Value-based heart care: the implementation in the Eindhoven region

Background

Worldwide, value-based healthcare (VBHC) is getting increasingly more attention. Maximizing patient value, defined as outcomes divided by costs, is the main goal.

Aim and relevance of the initiative

With our initiative, we aim at continuously increasing patient value by implementing the six components of VBHC as defined by Porter and Lee (2013): 1. Organizing integrated practice units (IPU); 2. Measuring outcomes and costs; 3. Introducing bundled payments for care cycles; 4. Delivering care across separate facilities; 5. Expanding excellent services across geographies; and 6. Building information platforms.

Setting

The heart center of the Catharina Hospital Eindhoven (The Netherlands).

Patient description

Data of patients (n > 25,000) treated in the Catharina heart center between 2011 and 2017. Patients treated for the following medical conditions are included: coronary artery disease, aortic valve disease, combined aortic valve and coronary artery disease, atrial fibrillation, and mitral valve disease.

Methods

In the Catharina Hospital, VBHC is implemented since 2011 by measuring and monitoring outcomes and executing improvement projects. The organization structure is adjusted and a number of process optimizations have taken place. Recently, we introduced a risk-adjusted model that makes it possible to measure patient value by combining both outcomes and costs.

Results

The various projects and adjustments led to improvements in outcomes on all tiers of Porter’s outcome measures hierarchy (reduced mortality, less complications and less re-interventions). For example, a checklist that was introduced in the operation room led to a decrease in surgical re-explorations among patients who underwent open heart surgery.

Formation of IPUs/collaborations/partnerships

The Catharina heart center is an IPU since 2014. A merger of the cardiologists and cardiothoracic surgeons took place successfully. We collaborate with referring hospitals, health insurers, the Netherlands Heart Registry and the Netherlands Heart Network.