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USE OF

TECHNOLOGY

TO EASE

IMPLEMENTATION

AND MAXIMIZE

VALUE

FOR PATIENTS

IN HEALTH CARECHALLENGES FOR INNOVATIVE HEALTHCARE AND TECHNOLOGIES

VBHC

THINKERS

MAGAZINE

Christmas Edition

December 2018

Why follow the VBHC Green Belt Track?

❖ Learn the essentials of VBHC based on theoretical and practical examples;

❖ Bring conversations with colleagues and patients to the next level;

❖ Prepare yourself for the VBHC Green Belt exam with the VBHC Center Europe.

Once passed, you will become a Certified Green Belt!

In four sessions you will be immersed into the most up-to-date knowledge on VBHC.

The Green Belt track takes place year round. The program is very flexible: the sessions can be

followed independently and in any order, allowing you to enter the program whenever it is

convenient for you.

Non-Dutch participants may join the online Blended Learning program.

The Decision Institute is the organizing founder of Value-Based Health Care in Europe since 2008.

Since 2008, more than 25.500 (inter)national healthcare professionals followed VBHC education

at The Decision Institute.

VBHC GREEN BELT TRACK

Would you like to become a Value-Based Health Care expert and be recognized for it?

Follow the interactive VBHC Green Belt track and become a VBHC Certified Green Belt!

For more information and/or international options, please send an email

to [email protected] or visit www.thedecisioninstitute.org

VBHC GREEN BELT

4 VBHC THINKERS MAGAZINE – CHRISTMAS EDITION | DECEMBER 2018

Interview

p. 8 Prof. Dr. Michael Porter &

Prof. Dr. Fred van Eenennaam

p. 10 Dr. Griffin Myers

p. 12 Vincent Wiersma

p. 14 Dr. César Velasco Muñoz

p. 20 Dr. Maarten Ottenhof

p. 23 Prof. Matthew Cripps

p. 30 Thea Gutter

p. 32 Dr. Bas Nij Bijvank

Expert Blog

p. 6 VBHC Essential for Integration and

Innovation of Healthcare Technology

Perspective

p. 25 The Sixth and Seventh Reason Why

Value-Based Health Care is Beneficial

p. 18 VBHC Value Agenda 2019

VBHC Thinkers Magazine

is now available in the following versions:

Print: Request a hardcopy via [email protected]

Digital: www.vbhc.eu

Editors

Fred van Eenennaam

Tahita Ringers

Mirte van Holsteijn

Lena van Selm

Publisher

Value-Based Health Care Center Europe

Designed by

Tahita Ringers

VBHC Thinkers Magazine serves as a

catalyst for the VBHC community to

collaboratively work towards excellent

patient value. By sharing best practices and

the latest insights in VBHC implementation,

VBHC Thinkers Magazine aims to inspire the

VBHC community to push VBHC

implementation to the next level.

VBHC Center Europe is the European

platform for VBHC implementation. Sharing

implementation experiences, connecting the

VBHC community and creating new

collaborations are the goal of the VBHC

Center Europe.

Get in touch via [email protected]

Mirte van Holsteijn - Manager

Aida Nooshin – Community Manager

Lena van Selm – Chapters and Magazine

#VBHCPrize2019

mailto:[email protected]

http://www.vbhc.eu/

mailto:[email protected]

DECEMBER 2018 | VBHC THINKERS MAGAZINE – CHRISTMAS EDITION 5

CONTENT

VBHC Essential for Integration and Innovation of Healthcare Technology

Prof. Dr. F. van Eenennaam – Chairman of VBHC Center Europe

10 Years of Value-Based Health Care Center Europe with Professor Porter

Prof. Dr. F. van Eenennaam – Chairman of VBHC Center Europe

VBHC Dragon’s Grant 2018

Dr. G. Myers – Chief Medical Officer at Oak Street Health

Five pleasant VBHC implementation surprises - Vincent Wiersma

L. van Selm – VBHC Center Europe

Meet the VBHC Prize 2019 Jury – Dr. César Velasco Muñoz

T. Ringers – VBHC Center Europe

Towards a Service-Oriented Processing Model in Spain – Dr. César Velasco Muñoz


VBHC Value Agenda 2018

M. Van Holsteijn – VBHC Center Europe

Machine Learning in Plastic Surgery – Dr. Maarten Ottenhof


Consensus is Key

Prof. M. Cripps – NHS Right Care

The Sixth and Seventh Reason Why Value-Based Health Care is Beneficial

L. van Selm & Prof. F. van Eenennaam – VBHC Center Europe

Applying Innovative Technology to Epilepsy – Thea Gutter


We have a Good Opportunity with VBHC to Change Maternity Care – Dr. Bas Nij Bijvank


6

8

10

12

14

16

18

20

23

26

30

32


EDITOR’S LETTER

Europe has become one of the leading places in the world for innovation in health care. Over the course of the past

ten years, VBHC has proven to have changed the face of health care as we know it. With a network of more than

5,000 practitioners in Europe and worldwide, the Value-Based Health Care Center Europe is a leader in pioneering

Value-Based Health Care (VBHC) implementation. VBHC Center Europe facilitates people with an interest in

VBHC to connect, create, and share VBHC best practices.

We are moving towards the fourth revolution in which digitalization in healthcare has become evident. For a long

time we have been gathering information through the world wide web, but with the rise of Block chain a new asset

has been added: “value of information”. This shift has made fundamental redesign for all actors in the value chain

possible. But with integrating data alone we will not get there, the essential question of how to integrate these new

developments in our old healthcare systems remains.

Integrating and innovating healthcare technologies has never been more important than it is now. The 6th edition

of the VBHC Prize will celebrate how far VBHC has come over the past years and how much progress there remains

to be made in the future. The applicants and nominees for this year’s VBHC Prize are an ode to the dedication

shown by our healthcare professionals to improve the quality and value for patients worldwide.

We are enthusiastic to bring together leaders in VBHC to give an up-to-date view of this exciting and rapidly

moving field. As we move towards the fourth revolution we must work together to face the the pressing challenges

in healthcare ahead. Thank you for being a friend in implementing VBHC over the past decade. I look forward to

continue this journey together with you in the future.

VBHC Essential for Integration and Innovation of Healthcare TechnologyBy Prof. Dr. Fred van Eenennaam

Prof. Dr. F. van Eenennaam

Chairman VBHC Center EuropeNon-voting Chairman VBHC Prize


VBHC EVENTS

Crash Course Value-Based Health Care

The Decision Institute | Nijkerk, Netherlands

January 11, 2019

Is 2019 the year you are becoming a leader in the field

of Value-Based Health Care? This Crash Course will

provide you with a VBHC Toolbox in order to

successfully implement VBHC in your organization.

Value-Based Health Care Delivery: An Intensive

Seminar for Students & Practitioners

Harvard Business School | Boston, USA

January 14– 18, 2019

VBHC delivery concepts start with providers but

encompass new strategies for health plans, employers,

and government. Prof. Porter and the institute have

developed an intensive seminar focused on

frameworks, application tools, and case studies

highlighting real-life examples of organizations moving

toward value-based care delivery models.

VBHC the Basics

The Decision Insititute | Nijkerk, Netherlands

January 24, 2019

Are you new to Value-Based Health Care? During this

Masterclass you will learn about the theory of VBHC as

well as the basic tools needed to implement VBHC

within your organization. This is an interactive

opportunity to not only learn about VBHC, but to learn

how to make a practical start.

Champions of Health Unite

HIMSS | Orlando, USA

February 11 – 15, 2019

The HIMSS Global Conference & Exhibition brings

together 40,000+ health information and technology

professionals, clinicians, executives and market

suppliers from around the world.

Shaping the Future of Healthcare

Innovation for Healthcare | Rotterdam, Netherlands

February 14, 2019

Innovation for Health is the premier event for key

players in Health & Life Sciences in the Netherlands. It

provides a unique opportunity to meet leading

innovators, to catch up on the latest trends, to present

cutting-edge innovations and to engage leaders and

decision makers in Life Sciences & Health.

VBHC Thinkers Masterclass Series with

Prof. R. Kaplan

The Decision Insititute | Netherlands

March 14, 2019

Learn from the VBHC Cost expert Prof. R. Kaplan

during this interactive masterclass. Prof. Kaplan is

emeritus Harvard Business School, co-author ‘How to

Solve the Cost Crisis in Health Care’, co-inventor Time-

Driven Activity Based Costing method.

