation is analysed and improvements are implemented. This initiative is doctor-led by multidisciplinary teams that include patients.
As of 2016 we started with the first five conditions (breast cancer, prostate cancer, lung cancer, hip osteoarthrosis, and stroke). For each condition a multidisciplinary team was set up in each hospital, including 1-2 patients in each team, and support was organised. These teams agreed on a Santeon scorecard per condition: what to measure and compare. This scorecard contains outcomes that are relevant to patients, key cost indicators, and process indicators that are relevant for patients. We have taken a thorough but practical approach, to keep it simple and get started. This means that in principle we look at the full cycle of care for each condition, but if data are not available, we narrow down the scope to what is attainable. We use ICHOMs basic outcome sets. And we use data that are available, and not register new data (yet). For costs, we do not map all the costs per patient, but rather determine the key cost drivers in the care delivery process. In the improvement cycle per condition we simultaneously collect and validate data in each hospital, at least twice a year at the Santeon level. Each improvement team has regular meetings to discuss variation and look for improvement. Twice a year we discuss results with all the hospitals within the Santeon group, define ambitions, determine which areas need to be improved and organise that the sites exchange best practices and learn from each other. The result of this initiative so far have been concrete and numerous: a concentration of treatments in the better performing centre (in the case of prostate cancer), better informed discussion about treatment options (prostate cancer), reduction in complications (prostate cancer), improvement in rate of operations in day care (breast cancer), reduction in non value adding diagnostics (breast cancer, hip osteoarthrosis), implementation of way to reduce bleeding after surgery (breast cancer). And very importantly it has resulted in a value based payment contract with Menzis and other health insurers for breast cancer, stimulating improvements in care delivery. Last but not least: motivated doctors that are committed to continuously improving care for their patients.