The VBHC evolution 2014-2019

The VBHC evolution 2014-2019
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Prof. dr. Fred van Eenennaam and Meagan Jongepier offer an overview on
the achievements of the Value Based-Health Care Prize since 2014.

With the 6th edition of Value-Based Health Care Prize quickly approaching on April 18th in the theme of ‘How to implement VBHC - the legacy of 10 years VBHC inspiration’, what better time than now to take a look back at our previous five editions, five editions of the VBHC Prize that have been able to inspire and teach us a lot, as well as leaving a legacy of VBHC inspiration in its wake. All of the inspiring initiatives that have been involved, have given us a unique insight into the VBHC healthcare world each year. The initiatives provided somewhat of a snapshot, of that year and it’s trends in terms of what VBHC looked like at that point, and where it was going.

With this unique peek into the VBHC landscape that’s been provided with every VBHC Prize edition, we would like to take you through what VBHC trends and legacy we have had the privilege to observe over the last five years. How these trends have evolved and what we could possibly expect the direction of VBHC to be in the near future. A snapshot of each of the last five years will be given and as this blog series progresses take you through them one by one.

2014 – Measuring outcomes

In 2014 with the VBHC Prize being awarded for the first time, it was noticeable that many initiatives were only just getting introduced to the concept of VBHC. Despite VBHC being a new concept to many at this point, they were looking and eager to get started. This, for many, was the start to systematically measure patient outcomes. In 2014, the winner of the VBHC Prize was Meetbaar Beter, which is the perfect example of measuring patient outcomes. They were unique, as they were not only pioneering in systematic and consistent patient outcome measurement, but they were also a collaborative effort between cardiologists spanning across multiple hospitals. They were able to build a strong collaboration between multiple hospitals, as well as systematically measuring patient relevant outcomes.

2015 – Network approach

With the familiarisation and first steps being passed for many healthcare initiatives looking to implement VBHC, it had now become the time where initiatives were reaching out to each other. Finding in the network approach a new way to reach the best possible value for their patients. Many initiatives were learning first-hand how there is strength in numbers. This was done by creating a network where they were able to combine their strengths and expertise, to benefit from them as a whole, in the best interest of the patient. Take for example, ParkinsonNet, the winner of the VBHC Prize 2015. ParkinsonNet created a national network of over 3000 care providers from multiple disciplines. Their aim was to create a large network of care providers, to in turn expand the expertise, in terms of schooling and certification, to thereby provide the best care possible for patients affected by Parkinson’s disease. 

2016 – Bundled Payments

Around 2016 it became clear that certain hurdles of VBHC implementation had been easier to tackle than others. Bundled payments were the next obstacle in really making a difference for patient value. It was evident at this point that many initiatives were finding themselves at the bundled payment stage, and it was the next necessary step for many to really move towards VBHC. There seemed to be a growing understanding that when aiming to increase patient value, lowered costs and bundled payments were essential for VBHC, in contrast with the traditional volume based payment systems and mentality. In 2016 there was a wonderful example of this mentality switch. Health insurance company CZ and the Catharina Ziekenhuis (hospital), created the first Dutch bundled payment agreement together. They were able to make purchasing contracts on the basis of patient-relevant outcomes, and a bundled price on the basis of patient value.

2017 – Institutional Transformation

Around 2017 it started to become apparent for many initiatives and health care providers that real progress towards a VBHC system and significant increases in patient value may only be reachable if a real institutional transformation were to be realised. A transformation where organisation or initiative wide a VBHC commitment were to be made. A commitment to make changes, to record outcomes, to collaborate, and above all, a commitment to increase patient value. This mind-set change started to take shape around 2017. At this point it had become rather widely accepted that VBHC is the future. The future for a more sustainable healthcare system and a healthcare system that is focused on the patient and the value for the patient. However, as you will see from the trend of 2018, the initiative that won the VBHC Prize 2017 was an early adopter and ahead of their time.

2018 – Formation of IPUs

Once health care providers, organisations, and initiatives had gotten the ball rolling on VBHC, the next observable trend was that IPUs were starting to be formed around care questions and medical conditions. IPUs being an integral part of VBHC, they are essential to patient value and making care decisions in collaboration with all involved parties, including the patients and their families. That’s why this trend showed to be quite an essential one to make sure that the optimal care pathway was chosen for the patient, to in turn lead to better patient outcomes, lowered healthcare expenditure, and increased value for the patient. One initiative which already showed great promise in this area was the 2017 winner of the VBHC Prize, Diabeter. Diabeter is a patient-centric, Dutch-certified clinic network that specialises in providing comprehensive and individualised care for children and young adults with type 1 diabetes. They have 5 locations across the Netherlands where they deliver diabetes care which is organised in an IPU. They have a multidisciplinary, interdependent team which focuses solely on diabetes care takes joint responsibility for the full cycle of care. Furthermore, the VBHC Prize 2018 winner NHN (Netherlands Heart Network) is also a great example of an IPU, but takes the approach of a networked IPU. The NHN is a joint effort of all relevant healthcare providers in primary, secondary, and tertiary care that aims to continuously improve outcomes that matter most to cardiac patients by organizing the total care delivery value chain in an optimal and uniform way.

What’s next?

What becomes apparent from a year to year breakdown of VBHC trends, is that of course at all times many different initiatives will find themselves at different stages of VBHC implementation. However, what is great to see when looking at the overall themes of incoming VBHC Prize applications over the years is that there has been a strong and growing trend of VBHC overall. Where 2014 was really able to show how the concept was starting to become widely accepted and understood, and as the years progressed, how many initiatives were exploring how to make VBHC work for them, how to make it their own, and how to make it work in practice. With at all steps and phases keeping the value for the patient in mind. The next challenge which can already be observed in many of the wonderful applications for the VBHC Prize 2019, is upscaling. Many initiatives have found themselves at the stage where they need to take the next big step. For many initiatives this is expanding either vertically or horizontally. However, this is of course an incredible challenge to do successfully, while making sure to keep VBHC in mind, and not sacrifice on their patient value. Another challenge, and upscaling opportunity for VBHC, which several initiatives already have caught onto is the use of big data and blockchain. It’s noticeable that within the VBHC environment there are multiple institutions and initiatives working on how to make these resources work in favor of VBHC, and facilitate for example outcome measurement or bundled payment contracts. To conclude, it is inspiring to see the immense progress that VBHC implementation has made over the past years and we cannot wait to see which new exciting lessons will be learned in the future and which direction VBHC will take next.


Click here to find out more about the previous VBHC Prize winners and other prize applicants.


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Published on : Tue, 16 Apr 2019

VBHC Prize Event 2019, nominees, ICHOM 2019 Conference Prof. dr. Fred van Eenennaam and Meagan Jongepier offer an overview on the achievements of the Value Based-Health Care Prize since 2014. With the 6th e...

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