VBHC Prize 2019

VBHC Center Europe | Netherlands

April 18, 2019

The VBHC Prize rewards and recognizes inspiring

initiatives that have adopted a fundamentally new line

of thinking in creating excellent patient value. Each

year, one excellent initiative is awarded the VBHC

Prize, a prestigious prize awarded by a internationally

renowned jury, and announced by honorary chairman

Harvard professor Michael Porter, PhD.

ICHOM Conference 2019

ICHOM | Rotterdam, Netherlands

May 2-3, 2019

The ICHOM conference is the world-leading event for

providers, life sciences and industry on Value-Based

Health Care.


INTERVIEW

Van Eenennaam: First of all I would like to thank you

for all your help over the past years, not just the cases

but all of the other information that you have given us

to help with the VBHC Prize and VBHC Center Europe.

If we look at the past 10 years of VBHC what have

been our most important achievements?

Porter: Well I would say that VBHC has become widely

understood over the past 10 years and that there are

very few people in healthcare that have not

encountered the idea of VBHC. I think there is a

widespread agreement that VBHC as an overall

philosophy, definition and framework, is where we

have to go. The challenge that continuously remains is:

“how do you do it”? It is hard! Because healthcare

delivery is complicated and there is just a massive

complexity in terms of nature of the disease, nature of

the problem, the co-occurring conditions and so forth.

Additionally, there is an inherent conservatism in

healthcare because we do not want to try new things

unless we are pretty darn sure that they will work.

Physicians in particular are always thinking of the

exception and things we never thought of, which can

turn out to be negative. In addition, the widespread

proliferation of examples means that we can now find

examples from all over the world and in many different

ways across the whole VBHC agenda. Healthcare

literature is now full of work and research on VBHC

which is helping codify and show how this actually

works.

We are starting to see that the technology industry

supplying healthcare are starting to change its model to

reflect VBHC. A good example is the case from

Medtronic, a medical device company that is really

moving to VBHC models in how they deliver their

service.

Medtronic actually bought Diabeter (winner of the

VBHC Prize 2017) because they believe that for a

complex chronic condition you really have to control

the IPU in order to maximize the development of care.

They have entirely new payment models and they are

one of the first to start taking risks on outcomes and

really guaranteeing outcomes in the payment model.

and we're seeing that in the pharmaceutical industry as

well. As we can see, not just the providers have started

this journey but we are now starting to see it move into

the supporting and supplier industries and that might

just speed up the whole dynamic of healthcare.

“We are starting to see the technology

industry supplying healthcare to start to

change its model to reflect VBHC”

Europe has become one of the leading places in the

world for innovation in healthcare and I think that's

partly because of the wonderful work you have done at

the Value-Based Healthcare Center Europe.

Furthermore, Europe has been flourishing because they

did not have a big debate over whether there should be

mandatory coverage which has caused a lot of the

issues we have in the United States.

“One of the big challenges now is to accelerate

implementation and…”

All in all the concept of VBHC is well established and a

lot of the key concepts have been accepted, so one of

the big challenges now is to accelerate implementation

and not so much the selling of the basic idea. Another

big challenge is scaling. We have seen a lot of great

experiments (some of which have been very successful)

and have excited many people in the healthcare

industry, but how do we bring this to scale?

Ten years of VBHC andVBHC Center EuropeProf. Michael PorterProf. Fred van Eenennaam

VBHCTHINKERS

SERIES


INTERVIEW

“Scaling the implementation is going to

require more payer mandates than we have

been comfortable with so far”

This is where we are going to need some new actors to

play a bigger role. Governments have been supportive

of VBHC but ultimately they have been less willing to

take steps such as: “you must measure outcomes” or

“we are going to move to value-based reimbursements

on this time scale”. Scaling the implementation is going

to require more payer mandates than we have been

comfortable with so far.

The Value-Based Health Care Center Europe has been

very important in the European VBHC movement and

the tremendous number of organizations affiliated with

The Value-Based Health Care Center Europe have

become some of the leaders in the world in this field.

Altogether, The Netherlands has put itself in the

position where it can legitimately claim to be the most

innovative country, so I think it's been a great 10 years

but there is a lot of work that can still be done.

Van Eenennaam: If we look at the next 10 years in

value-based health care what do you think we in

Europe could contribute to the global development of

VBHC?

Porter: I would like to see either European

governments or European payers actually make VBHC

ubiquitous by requiring outcome measurement or

moving on a schedule to all bundle payments or all

value-based payments. That is something that in the

United States, given our political system and the

fighting we have about philosophy and values among

our parties, makes it unlikely to happen in the near

future or at least in the next few years.

We accelerated the process in government in the US

towards the last part of the Obama administration, we

had a Secretary of HHS that made a very clear public

commitment towards moving rapidly and substantially

into value-based health care. However, during the

elections and the politics there's been a lot of debate

between parties on this subject. In addition, Asian

countries tend to be further behind and a little less

confident and aggressive about VBHC even in places

like Japan and Singapore where I have worked

extensively there is a cautious and conservative

philosophy.

“…it would be a tremendous shot heard round

the world and I think we need Europe to do

that”

So if we would see a major European government that

is willing to really put the stake in the ground and say:

“we will measure outcomes over time for all patients

getting care in this country” it would be a tremendous

shot heard round the world and I think we need Europe

to do that. Europe is ahead and in a better place to take

some of these big steps. We're hoping that our

relationship with the OECD, through ICHOM our

outcome measurement consortium, is going to be a

catalytic device again for having some governments

kind of take those steps.


INTERVIEW

Dr. Griffin Myers, founder and Chief Medical

Officer at Oak Street Health. Myers is a board-

certified physician responsible for the excellence of

health care delivery at Oak Street Health. Oak Street

Health is a growing organization of value-based

primary care centers serving adults on Medicare.

Can you tell us something about your

experience at the 2-Day VBHC Celebration?

Having spent time with Professor Porter and his team

at Harvard Business School (HBS) and going through

the case writing process and then just being in in the

world of VBHC, The Netherlands is certainly known as,

probably internationally, a leader so I was very excited

to be invited for this two day celebration.

I would say two things about my experiences: first of all

it has been a very unique opportunity to get away from

our centers and our work and think a little bit about

what VBHC means globally, outside of the American

context and I think there are some important

implications. The second thing is that I wish there was

something like the VBHC Dragon’s Grant when we

started with Oak Street. I think we made a lot of

mistakes we wouldn't have made, had we had a

community to support us in moving down the path of

VBHC. To be able to share ideas and get direct feedback

about what works and what doesn't from people that

also recognize the value this has for patients probably

would have saved us a lot time. I think the fact that we

“Delivering high-quality value-based care is

hard, complicated, expensive and takes time

but we think there are real advantages…”

have a competition such as the VBHC Prize, to deliver

high-quality, equitable accountable and high value care

is not only important for those of us who are doing it

but there is actually a great use for patients and like I

said before, I wish that we had a community like this.

There were a lot of initiatives that were very forward

thinking about what it means to deliver value-based

care and essentially it means you're willing to make

hard sacrifices and compete for the benefit of patients. I

was also impressed by the sophistication of the models,

by the consistency of the business plans and I expect a

lot of these models to create a lot of value for

themselves and obviously most importantly for

patients.

What did you think of the competing

initiatives?

You know people ask me all the time: where are we in

the development of value-based care? We often use

Sports analogies for this and in The States, we use a

baseball analogy. If we were to use a football analogy

we are in the first half of the second half. I think a lot of

people think that it is very early, whereas we as a team

at Oak Street think that value-based care is far further

along and and if we disagree on this, then it means one

side is wrong. If we are wrong it means we have more

time to develop, but I think if the rest of the healthcare

systems are wrong that’s a different thing. Delivering

high-quality value-based care is hard, complicated,

expensive and takes time but we think there are real

advantages to being the first in marketplace to be able

to do it, not only for patients but also because the tools

and the infrastructure you build to make it easier for

you and harder for others and I think that competition

is good for patients.

The Dutch VBHC experience

Dr. Griffin Myers By Tahita Ringers – VBHC Center Europe

VBHCTHINKERS

SERIES


INTERVIEW

Congratulations on winning the Inspirational

award, what are your thoughts on this?

Thank you so much. But I’d like to remind you that it’s

not my award, its our team’s award, even our patients’

award. We have over 1,300 people on our team at Oak

Street, and for our team to be recognized is very special.

This award will go on the trophy shelf at Oak Street and

is something we will all celebrate.

What is your takeaway of the past few days here

in The Netherlands?

