This document discusses value-based healthcare initiatives at Erasmus MC in Rotterdam, Netherlands. It provides details on: 1) Defining outcome measures and collecting data on outcomes and patient characteristics for various conditions through tools like Gemstracker to enable value-based care. 2) Measuring costs using time-driven activity based costing to understand spending. 3) Creating multidisciplinary teams focused on specific conditions to improve quality, efficiency and value through continuous measurement, analysis and quality improvement efforts. The goal is to continually improve value for patients by understanding outcomes that matter to them, benchmarking performance, and ensuring best care is delivered at sustainable costs.

1. Value & Science Driven Healthcare
Jan A. Hazelzet, MD PhD
CMIO &
Vice-Director Strategy & Policy IT
Erasmus MC, Rotterdam, The Netherlands
j.a.hazelzet@erasmusmc.nl

2. ERASMUS MC Sophia Children’s Hospital
 Pediatric Intensivist
 ≈ 1400 admissions/y
 28 + 6 beds
 Age: 0-18 y
 Staff:
 12 intensivists / 4 fellows
 ≈ 120 fte. nurses
 CMIO
 Strategic planning of IT
 Clinician’s perspective
 IT-Governance
 Clinical Documentation / EMR
 Personalized Medicine
 Value Based Health Care
Liaison Medical <=> Informatics

3. Healthcare: Rapidly Increasing Complexity
 Diagnostic and treatment options are expanding and changing
 Chronic diseases and comorbid conditions are increasing
 Care delivery has become increasingly fragmented
 Health care safety, quality, and outcomes fall short of their potential
 Growth rate of health care expenditures is unsustainable
 Overtreatment / under treatment
 Pace of change is too slow
 No Patient Centered Care
Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. IOM 2012

8. These are our aims!
More information:
http://koers18.online-magazine.nl
Ambition 1: Continually adding Value
Our guiding principle for research, education, and
health care is creating added value for patients
Understanding the health, diseases, and wishes of
patients
Personalized medicine (individualized treatment)
Prevention
Translating knowledge into useful, innovative products
and health care concepts

10. Care Path

13. Focus on the outcomes that matter most to patients

14. What is happening in Erasmus MC?
 For 8 diagnose teams outcome measures and initial patient conditions
with instruments are defined
 Participation in (inter)national workgroups (ICHOM);
 A blueprint is developed to define outcome measures; 2018: 80%
 IT platform (GemsTracker) is organized to measure outcomes.
 Costs are measured on the basis of time spent (TDABC);
 Teams are accompanied and assisted for all sections of care
 Work in progress!!

15. 20141105_Call#3_v1029v2.pptx 15Copyright © 2013 by the International Consortium for Health Outcomes Measurement. All rights reserved.
Value based healthcare

16. Team around Disease or Condition

17. 5: Check4: Praktijk,
tijd & taken
3: Prioriteit
& instrument
2: Patiënt
& uitkomst
1: Proces
& pad
INLEZEN &
VERSIE1 ZORGPAD
0: Intake
Blueprint Value-Based Care Cycle
THEORIE,
AANDOENING, PAD
EN TEAM
DE SESSIES PLENAIR
OUTCOME MANAGER & LEIDING ZORGPAD
OUTCOME MANAGER INDIVIDUEEL
OUTCOME TEAM ZORGPAD X INDIVIDUEEL
SAVE THE DATE EN
INLEZEN THEORIE
VOORBEREIDING
VERSIE 2 ZORGPAD
THEORIE,
AANDOENING EN
PROCESPAD
CHECK OP
GUIDELINES EN
PREMS
VOORBEREIDING
VERSIE 3 ZORGPAD
UITKOMSTMATEN
EN PATIENT INITIAL
CONDITIONS
SCORING MATEN
EN CONDITIONS
VOORBEREIDING,
INSTRUMENTEN &
SCORINGEN
UITKOMSTMATEN
CONDITIONS EN
INSTRUMENTEN
LITERATUURCHECK
EN PEERLIJSTEN
VOORBEREIDING
FINAAL PAD,
PROCES,
METINGEN & TAKEN
START 4WKN
PAPERBASED
PILOT
EINDPRESENTATIE,
INPUT FINANCE EN
EVALUATIE
VOORBEREIDING
TERUGKOMSESSIE
NA 4 WKN
PAPERBASED
PILOT
FINAAL PAD EN
IMPLEMENTATIE IT

