Value based healthcare – PorterCombinatie van kosten en kwaliteitinformatie is eerste stap2012: Proof of Concept2013: Promotie Johannes GovaertSwitch naar presentatie/agendaJohannes gaat de eerste resultaten van het onderzoek toelichtenHubert Prins (Jeroen Bosch ziekenhuis ) over het sturen met behulp van deze cijfers
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How does benchmarking create more value in healthcare?
Michael Porter PhD, Professor, Harvard Business School, “What is Value in Health Care“
New England Journal of Medicine, December 23, 2010
“The Strategy that will fix healthcare”, September 2013
About the costs
Porter et al (2013): Calculate the full patient cycle costs
Measure activities per patient
Measure resources per activity
Requires a well defined uniform costing methodology
Status of costing in Ireland
Costing requires local hospital knowledge, feedback and actions
National costing project important
Access to data needs to be improved
Galway/WNWHG first public group to deploy costing properly, with
Bon Secours System first private group to deploy costing on a group-wide
Cost benchmarking possibilities
European market for high costs elements, devices.
Are prices too high?
We all have doctors, nurses, administrative staff.
How much should they produce?
Activities per patient
Same patient diagnoses
How many activities are expected? (LOS, theatre, laboratories)
Treatment possibilities are global.
Which options do we choose? (PCI, CABG)
Indicators set per disease/treatment in collaboration with doctors, for example:
Complications (Intensive Care/infections/re-operations)
New indicator sets define quality of life
Hospital mortality is getting very low
High differences in functional results
For example after prostate surgery
Indicators supported by professionals
DSCA means Dutch Surgical Colorectal Audit. The DSCA records the results of cancer surgeries.
This gives the professional insight into the quality of their own care and that of colleagues.
This so-called benchmark information can demonstrably improve their work.
The DSCA was created by: The Dutch Society of Surgical Oncology, the Dutch Society for Gastrointestinal Surgery
and the Dutch Colorectal Cancer Group.
DSCA is part of the Dutch Institute for Clinical Auditing (DICA).
Performation and DICA team up in measuring value of healthcare
A PhD study is focusing on relation of costs and clinical quality
Jointly with you we create high value healthcare for Europe
Value chart, colorectal surgery
Less complications (case mix corrected)
0 0,5 1 1,5 2 2,5
Volume of interventions
: <85 per year
: 85-140 per year
: >140 per year
20% 30% 40% 50%10%0%
This team saves 7 complications/year
and saves € 3,300 per patient = € 270k/year
(compared to average hospital)
Focus: making choices
Less complications than peers
Observed/expected outcome compared to costs
Good & efficient
Cheap & sub-standard
The key: reliable data
Central ‘cloud’ data warehouse
> 200 hospitals in NL/UK/IE
Easy to understand and easy to utilise reporting
Experiences in the Netherlands
UHI introduced 1998
MFTP introduced 2007-2012
Freedom of choice in insurer, hospital
Safety nets along the route
Hospitals were already foundation trusts
Autonomous seeking for best information systems
Management information has improved dramatically
Waiting lists have reduced, quality has improved
Acute hospital costs are now going down
Outside – in observations
MFTP/UHI is the way to go
In Ireland, administrative data is widely available, however data is not structured
Most key players are still in the dark on essential information!
Major backlog on ICT investments (expenditures are only 0.3%!)
Need for wall-to-wall HIS
Need for Business Intelligence, DWH, dashboards
High investment per hospital, or innovative, cloud solutions….
Cultural / regulations aspect make it very hard to innovate at local level
Hospital managers need to empowered to take a risk
Clinical data needs to be collected, monitored and actioned DICA?
Connect the doctors stronger to the hospitals
Value = Outcome / Costs (Porter)
Benchmarking is an essential driving force
Benchmarking on efficiency requires costing models
Benchmarking on outcome requires clinician involvement
Value charts allow strategic choices
With benchmarking, value increases
WNWHG and Bon Secours System are frontrunners in financial transparency
Data is a challenge in Ireland
Cloud Data Warehouse is a viable route, comparing UK/NL/IE
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