I've actually learned a lot outside of primary care. I

think we have been so focused on primary care and

interestingly we call ourselves something different,

people call us primary care because that's the easiest

way to describe it, but we actually think of ourselves as

a social determinants practice. So it's not just the health

care but it's all the things that feed into that. But the

last couple of days I have learned some of the really

interesting important VBHC techniques in specialty

healthcare such as the bariatric example and the

orthopedic example.

What do I take back with me? I am far more motivated.

I take back to our team that there are a lot of people

trying to do this work who are really smart and who

care a lot about their patients. I embraced that the old

competition is: how fast can I go and how much can I

do on a patient? Whereas the new competition is: how

well can I add value with the smallest amount of money

possible? However, also recognizing that there are a lot

of other people who are going to do this and we have to

keep getting better to compete for the right to take care

of our patients.

What is your final advice?

I've had a really unique opportunity to spend time with

a geriatrics practice in Brazil; one of the largest publicly

traded Primary Care Organizations of Australia, you

and our colleagues here in the Netherlands. There's

something happening, as we are globally understanding

how to change the delivery system to make it better for

patients and we are going to have to make some

important changes. So get started! I think that the

frontier of knowledge in VBHC is so far away from

where we are that if you’re going to take time to learn

all the things that we know to get there it's expanding

faster than we can get there and people need to get

started and assuming they have the right values around

evidence-based care, around provider accountability,

around equity in health care, if they have those values

and care about patients get's started and you'll learn

along the way, you'll make a lot of mistakes but there is

a lot of opportunity to do great work for patients.

For more information about Oak Street Health please visit: www.oakstreethealth.com

Cartoon from the VBHC Prize 2018 by Floris Oudshoorn from Comic House


INTERVIEW

Vincent Wiersma works as a consultant for The

Decision Group. He is an expert in the field of VBHC. In

his four years with the company he has been involved in

44 VBHC implementation projects and he has provided

VBHC education in over 250 organizations over the full

spectrum of stakeholders in healthcare. He has been

involved in VBHC projects that show the value of early

diagnostics, e-health implementation from a VBHC

perspective, implementation of ICHOM sets and the

development of VBHC oriented management

development programs.

When managing these projects he acts as a connecting

link between groups; guiding them through the process

step by step, in a team oriented way. Vincent has

experience with working in a broad range of medical

conditions including oncology, hematology, cardiology

and chronic conditions. His extensive VBHC

implementation experience, medical knowledge and

project management skills combined with theoretical

and practical knowledge on VBHC are essential factors

in the successes of his implementation projects.

“Creating value for patients is in the DNA of

medical teams. VBHC gives structure and

support to this aim”

What is noticeable during VBHC

implementation projects?

Medical teams are often already working with VBHC

without realizing. It is in their DNA to create value for

patients. VBHC gives structure and support to this aim.

It allows medical teams to utilize their improvement

potential, as an individual, as a team and as an

organization, in an optimal way. This leads to learning

faster, better and more.

What are the key elements for successful VBHC

implementation?

First of all it is important to formulate a clear goal that

needs to be reached. This goal needs to be cut down

into smaller manageable steps. A project manager who

keeps track of the progress is essential. Enthusiasm is

another important factor. If the team is not enthusiastic

and motivated about the goal to be reached it is unlikely

that the project will succeed. I have seen that top-down

implementation and financial incentives do not work

sufficiently without intrinsic motivation. Most people

we work with are very motivated and often work on

projects in their own time, which brings me to another

important factor: sufficient capacity. It helps a lot when

people get a day off from their other activities to spend

on the VBHC implementation project or when a trainee,

PhD student or intern is assigned to focus on VBHC

projects. Finally, it is important to keep patients and

the entire multidisciplinary team involved in the

development process. This prevents difficulties in the

implementation phase.

What are the main misconceptions in VBHC

implementation?

First, VBHC is not a goal in itself. That is how it is

sometimes perceived. VBHC is a means to reach the

goal of continuously maximizing patient value.

Therefore, it can go hand in hand with other concepts

or tools as long as the goal remains maximizing patient

value.

Second, outcomes are not only Patient Reported

Outcome Measures. They are part of the health

outcomes but by only focusing on PROMs, clinical

outcome measures are forgotten. All of the outcome

measures should reflect the value of all care delivered:

the true health outcomes. Also, it should be possible to

Five pleasant VBHC implementation surprises

Vincent WiersmaBy Lena van Selm– VBHC Center Europe


INTERVIEW

improve and act on health outcomes in a medical way.

Therefore, according to Porter, patient reported

experience measures (PREMs) are no health outcomes.

Health outcomes should be defined by the patient and

the doctor together and partly consist of clinical

outcomes and partly of patient reported outcomes.

Third, reimbursement is not similar to costs. There are

many misconceptions about the meaning of costs in the

value equation. Costs are often looked at from a macro

economical perspective rather than a micro economical

perspective. Healthcare budget, reimbursements from

insurance companies or funding for hospitals are not

costs directly tied to healthcare delivery. Costs are the

direct expenses made to achieve the defined relevant

health outcomes. These costs are almost never the same

as the funding received to provide the care.

Fourth, The VBHC equation does not need to be solved.

Porter’s definition of patient value is patient relevant

health outcomes divided by costs to deliver these health

outcomes. This is the guiding information you want to

act on, not an equation that has to be solved. The goal is

to create a delta either on the health outcome part of

the equation or on the cost part of the equation,

without compromising the other!

Fifth, there is suitable IT available for VBHC

implementation. A lack of suitable IT is often used as an

argument to not start VBHC implementation. Indeed,

sometimes the right IT is not available at the right

location. However, this should never be a bottleneck for

VBHC implementation. The first VBHC initiatives even

started by making use of Excel next to all available

systems. The real strength of VBHC implementation is

inside people and IT can only facilitate this and make it

a lot more user friendly and fun.

The 5 VBHC Implementation misconceptions

“The real strength of VBHC implementation is

inside people, suitable IT only has an enabling

role”

Do you have any advice to overcome these

misconceptions in VBHC implementation

projects?

Yes, I have three pieces of advice. First, it is important

to keep everybody’s interest in mind. Everybody

involved in the project has their own personal interests

and goals and it is helpful to map these before starting

implementation to make sure everybody is on the same

page. Second, don’t be afraid to ask. It is important that

everyone understands each other to avoid

misconceptions and to speak the same language.

Finally, it is very important to include the patient in the

process because in the end we are doing this for the

patients and their families.

For more information about Oak Street Health please visit: www.oakstreethealth.com


INTERVIEW

The Value-Based Health Care Prize welcomes an

international jury composed of key healthcare experts

and academics. This panel of independent and

international VBHC experts will judge your

application and give feedback on how to push your

initiative to the next level. The newest addition to the

VBHC Prize jury is Dr. César Velasco Muñoz, MD,

PhD. César serves as the Healthcare Innovation and

Integral Management Director at Vall d’Hebron

Barcelona Hospital. He is also an adjunct Professor of

RMIT University, Board Member, new technologies

and innovation of the Spanish Vaccinology

Association, and former Medical Vice-Director of

Hospital Clínico Lozano Blesa.

Could you tell us a bit more about your

experience with VBHC in Spain?

At Vall d’Hebron I'm taking care of generating the

healthcare models for the future in order to ensure that

our system goes through a sustainable roadmap and

that we are adapting to what the patients and their

families need in the future. Furthermore, we are

continuously working on our innovation model - how

do we innovate? How do we de-innovate and; how do

we find the projects that do not add value? Vall

d’Hebron performs the biggest percentage of the

clinical trials in Spain, but for us it is not only about

research, translation of patents and spin-offs to the

market; it is also about innovation in the healthcare and

in the teaching arena. We need to innovate in a

transversal way in those different topics, not only in

one of them. My vision is to have an innovative

structure and innovative institution, with over 9,000

professionals in our hospital we want all of them to use

innovation as a way to improve what they are doing,

and also as a way of motivating each other.

Congratulations on becoming a jury member of

the Value-Based Health Care Prize 2019. What

do you expect from this experience?

It is a great recognition as an institution to be part of

the jury. We have attended the VBHC Prize in the past

and in our experience it was an excellent platform to

understand the expertise in other centers and to learn

what golden standard is being developed at a European

level. In a way, becoming part of the VBHC Prize jury

makes it less of a passive position, as an observer, but

we will be able to use what we learn and to implement it

here in Barcelona. We look forward to disseminate the

projects that are being awarded and hope to attract

some of the aspiring Spanish VBHC initiatives that we

are familiar with, but that have not participated in the

VBHC Prize yet.

What kind of initiatives should apply to the

Value-Based Health Care Prize?

