(Santeon Together Better Program)
At Santeon, we have developed a scalable VBHC model in which doctors and care delivery teams from seven hospitals structurally measure and compare patient outcomes and associated costs to learn and improve the care at their hospitals, and to better inform and empower individual patients.
In the program the 7 hospitals work closely together on a daily basis in which projectleaders, data analist and care professionals work together between the hospitals. We share data openly between the hospitals and discuss the results. The Santeon hospitals embrace an open culture in which they work together to achieve better patient outcomes faster. Until recently, Santeon’s approach to VBHC primarily focused on improvement at the patient group level. Our newest step is to also use the collected outcome data to better inform and empower individual patients and explicitly involve them in decision-making about diagnostic and treatment-options.
A big achievement of the program is that we are able to benchmark between the 7 hospitals and over time. Benchmarking is more difficult than only benchmarking over time because across hospitals trust, transparency and comparable data is crucial.
At this point we run improvement cycles on 14 medical conditions. These conditions cover approximately 20% of the costs of care in the Santeon hospitals.
Results for the first 3 conditions for which we run improvements cycles (breast cancer, hip osteoarthritis, stroke, also available on our website) include:
• reduction of nearly 30% in unnecessary inpatient stays for breast cancer patients
• up to 74% reduction in the rate of reoperation due to complications in breast cancer patients
• reduction of 23% of patients with a stay of four days or longer around a primary total hip operation
• an increase of 23% of hospital admission on the day of the operation instead of an hospital admission on the day before the operation.
• reduction of 18% of patients with three or more X-rays for a primary total hip operation
• 8% reduction of “door-to-needle” time for stroke care, where the national average is 24 minutes, the Santeon hospitals have reduced the door to needle time with 2 minutes.
Starting with 3 medical conditions, breast cancer, stroke and chronic renal failure, we are in the process of developing and implementing an effective approach for the use of outcome data in the process of SDM in patient-clinician encounters. Patients are provided with personalized, up to date outcome data, including information based on patient-reported outcome measures (PROMs), in order to inform them on the outcomes and risks of all relevant care options, including the option of doing nothing. We aim at more realistic expectations, improving knowledge, supporting patients in forming a preference for care which is in line with their values and enhancing the patient-clinician decision-making process. Examples of decisions in the care pathway we currently focus on, include:
• follow up in breast cancer care
• the form of rehabilitation and discharge destination in stroke care
• treatment modality in advanced kidney disease (dialysis, transplantation or conservative care management).
The VBHC model at Santeon is unique because it demonstrated to be scalable over multiple medical conditions, multiple hospitals, and potentially also with partners in the full cycle of care. The program is based on a phased advancement of the improvement cycle per medical condition, combining various aspects of VBHC: Measuring outcomes and costs; managing change and building of a ‘learning culture’; embracing transparency; value based contracting with health insurers; information modelling and ICT; using outcome information in the process of SDM in patient-clinician encounters; developing a Standard of Care, and gaining insights in the full cycle of care.