19. https://gemstracker.org/

20. Cooperation
Participation:
• Prostate ca
• Cleft Lip Palate
• Stroke
• Macula
Degeneration
• ……

21. The first ICHOM publication, the localized
prostate cancer set, is in press!

22. Time driven activity based costing

23. Our implementation
Value Based Carepaths as Management Tool
We measure & manage:
• Quality of Care (Outcome)
• Efficiency Tasks & professionals (Processes)
• Spending vs Reimbursement (Costs)
• Benchmarking (Analyse)

24. What to do in 2015 and onwards
 Proceed with defining process and outcome measures.
 Increase patient involvement
 To define a (corporate) standard set of outcome instruments
 Train clinicians in each disease team in analysis and quality
improvements
 Measure, analyze, interpret and reporting results.
 Cooperation with peers and payers, benchmarking

25. Erasmus MC
Institute for Public
Health & Prevention
Erasmus MC
Quality of Care
Organization
Erasmus MC
Center for
Value-Based
Health Care
“The Center for Value-Based Health Care brings
together disciplines from across Erasmus Medical
Center to develop and implement strategies for
driving demonstrable improvements in the value
we deliver for our patients.”
Sustainable and transparent results for all stakeholders
inside and outside the Erasmus MC are central.

26. 2014 2015 2016
Brain tumors*,
Prostate Ca*, Stroke*,
Breast cancer*, Cleft
Lip*, Bladder cancer*,
Obesity*, Turner
Syndrome, Macula
Degeneration*,
Larynx cancer
Heart failure, Sickle
cell, Hemophilia, IBD,
Colorectal Ca,,
Pancreas Ca, Frail
Elderly, Pregnancy +
Childbirth, Hemifacial
Microsomia,
Dementia, Liver
failure
Neuro trauma, Bipolar
Disease, ICU
treatment, Cystic
Fibrosis, Lung cancer
Future Plans:
* Outcome measures defined Together with ICHOM

28. j.a.hazelzet@erasmusmc.nl
@JanHazelzet

30. Voorbeeld professionalblok
HI.48-1.SEH.VPK
Things to do
☐ Stroke sein uitzetten na vooraanmelding
10 minuten voor aankomst AMB
☐ Triage
☐ Gewicht & bloedglucose noteren
☐ Patiënt naar CT scan brengen
☐ Patiënt van CT tafel halen
☐ Venflon (groen rechts in elleboog) & Stroke Lab
☐ Monitoring: bloeddruk & neurologische uitval iedere 15 min
☐ ECG maken
☐ Op indicatie: alteplase spuit klaarmaken
☐ Op Indicatie: CAD plaatsen
☐ Op Indicatie: Point of Care & INR via lab
Things to measure
 Binnenkomst tijd en datum SEH _____________
 Starttijd Trombolyse _____________
 Starttijd Bolus _____________
Datum & HandtekeningMicrosectienummerPatiënt ID
Tijdsduur in 45 min
Vul hieronder uw taakspecifieke things to do en things to measure in en lever iedere woensdag de ondertekende lijsten in op Hs645 code 0104. Alle proces
en uitkomst metingen worden maandelijks met u gedeeld en verzameld in een Erasmus MC Key Outcome Report eind 2014. Dank voor uw medewerking!

31. Uitkomstmaten en Meetinstrumenten
Uitkomstmaat Meetinstrument
Mortaliteit <7dgn < 3mnd
Basale Zelfredzaamheid Barthel / MRS
Verfijnde Zelfredzaamheid UserP
Uitval NIHSS opn
Kwaliteit van leven EuroQoL (bij hoge depressie score HADS)
Vermoeidheid Fatigue Severity Scale
Cognitieve functies MOCA
Pneumonie PSI Ontslag
Bloedingscomplicaties Intracranieel en extracranieel Ontslag
Delier Bij risicoprofiel>3 DOS
Vallen Val lijst
Last Mantelzorger Care Giver Strain index

32. Initiële Patiënt Condities en Categorisaties
Initiële Patiënt Conditie Categorisatie
Ernst van het infarct 2e meting NIHSS
Leeftijd In jaren
Socio Economische Situatie Codes SES + taalbarrière j/n
Geslacht m/v
Comorbiditeiten Comorbiditeitlijst
Atrium Fibrilleren j/n
Previous Stroke j/n
Woonsituatie Alleen/
VPhuis/Partner/Partner+Kinderen/Alleenstaand+
Kinderen

33. Time Driven Activity Based Costing
per blok en per scenario
T= tijd in minuutprijs (bruto jaarsalarissen)
M= diagnostiek
O= overhead in FTE/m2
x
P= productiviteit %
 Check kosten met vergoedingen, STZ
tarieven, productieaantallen en manage het tarief