All those working with innovation purchasing, new

ways of procuring, evaluation of value in terms of

outcomes and patient involvement. Such as, hospitals,

primary health care facilities and quality and

innovation agencies from different regions in Europe.

What would be your best advice to future VBHC

Prize applicants?

I would say if you're small, apply, because it is a great

way to learn what the big ones are doing. Also, I would

say that we aim to evaluate the quality of the projects,

not the quantity or volume, but their potential impact.

Sometimes small projects with a nice approach and the

capacity of transforming the healthcare arena can be of

more interest than very mature organizations in VBHC.

We need both.

Meet the VBHC Prize 2019 Jury

Dr. César Velasco MuñozBy Tahita Ringers – VBHC Center Europe

VBHCSTORIES

SERIES

VBHC in The Netherlands and beyond

ApplicantsValue-Based Health Care Prize 2018

Application facts 2018

14 times more international applications

2 times more primary care initiatives

2 times more e-health initiatives

34 medical conditions treated

“We were impressed by the quality of the

inspiring initiatives which were submitted

this year. Value-Based Health Care is on

the rise, nationally and internationally!”

Prof. dr. Fred van Eenennaam

Non-voting Chairman of the VBHC Prize

On behalf of the international jury

Over 80% of Dutch healthcare organizationsinvolved.

Over 750 million € collectively saved.

Over 8 million patientsaffected.

Applicants VBHC Prize 2014-2018

Measuring outcomes

Network approach

Bundled payment

s

Institutional transformation

2014 2015 2016 2017

Throughout five editions of the VBHC Prize, several trends

have been seen in the applications regarding the VBHC

approach. Today, the VBHC approach has let to multiple

IPUs.

Key trend – From VBHC projects to VBHC

Integrated Practice Units.

Formation of IPUs

2018

“The application for the VBHC Prize hasbeen an opportunity for our team tolook back at the amazing work we didtogether and to look forward to newsteps.”Giulia Goretti, Applicant 2018

“The VBHC Prize gives a greatopportunity to expose yourinitiative. Writing the formalapplication made us focus on thecore value of our initiative, how topitch our initiative and inspireothers.”Hannes Seesing, Applicant 2018

vbhcprize.com @VBHCEurope Value-Based Health Care Center Europe


INTERVIEW

Dr. César Velasco Muñoz is the innovation and

general strategy director at Vall d'Hebron in

Barcelona. He is a medical doctor by trade and

specialized in preventative medicine and public health.

After years of working abroad in several

organizations he ended up working in Spain as a

healthcare manager in the public health system.

How is VBHC expanding in Spain?

As European institutions we are all in the same family,

together we are trying to push for implementation and

measuring outcomes. However, there are many

different healthcare systems across Europe, which

makes the implementation of VBHC different. When we

first started applying VBHC here at Vall d’Hebron we

started with thinking of our design and how we could

put the patient first, whilst evaluating the impact of the

processes that we were implementing. We decided that

the best way to measure the impact was measuring the

impact on patients for whom value was the most

important. For us it was not just about numbers, but

how the patient valued their journey in terms of

outcomes and experience. When we had developed our

standards, we started looking for a way to benchmark

our findings with other institutions globally. Thus, we

are not just implementing but also showing the

scientific community that there is an added value of

implementing value-based health care. By our

participation in the ICHOM consortium we have been

able to collaborate more and we want to start shifting

our model from a product-based processing model to a

service-oriented processing model. Now we have to

think about the innovative healthcare models of the

future and how to continuously develop these tools.

For example, using artificial intelligence and virtual

assistants could be the way of interviewing patients in

terms of value-based health care without adding a high

cost or work volume. We could use this kind of

transformation to implement value-based health care in

a really systematic way in Europe.

What are three trends that are currently

shaping the healthcare arena?

First of all, there are a lot of new actors entering the

healthcare arena. Big companies, most of them working

in the digital transformation, are entering in a really

smart and strong way. Secondly, we have the active

patient, patients who want to be involved, require more

services and want design-centered solutions, they don't

want just products anymore. Thus, the patient and

family involvement is huge and we need to take that

into consideration. Finally, we must focus on how social

or demographic changes are forcing us to do these

kinds of transformations. We need to think about the

way that we are measuring the value of the healthcare

system and how we transform the healthcare systems in

Europe to ensure that sustainability will be an

important matter.

“We have to think about the innovative

healthcare models of the future and how to

continuously develop these tools”

How are you collaborating with other European

hospitals?

We can not be innovating from scratch, we should look

at what has been previously developed, and collaborate

with other European hospitals and try to expand

globally. That is why we decided to go towards a

European alliance project.

Towards a Service-Oriented Processing

Model in Spain

Dr. César Velasco MuñozBy Tahita Ringers – VBHC Center Europe


INTERVIEW

The European University Hospital Alliance was formed

in 2017 with the commitment of nine of the best

university hospitals in Europe to share their expertise

in healthcare, research and education. University

hospitals play an important role in driving innovation

and translating this into practice. Through the alliance

our members aim to play an active role in shaping the

future of European healthcare, learn from each other to

maximize patient outcomes and combine efforts to

drive high quality research. The initiative has a huge

potential of generational impact worldwide, but we

need to be organized and we need to be able to generate

solutions that are applicable to many countries at the

same time. We aim to have a European platform with

shared information, shared best practices, shared data.

We want to be a pilot on how that can work.

What role does digitalization play in the

current healthcare landscape?

In order to be digital you need to transform. The

concept of digitalization is about ‘how’ you are

implementing digital tools to save lives and we have a

lot of information systems in the hospital and

technologies that are changing lives. However, there

are also a lot of technologies that are not adding any

value, specifically the ones measuring results which just

add general numbers, quantity but not quality. We need

digital platforms in order to generate this

transformation and for that we need a system that

provides feedback to patients and clinicians, and that

change the way we interact with the analytical world.

We have been doing this wrong for many years, for

example collecting a lot of medical information in the

electronic patient files, but not being able to do

anything with this information.

Thus, we need to really work hard to make this

qualitative jump in order to give value, not just take

information. Finally, we have to understand that

digitalizing alone is not enough; it is part of the entire

innovative strategy and I think the Value-Based Health

Care Prize has something to add within this roadmap.

What is your final advice to other healthcare

professionals?

In order to answer this question we need to get into the

real objective of why we are making all of these

transformations, we need to be aware that healthcare

systems in Europe are a way to provide social justice.

We have a huge number of healthcare professionals

who want to give their everything to improve the

healthcare system, but to keep improving we need to

know what the patients and the families need. We need

to engage them in order to know what they need, in

order to provide them with universal healthcare that

gives them what they really need, because the resources

are not unlimited, but the needs could be unlimited. We

need to know what is really valuable and we are

responsible for the sustainability of our healthcare

system. A lot of the European success is based on the

fact that our citizens have the opportunity to live a

healthy life. We need to work on maintaining our

system because we are getting older, the aging

population is a fact and this knowledge gives us a

chance to be prepared for that. We have a chance to use

this knowledge to develop patient-centered solutions

and use digitalization in combination to provide a more

robust healthcare system. It is our responsibility and

social mandate to work together with our professionals,

to give them the best healthcare system that we can

dream of.

For more information about Valle d’Hebron please visit: https://www.vallhebron.com/ca


PERSPECTIVE

VBHC Value Agenda NL 2019By Mirte van Holsteijn – VBHC Center Europe

To generate and discuss actions on taking

VBHC to the next level, in 2017 The Decision

Group, Amgen and Medtronic organized a

Working Session with Harvard Professor and

founding father of VBHC Prof. Michael Porter

and 25 key decision makers in Dutch

healthcare. As a result of this Working Session,

the Value Agenda for the Netherlands was set

out. This agenda consists of six Calls for Action

to accelerate the implementation of VBHC in

the Netherlands.

Over the past ten years, the Netherlands has become

one of the leading countries in the world for VBHC

implementation. However, a full-scale implementation

of Value-Based Health Care in the healthcare system of

the Netherlands is not yet fully realized. In 2017, the

Value Agenda for the Netherlands was composed by 25

key decision makers together with Prof. Porter, which

contained six Calls for Action to help accelerate large

scale Value-Based Health Care (VBHC) implementation

in the Netherlands.

In order to respond to the Calls for Action of the Value

Agenda NL and to stay ahead of the curve, a follow-up

Working Session was organized in 2018 with 30 key

decision makers in Dutch healthcare and two

prominent VBHC experts: Dr. Bohmer and Prof.

Cripps. The aim of this session was to build on the

Value Agenda 2017 and the six Calls for Action and to

identify practical actions and solutions for each

stakeholder group in order to accelerate VBHC

implementation in the Netherlands.

According to the attendees and key decision makers in

Dutch Health Care, the Call for Action “Leadership and

Culture” is the most important action at this stage and

has the highest future potential (31%).

The Working Session 2018 resulted in five actions to

promote and stimulate VBHC Leadership and Culture.

Healthcare stakeholder groups can respond and

contribute to one or more key action(s).

A focus solely on the Call for Action Leadership and

Culture will not be enough. Therefore, in addition to

the five key actions on Leadership and Culture, ten

additional actions were formulated for the other five

Calls for Action on the Value Agenda NL, resulting in

the 15 actions on the Value Agenda for the Netherlands.

The 15 actions together provide a guide for the onward

journey towards large scale VBHC implementation in

the Netherlands. We encourage all stakeholders in

healthcare to support the actions and move the VBHC

needle together.


PERSPECTIVE


INTERVIEW

Dr. Maarten Ottenhof is a plastic surgeon at the

Catharina Hospital in Eindhoven in the Netherlands.

Maarten has dedicated the past few years of his career

to a revolutionary patient-reported outcome

instrument: the Face-Q. This instrument is designed to

evaluate the unique outcomes of patients undergoing

facial cosmetic procedures.

Can you tell us something about the project you

are working on?

Plastic surgery is a branch of medicine that mainly

focuses on improvement and finding a way to move

forward, which is what first sparked my interest in this

area of medicine back in the day. As a plastic surgeon I

see patients who for example survived breast cancer

and seek my help to regain their body confidence or

patients with skin cancer who want to cover up skin

that needed to be removed. Improving their quality of

life and giving them a way to move forward is

unexplainably motivating.

During my residency I discovered that there was no

strict guideline for treating a patient with skin cancer.

For example, you have four ways to treat a skin

deficiency on the nose; every physician does something

else, based on their previous experiences, but which

treatment is the best?

In a world where patient reported outcome measures

(PROMs) are becoming part of daily practice, we came

up with the idea of a decision tree that shows the best

options for every defect in the face. We are using the

internationally developed FACE-Q to develop a clinical

decision-making tool to assist in deciding which

patients will benefit from facial skin reconstruction,

using PROM data.

This will improve patient care through shared decision-

making and act as a guide to the best treatment method

for any given location of a facial skin cancer.

How does this add value to the patient?

What is so interesting about this project is that we are

involving the patient’s perspective into the system. The

project involves a comprehensive questionnaire in

which the patient’s experience regarding their

reconstruction and the visit to the hospital are

recorded. If you consider that we have been doing

reconstructions for more than 50 years but we started

asking patients for their opinion and experiences only a

few years ago, including the patient in the process

improves the value to them tremendously. First,

because they feel heard and feel that they can voice

their opinion. Secondly, by collecting opinions and

experiences from patients we are able to create a

learning cycle, which we as physicians can use on a

patient level and on a group level, to see how the

physicians are doing and compare them to their

colleagues.

Machine Learning in Plastic Surgery

Dr. Maarten OttenhofBy Tahita Ringers – VBHC Center Europe

Cartoon from the VBHC Prize 2018 by Floris Oudshoorn from Comic House


INTERVIEW

How do physicians experience the new learning

cycle?

That depends very much on the culture within a

hospital or department. If you take an astronaut that is

going to Mars for example: they will continuously

discuss what they can improve with their fellow

astronauts and after months of exchanging their

experiences and learnings the entire team realizes that

it benefitted the successful mission and it was nothing

personal. If we translate this to physicians, we can learn

that it is a way to move forward, to improve and realize

successes. However, how we present the feedback is

essential and if this is done in the right manner it will

encourage everyone to learn what they are good at and

what needs improvement.

Where do you see the project in five years?

Exposing patients to long questionnaires is quite a

heavy burden and studies have shown that people with

different levels of intelligence respond differently to

questions. If we do not take the spectrum of intelligence

and perceptions into account we unnecessarily expose

patients to dreadful questionnaires. However, if we do

take these factors into account you only need a third of

all the questions to get to the same point. In 5 years I

would therefore like to see a shift towards prediction

models in which we can look at satisfaction of a patient

and simultaneously decide the treatment route. This

principle is new in medicine and plastic surgery is a

very suitable field to eradicate this because the

treatments are focused on improvement.

The final stage of this project would entail an app in

which patients can fill in questionnaires at home, based

on their input we can evaluate the status of their

recovery and decide whether the patient needs to stay

home or come back to the hospital, which eventually

leads to more efficiency and less costs.

The potential benefits we offer patients through the

integration of PROM data is huge and what we are

doing now is a small part of the bigger picture. The

principle of prediction models on large scale data

analysis, combined patient characteristics,

reconstructive type and PROM data can be rolled out to

many other specialties.

What is the biggest trend in digitalization for

plastic surgery?

The patient reported outcome measures. However,

hospitals are still unsure on how to implement this and

how the logistics of it work. With the Dutch Scientific

Plastic Surgery Department we are now working on

finding a way to implement PROMs and especially the

FACE-Q, in every hospital in the Netherlands.

What is your best advice to other healthcare

professionals?

We must realize that the old way of working, (everyone

for themselves on their own little clinical island) no

longer suffices and in order to scale up we have to

collaborate and work together. My proposition for the

future is: collaborative authorship. Let’s all exchange

data and learn from each other, let’s contribute to the

bigger picture without losing authorship.

For more information about Face-Q please visit: http://qportfolio.org/faceq/


INTERVIEW

Professor Matthew Cripps is the Director of the

Sustainable Healthcare team in the Medical

Directorate in the NHS England. The primary aim of

this team is to focus on population healthcare

improvement and help the wider health service to

identify and use techniques, tools and methodologies

to increase value in healthcare.

What is your take from the VBHC working

session organized by The Decision Group,

Amgen and Medtronic to ‘call for action’ and

formulate the key actions in order to

collaboratively accelerate VBHC

implementation in the Netherlands and

improve value for patients?

That no matter how different healthcare systems are in

different countries and there are always similarities and

differences, everyone is trying to do the same thing

which is: continuously improve what we are doing for

our populations, recognizing that we are very good at

some things and not so good at others things and trying

to work out how to become better at them. This

includes very complex and philosophical problems of

‘why are we doing this?’ and ‘how do we need to change

our approach thus far over decades and decades?’.

VBHC is all about what value we intend to add and

exploring if our system delivers this defined value. If we

haven’t defined it, it is very unlikely that it adds value.

So once we have defined it: how do we go about it? Via

the traditional improvement routes or do we need new

ones? I feel that this was basically the gist of the whole,

very interesting, discussions we had during the working

session.

“This includes very complex and philosophical

problems of ‘why are we doing this?’ and…”

From what you have learned at the VBHC

working session, what aspects of what you are

doing in the Sustainable Healthcare Team do

you think we in The Netherlands can learn

from?

I would not like to pass judgment on the Dutch health

system not least because I am not fully versed in it. But

the generics of what I have always found to be

successful in England are applicable to any country and

I suppose what I would suggest anyone can learn from a

successful improvement program is: what do we lack

and how can we translate it to our environment.

“If we haven’t defined it, it is very unlikely that

it adds value”

For example: are you using unwarranted variation data

and comparing each local health economy’s data with

their demographic peers? (We believe this is the

catalyst for optimal improvement) Or do you get local

clinicians and all of the other professions in the system

to sit down together at the beginning of the

improvement journey and do the optimal design of

what you're going to deliver together, and by

consensus? If you don't do these things yet, maybe

you'd like to think about doing them, because they have

worked for us.

Consensus is key

Prof. Matthew CrippsBy Tahita Ringers – VBHC Center Europe

VBHCTHINKERS

SERIES


INTERVIEW

What has been the most challenging aspect of

setting up a National Programme?

I suppose it has got to be the culture change. This year

marks the 70th anniversary of the NHS and over those

70 years the system has evolved into a supply driven

system, built very much around acute care and things

that weed into it, through it and out of it. I think the

biggest challenge is not to get the system to recognize

that it is not optimal, but the focus should be on

primary prevention and secondary prevention. I think

everyone recognizes that it is about getting the culture

of those very same people to shift, not just the leaders

but everyone in the system so that we can actually move

towards it at a much faster and more comprehensive

pace than we are doing at the moment. That is

essentially what I was aiming to do when I directed the

National program, NHS RightCare .

“The system has evolved into a supply driven

system, built very much around acute care and

things that weed into it…”

“Consensus and not just consensus of the

perceived important people…”

What would be your best advice to other

healthcare professionals?

Consensus and not just consensus of the perceived

important people like accountants and medics.

Consensus of everybody because, everybody including

populations, patients, local and national charities,

academia, all the different clinicians and beyond just

the medics and all support professions. Everybody can

either block or slow down change or can dilute the full

impact of the challenge. This is not something that is

done consciously or cynically, however if you do not

own a thing it can be hard to fully embrace delivery on

it. If you have consensus of all of the right stakeholders

from the beginning, every single improvement you will

do will then enhance your delivery by: a. getting the

right answer in the first place and b. asking the front

line to deliver something that they originally designed.

For more information about NHS RightCare please visit: https://www.england.nhs.uk/rightcare/


PERSPECTIVE

With over a decade of experience Value-Based Health

Care (VBHC) now has a considerable international

influence on healthcare. Two years ago we wrote an

article about five reasons why VBHC is beneficial

(Fakkert et al., 2017). These reasons are still

compelling today. In addition, many new VBHC

highlights and experiences have led to two new

reasons to be added to this list: (VI) VBHC accelerates

the effects of other partial healthcare delivery

improvements and (VII) rapid VBHC implementation

is now possible through affordable VBHC supporting

software. This article explains the seven reasons why

VBHC is beneficial including additional boxes for

further must check examples.

Reason VI: VBHC accelerates the positive effects of

other healthcare delivery improvements

VBHC has inspired medical leaders to improve and

organize care better with more fun for the teams and

the patient. Now we have learned that, in addition to

that, VBHC amplifies the strengths of different

approaches, accelerating the creation of patient value.

For instance, patient journeys and joint decision-

making approaches work much better when embedded

in the defined medical condition, health outcomes and

patient episode cost approaches. For more examples

and further readings see Box 1.

Standalone care improvement approaches fade away

quickly. Under VBHC multiple approaches can be

combined to create a long-lasting impact. For

example, Lean based approaches work much better

when organizational streamlining and improvement

cycles are combined with VBHC concepts, such as

patient value definitions and stratifications. VBHC has

been a wonderful approach to combine and organize

other partial health care improvements in a cohesive

team journey with patient value and team work as the

clear measures of success. Figure 1 Shows health care

improvements that when embedded in VBHC

implementation will accelerate patient value and team

work.

The Sixth and the Seventh Reason Why Value-Based Health Care is Beneficial Lena van Selm, MSc and Prof. Dr. Fred van Eenennaam

Figure 1: VBHC amplifies the strengths of different concepts, theories, and ideas of (integrated) care delivery.


PERSPECTIVE

Reason VII: Rapid improvement is now possible through

affordable software

Specific software that facilitates VBHC implementation is

now available and affordable. During the VBHC Prize 2014

lack of data and software was considered to be one of the

main barriers to VBHC implementation. We already knew

what was needed to make VBHC work from a data and IT

perspective (see figure 2), but the right software was not

yet available.

Now after years of false software claims, we have finally

turned the corner. A lack of suitable and affordable

software is no longer a barrier for VBHC implementation.

Suitable and acceptable software and technology is

available to provide the right data at the moment of the

patient doctor interaction. We are now able to fulfil

bundled payment contracts and planning and scheduling

from the patient’s perspective rather than from the

providers availability is possible. Data analyses to support

more predictive and personalized treatments, as well as

insights into the real costs of individual patient journeys is

available when teams have defined the patient medical

conditions carefully.

A good example of VBHC software is COPD InBeeld,

winner of the Value-Based Health Care Primary Care

Award 2018. This collaboration between multiple Dutch

health organizations aims to stimulate the self-

management of patients suffering from COPD in the

Netherlands. For more information and examples see Box

2.

Box 1 - Must Check: Combining approaches to accelerate

implementation

a. The article: Meetbaar Beter: Health insurance

outcome-based purchasing: The case of hospital

contracting for cardiac interventions in the

Netherlands – Dennis van Veghel (2018): shows how

a value-based purchasing contract based on outcomes

rather than volume can increase patient value.

b. The Netherlands Heart Network, winner of the VBHC

prize 2018: patient centered pathways covering the

full cycle of care are standardized and continuously

optimized based on insights in outcomes.

c. Diabeter, winner of the VBHC prize 2017: deliver

individualized and comprehensive care and ensure

excellence through measuring, tracking and analyzing

outcomes for every patient.

Figure 2: The four key areas where enabling software and technology are required to create maximal patient value


PERSPECTIVE

I. Patient Value: A Common Definition

Doctors would base the meaning of patient value on the

skills of a doctor, an improved medical lab result, or a

well-performed surgery. These measurements are mainly

based on the treatment or intervention process. On the

other hand, a patient may base patient value on aspects

such as the length of waiting lists, how kind the doctor was

or perhaps how good the coffee or breakfast tasted. Most

people would agree that both sets of measurements do not

truly reflect the quality of care from a medical perspective.

A combination is needed that reflects patient relevant

health outcomes upon which can be medically acted. For

more information and examples see Box 3.

II. A Common Language

Value Based Health Care provides a common language

that is comprehended by doctors, medical teams, patients

and their families. Patient value is defined by an equation

whereby health outcomes are the numerator, and costs per

patient in delivering those outcomes are the denominator.

Patient value is defined for a specific medical condition

over the full cycle of care. It is important to note that

outcome measurements should be defined around a

medical condition and should be manageable and

actionable. Doctors and their teams are then intrinsically

motivated to improve the quality of care they deliver to

patients. All they need are the tools to measure and the

ability to visualise accurate and valuable outcomes. For

more information and examples see Box 4.

III. Focus on Measurable Health Outcomes to Facilitate

Improvement

Measuring outcomes in healthcare began in the 1950s, and

mainly consisted of process and structure measurements.

For example, the length of waiting lists or the amount of

Box 2 - Must check: Affordable software for further

improvements

a. Mijn IBD coach, Nominee of the VBHC Prize 2017:

the Telemedicine tool myIBDcoach reduces health

care utilisation, and improves adherence with equal

patient-reported quality of care compared to

standard care.

b. Awell Health: developed a toolkit for Value-Based

Health Care teams including patient engagement

and information, care delivery, outcomes and cost

measurement. https://awellhealth.com

c. The Santeon Farma database: Santeon built a

database to enable them to collect and track data

concerning medicine prescriptions across their

different hospitals. More information on

https://www.santeon.nl/santeon-farmadatabase/

or check the interview with Ewoudt van de Garde in

the 2017 Christmas edition of the Thinkers

Magazine.

Box 3 - Must check: Patient Value, A Common Definition

a. Video: healthcare’s dirty secrets, by Michael Porter:

Shows the key issues VBHC addresses

b. The article: What Is Value in Health Care? (2010) –

M. Porter: Explains the importance of measuring

patient-relevant outcomes and over a full cycle of

care.

c. The Harvard Case The Martini Klinik: this

outstanding example of VBHC implementation

shows how organization and learning cycles can lead

to extraordinary outcomes while lowering costs.

https://hbsp.harvard.edu/home/

Box 4 -Must check: A Singular Language

a. The article: The Strategy That Will Fix Healthcare

(2013), by Michael Porter & Thomas Lee: explains

how to build a system around what patients do

rather than what physicians do, that measures

patient outcomes rather than volume and

profitability.

b. Netherlands Cancer Institute, Winner of the VBHC

Dragon Grant 2018: improve quality of life for

women with Premalignant Breast Disease by

labelling fewer women as cancer patients, reducing

associated medicine use and preventing

unnecessary surgeries. This and other game

changing examples in patient value creation on

https://www.vbhc.nl/vbhc-dragons-grant-

endorsement

c. The aticle: The Big Idea: How to Solve the Cost

Crisis in Healthcare (2011), by Robert Kaplan &

Michael Porter: explains the concept of Time-

Driven Activity-Based Costing, which is the

preferred method to estimate costs in VBHC.


PERSPECTIVE

(certified) staff. This led to quality management based on

the optimization of processes, rather than the outcomes.

Patient and family perception only started to become

important from a measurement perspective in the 1990s

and it took the healthcare sector quite some time to realize

the significance of patients in healthcare delivery. Luckily,

today healthcare providers are able to present true

patient-relevant outcome measurements to their

colleagues and patients.

IV. Protocols Do Not Fit Every Patient, But Patients

Benefit from Protocols

Every patient is unique and they each walk a different path

through the cycle of care. Protocols are very useful as they

provide care delivery guidelines for patients with common

medical conditions, but they won’t fit every patient. By

good communication with patients, protocols can be

changed and care delivery can be opitmised and adjusted

to fit every individual.

V. Become a Patient-Centered, Fast-Learning Team

Value-Based Health Care is centered around learning.

Doctors who have a drive to show medical leadership and

create a learning culture are key for the implementation of

VBHC. Learning to improve value for patients provides

satisfaction. This motivates doctors and their teams and

also cuts costs. VBHC empowers doctors and their teams

to do what they do best—provide excellent patient value by

using clinically relevant and evidence-based insights.

Creating excellent patient value

Patient centered care is on the rise. In the last decade

VBHC has helped many healthcare delivery teams to

increase value for patients by providing them with a

common definition for patient value and a common

language to communicate with other stakeholders in

healthcare. Also, measuring outcomes, focusing on

meaningful variation between patients and creating

learning cycles in medical teams have increased the quality

of care tremendously. Recently, value creation has started

to accelerate by combining different healthcare

improvement approaches under VBHC and by the

availability of suitable IT. With the ongoing creation of

new technologies and the upscaling of VBHC the future

will bring us many exciting new lessons to be learned in

the pursuing of great patient value. Working towards

excellent patient value has never been more enjoyable

than it is now!

Box 5 - Must Check: Focused on Measurable Health

Outcomes to Facilitate Improvement

a. ICHOM: to learn about health outcomes

measurement and the development of standard

outcome sets. https //www.ichom.org/

b. The article: Better Value in Health Care Requires

Focusing on Outcomes (2015) by C. Stowell & C.

Akerman: explains the importance of measuring

outcomes

c. Meetbaar beter, winner of the VBHC Prize 2014: is

a great example of transparently reporting patient

relevant outcome measurements for specific

medical conditions.

Box 6 - Must check: Protocols Do Not Fit Every Patient,

But Patients Benefit from Protocols

a. The Harvard Case: The Dana-Farber Cancer

Institute: shows the importance of protocols to

assure patient safety.


b. The Harvard Case UCLA: learn about reducing

meaningless variation in healthcare delivery.


Box 7 - Must check: Become a Patient-Centered, Fast-

Learning Team

a. The article: Double Loop Learning in Organizations

(1977), by C. Argyris: explains hoe learning should

not only detecting error but questioning underlying

policies and goals as well as its own program.

b. The Article: New Science of Building Great Teams

(2012), by A. Pentland: explains how to improve

team performance by the manner of

communicating.

c. The original article: Five Reasons Why Value-Based

Health Care is Beneficial (2017), by Michelle

Fakkert & Fred van Eenennaam

Applications will be accepteduntil February 4th, 2019

Why should you apply?• Boost your initiative through exposure to >350,000 healthcare

professionals;

• Receive feedback from a renowned jury of VBHC experts;

• Be recognized as a leading initiative in patient- centered care and

inspire others;

• Network with other VBHC pioneers;

• Be at the center of healthcare innovation;

• Push your initiative to the next level.

@VBHCEurope Value-Based Health Care Center Europewww.vbhcprize.nl

6th VBHC Prize EventApril 18, 2019

Subscribe to the newsletter for more information: www.vbhcprize.com

“Winning the Prize brought us recognition and new possibilities by all different stakeholder-groups.”

Dr. Henk-Jan Aanstoot (Diabeter, winner VBHC Prize 2017)


INTERVIEW

Thea Gutter, clinical epidemiologist and investigator

at SEIN. Thea was part of the development of the

VBHC Endorsement winning initiative the

Nightwatch. SEIN, as member of the consortium Tele-

Epilepsy, designed a smart wearable bracelet that

warns caregivers of a person suffering from nighttime

epileptic seizures.

Can you introduce yourself?

I have been working at SEIN since ‘89; SEIN is an

expertise center for epilepsy and sleep medicine. SEIN

is specialized in diagnosis, treatment, support and

scientific research in epilepsy and sleep. SEIN aims to

improve the quality of life of people with epilepsy.

During my career in the EEG-department I worked

with many people with epilepsy. Sudden unexpected

death in epilepsy is a major cause of mortality in people

with epilepsy. People with an intellectual disability and

severe therapy resistant epilepsy, may even have a 20%

lifetime risk of dying from epilepsy. Although there are

several techniques for monitoring patients at night,

many seizures are still being missed. Later on in my

career I had, as clinical epidemiologist, the opportunity

to use my creativity to develop new systems and this is

how I started looking for the best way to develop an

epilepsy detection system for children with seizures

during the night, living with their parents.

How did you go from an idea to the actual

product?

It all started during gaining data for diagnostic reasons.

I travelled to the homes of people that had a child with

epilepsy and monitored them with video and EEG

through the night.

During my many visits I had the unique opportunity to

not only monitor patients but also to talk with the

families and see the situations they were in. Many of

these children were sleeping with their parents or

siblings in order to monitor their seizures during the

night. This was a heavy burden on all family members

and I felt that this needed to change; we needed to find

a solution that would benefit both the person with

epilepsy and the caretaker. Simultaneously we started

creating a bigger network of physicians and caretakers,

which led to the opportunity to get in contact with

healthcare insurers Achmea. At this point we got the

ball rolling and eventually this led to the creation of the

consortium Tele-Epilepsy.

We realized that we needed a multimodal system,

which incorporated movement, heart rate, video and

audio together. Kempenhaeghe, the other in epilepsy

specialized center in our consortium already had been

developing a movement detection system for epilepsy.

The video and audio detection system, developed in

SEIN, was used as a control mechanism. It took a long

time to develop a system that was user-friendly, non-

invasive and reliable. Through meetings with

caretakers and other stakeholders we have managed to

develop a system that caters to everyone’s needs.

The Nightwatch bracelet now detects 85 percent of all

severe night time epilepsy seizures. I believe that this

bracelet can reduce the worldwide number of

unexpected night time fatalities in people with epilepsy.

Currently, the Nightwatch still generates alarms based

on the two sensors (heart rate sensor and motion

sensor), but we are investigating how the two can work

more intelligently together to achieve even better alerts.

Applying Innovative Technology to Epilepsy

Thea GutterBy Tahita Ringers – VBHC Center Europe


PERSPECTIVE

We are working on improving alarm systems based on

sound and video, which can be combined with alarm

systems via the bracelet in the future. In time, the aim

is to make the interpretation of the signals patient-

specific.

How are patients and caretakers experiencing

the use of the bracelet?

By having meetings with caretakers and hearing their

thoughts and experiences we have learned a lot. Firstly,

that the bracelet is very accepted in most children and

adults with epilepsy because it is small and reliable.

Caretakers felt that they could sleep comfortably

because they relied on the fact that they would be

alarmed when necessary, even though there were some

false alarms. However, in people with sever autistic

behavior, the device was less accepted. For these people

an unknown device on their body or a camera in their

room was not an option, they struggled and fought

when putting on the bracelet. For the caretakers it was

reason to stop. Finally, some people with epilepsy show

very few movements during their seizures, which

makes it difficult to detect a seizure. As you can see, it

was very important for us to gain this knowledge and

take all different situations into account. The great

thing is that by long-term collection of data and all the

input we received we were able to continuously improve

our system and resolve minor issues. The next step is to

optimize the algorithm in order to incorporate the

video detection into the current system.

Where do you see the Nightwatch in 5 years?

The Nightwatch is not a cure; it is a support tool for

caretakers, which leads to better management of

epilepsy and improves the quality of life in the person

with epilepsy, but also in his or her caregivers. It is a

utopia to expect that 100% of all people with epilepsy

can be helped with this device, but I would feel very

happy and accomplished if we could help two-thirds of

all people. One of the reasons I applied for the VBHC

Dragon’s Grant is that I knew I was going to retire in

October 2018 and I wanted to influence and motivate

the new generation that will further develop the

system. The Dragon’s Grant was truly an opportunity

for them to expand their network, learn from others

and gain experience. Winning the Dragon’s

endorsement was the crowning glory of all that we have

accomplished thus far. Seeing people with so much

passion and motivation for their purpose is very

inspiring and close to what I have always felt

throughout my career.

For more information about the Nightwatch e please visit: https://www.nightwatch.nl/


INTERVIEW

Bas Nij Bijvank is a gynecologist and perinatologist

at Isala Clinics in Zwolle, The Netherlands. Dr Nij

Bijvank is specialized in maternal and fetal

complications during pregnancy. He is also part of the

ICHOM project group for pregnancies and childbirth,

and a member of the medical board at Isala Women

and Children’s Hospital.

What was your first experience with VBHC?

My first experience with VBHC was in Nijkerk, The

Netherlands at the VBHC Masterclass organized by The

Decision Institute. The masterclasses were motivating

and energizing, On the one hand because of the

interesting cases and on the other hand because of the

opportunity to meet a lot of different people in the

industry, such as healthcare insurers, managers,

directors, doctors etc. which was very inspiring.

Because of my good experiences during the VBHC

Masterclasses I decided to sign up of for the VBHC

Greenbelt Track and exam.

What have you learned during these courses?

For years I have been working on maternity care, in

particular the cooperation between first and second line

care. The past few years we have noticed that

cooperation is difficult, not because people do not want

to work together, but because of the way our system

works and all the different stakeholders and their

opinions that are involved. During the VBHC

Masterclasses I learned that our healthcare system

causes unnecessary incentives which increases the

barrier between first and second line care. One of the

cases we studied during the VBHC Masterclasses

showed me that we could do this differently.

“I am a certified VBHC Green Belt, which to me

means that I have gained specific knowledge

and broadened my understanding of the VBHC

concept”

During the VBHC Masterclasses I have also earned the

right to say that I am a certified VBHC Green Belt,

which to me means that I have gained specific

knowledge and broadened my understanding of the

VBHC concept. I use this knowledge in my day-to-day

activities, in different groups, internally in order to

motivate others in my organization. The VBHC

Masterclasses opened my eyes to the importance of

measuring patient reported outcomes and experiences

and I believe ICHOM has the future. After 2 or 3 VBHC

Masterclasses I joined the Dutch ICHOM project group

for Pregnancy and Childbirth where this knowledge is

very valuable.

Where do you see VBHC in 5 years?

What we can see now is that maternity care in the

Netherlands is not on the right track yet, in terms of

outcomes, the way the system works and with the nine

partial tariffs. The past few years our focus has been on

organizing first and second line care, which has led to

many conflicts. However, we have a good opportunity

with VBHC to do it right this time by taking quality as

the point of departure, taking responsibility together

and overcoming the initial barrier between the two care

lines. I see what the possibilities are but it’s just an idea

and a personal opinion. To establish what I have in

mind: paying for quality, we still have a long way to go,

at least 5 to 10 years. The next few years will be

important for maternity care.

We have a good opportunity with VBHC to change maternity

Dr. Bas Nij BijvankBy Tahita Ringers – VBHC Center Europe

VBHCSTORIES

SERIES

VBHC GREEN BELT


INTERVIEW

What would be your best advice to other

healthcare professionals?

One of the things that inspired me most during

the VBHC Greenbelt Track was the importance

of medical leadership and starting with small

local pilots in order to gain experience in

delivering quality and lowering costs. We

should not change the entire healthcare system

but we should start small, with a small part of

maternity care and a small group of patients

and figure out how to measure outcomes and

costs. Furthermore, I started this VBHC journey

just like everyone else, unaware and with little

previous knowledge on the concept.

“Having taken the step of educating

myself through the VBHC Masterclasses

has had many benefits…”

Having taken the step of educating myself

through the VBHC Masterclasses has had many

benefits. VBHC will probably not solve all the

problems in healthcare because new problems

will arise in the future, but VBHC broadens

your perspective and gives you an insight into

how our healthcare systems could work. I

would recommend everyone to join a VBHC

Masterclass; it opens doors.

Would you like to become a Value-Based Health

Care expert and be recognized for it? Follow the

interactive VBHC Green Belt Blended Learning

program in which you will be trained to become a

Certified VBHC Green Belt.

The Green Belt blended learning program takes place all

year round. The program is very fexible: the sessions can be

followed in any order, allowing you to enter the program

whenever it is convenient for you. The following sessions are

planned for 2018:

VBHC Core Concepts

• February 7, 2019 | April 25, 2019

Lean and other VBHC tools

• February 28, 2019| May 23. 2019

VBHC implementation challenges

• March 14, 2019 | June 13, 2019

Your role in implementation

• December 17, 2018 | April 4, 2019

Please contact us via:

[email protected] for more details and fees


NEXT

VBHC Dragon’s Grant 2019

The VBHC Dragon’s Grant & Endorsement is the

perfect opportunity for initiatives that are still at

an early stage but are very promising. VBHC

experts help these initiatives to realize true

impact on patient value. Initiatives are nominated

on the basis of their application for the VBHC

Prize and invited for the exclusive VBHC Dragons

Event on the 17th of April. The submission

deadline for the applications is February 4th,

2019. Email [email protected] for more

information.

VBHC Prize 2019 – April 18

Don't miss the deadline to apply for the VBHC

Prize 2019! Are you involved in a patient value-

driven initiative? Every value-driven initiative,

large or great, starting or advanced, academic or

from the industry, has a chance to win the

prestigious VBHC Prize. The submission deadline

for the formal application is February 4th,

2019. Visit www.vbhcprize.com to apply and you

might become the 6th VBHC Prize winner!

“It is a great honor for me to have a role in the VBHC Prize and to have my name associated with such a professional

and innovative effort.”

- Prof. Michael E. Porter, Honorary Chairman VBHC Prize

Special Masterclass CostsProf. R. KaplanMarch 14, 2019: 14.00 – 18.30 h

Emeritus Harvard Business School, co-author ‘How to Solve the CostCrisis in Health Care’, co-inventorTime-Driven Activity Based Costingmethod.

Special VBHC Prize Masterclass Speaker to be announced soonApril 17, 2019: 15.30 – 18.30 h

World-leading Value-Based Health Care implementation expert.

VBHC Thinkers

Masterclass Series

After the successful previous Thinkers

masterclasses with among others Dr. G. Myers and

Dr. M. Al-Ubaydli, The Decision Institute proudly

presents the next speakers of the special VBHC

Thinkers Masterclass Series:

VBHCTHINKERS

SERIES

Since 2008, more than 25.500 (inter)national

healthcare professionals have followed VBHC

education at The Decision Institute.

For more information visit:

www.thedecisioninstitute.org/vbhc-

masterclasses/

Special Primary Care MasterclassDr. G. Myers* 24 oktober 2019: 14.00 – 18.30 h

Co-Founder & CMO Oak Street Health, winner VBHC InspirationalAward 2018.

*subject to change

mailto: [email protected]?subject=VBHC Dragon's Grant

http://www.vbhcprize.com/

BUITENVELDERTSELAAN 106

1081 AB AMSTERDAM

THE NETHERLANDS

+31 (0)20 4040 111

[email protected]

WWW.THEDECISIONGROUP.NL

Y O U R P A R T N E R I N V B H C I M P L E M E N T AT I O N

“Focus on patient value and continuous learning while enjoy doing it”

- Prof. Dr. Fred van Eenennaam

“I appreciate your work and your recognition of the

work of people implementing value-based strategies”

- Prof. E.O. Teisberg, PhD -

Univ. of Texas, Austin

“I want to congratulate Prof. Dr. Van Eenennaam

for his pioneering work in this area”

- Prof. M.E. Porter, PhD -

Harvard University

VBHC implementation

It is all about coaching the team

➢ Implementing an ICHOM set

➢ Putting PROMs in practice

➢ Solving the data-extraction gap

➢ Integration: VBHC in primary care

➢ Academic & methodology councils

➢ Insight in real costs vs. reimbursement

❖ First:

Pioneer in VBHC

implementation &

methodology since

2006

❖ Experienced:

Over 155 unique

VBHC projects in

wide range of

medical conditions

❖ Loyal & Trusted:

A neutral party that

stays loyal to the

VBHC concept

❖ Leading:

Ability to solve the

latest/future

challenges in VBHC

From the founders of VBHC:

Or have a ‘tailored session’ for pragmatic VBHC advice on your case or project!

CONNECT CREATE SHARE

“One of the innovative things happening in The Netherlands, that we don’t see in many places around the

world, is the existence of VBHC Center Europe.”

– Prof. Michael E. Porter, Founder of VBHC –

@VBHCEurope Value-Based Health Care Center Europewww.vbhc.eu

Join the community!

The European platform for VBHC implementation

Become a member of VBHC Center Europe&

Expand your VBHC network

Membership privileges:

• Exclusive €200,- discount for the VBHC Certified Green Belt Track / Blended Learning*;

• Unlimited access to breakthrough VBHC articles;

• Free personal advice on the best suitable education;

• Initiate, participate, and have access to the work in chapters;

• Free recertification for VBHC Green Belts.

For more information, please visit www.vbhc.eu

*This offer is valid through September 2019 and is subject to change.

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