Value Based Health Care: #Patientsincluded?

Patients are still not included enough.


Lucien Engelen

Director of REshape and Core Faculty (Trainer) at Health Innovation School

I had the honor to address the audience at the Dutch 2017 Prize Event of Value Based Health Care. Earlier I was invited to speak at the same time – about the role of patients in clinical trials in a techno-world in Maastricht. But hence it’s 2017 isn’t it, so we decided to make this a virtual visit.

Speaking of virtual visits, why are we still bringing patients to clinics and professionals in a world where each and everyone of us at least once every two weeks has done a video conference with their peers, family or friends. In many of the routines done IN hospitals I would argue there is little to none added value for being physically IN the same room as the professional. Still there is a lot of debate about this and other digital healthcare opportunities. Meanwhile, our friends over at Kaiser Permanente crossed the 50% mark of the ratio of virtual visits versus physical visits last year. More the 6 Million of their 11 Million members had e-visits adding up to more than 23 Million in 2015. And in the Netherlands 4 years ago we’ve fixed the #1 barrier : reimbursement, still without the expected uptake. Research being done annually by Nictiz and Nivel four years on a row shows a gap. Over 70% of their patients want to make use of digital tools, but state not being offered so by their professionals and 75% of the professionals state our patients are not asking for it…

To me this touched on a point very near to my heart and mission. In preparing for this video I reach to the internet to try to find the latest on Value Based Health Care. Both the submissions for the prize, each and every one great opportunities to deliver better healthcare, as in the principles on which Value Based Health Care is based share values like: measurable processes and better outcomes on medical standards. Beautiful formulas and often great dashboards and graphics. All of them extensively shared, described and debated in articles on the internet in text, video’s slides and audiobooks.

But, the thing I MISSED the most (if not completely) in this content on the internet and the research I found about this topic, was the LISTENING and the ROLE of the patient in all of this. Sure, there is a lot of talk about the patient, but not so much with them or listening to them. What do they want, other than better healthcare outcomes? What matters the most to them, that might even be non-medical? In case these values indeed are incorporated in the principles of VBHC, they certainly are not discussed nor written about a lot. It’s obvious to me that this is the most important value.

In 2011, I started the #patientsincluded charter to create awareness for having patients on stage of healthcare conferences, giving them free access to those, incorporating patients in the program committees etc. Next I was able to help the BMJ to take a stance in adding to submission guidelines how patients were involved in the research and creating a patient panel. And now the next level is about curricula in Medical Schools, like we did in 2015 at Radboud University Medical Center, where patients are teaching students, are on the board of the curricula commitees and more.

I think there is extra added value if we strive for a #patientsincluded as part of Value Based Health Care. Make no mistake we often THINK we know what our patients want, but often we actually don’t have a clue. In 2011, I appointed the very first Chief Listening Officer to my team, making sure we incorporate the perspective of the patients that sometimes is NOT ALONE about the best medical outcomes but what THEY would choose as THEIR quality of life. The PhD Thesis of Cynthia Hofmann (Radboudumc geriatrics dept) for in example confirmed our findings at REshape Center as well : Elderly value independency over pain-treatment, while physicians although very knowledgeable don’t are now aware of what had most added value for the elderly. (sorry for Dutch image below)

I would suggest looking into the tool build by the Dutch Institute of positive health by Machteld Huber et al, that incorporates every perspective into what many say should be the new definition of health.

The majority of the new strategic models over the past decades did NOT incorporate the targeted groups unless they were clients. In a world overwhelmed with technological opportunities, it can be a valuable but actually i would say a necessary enhancement for the principles of VBHC to emphasize MORE to the added value from patients own perspectives as opposed bases om the assumed perspectives brought in gy professionals Technology could be very be well positioned as a tool -on a global scale- to evolve the worlds of VBHC to be even more #patientsincluded

The world can be so beautiful and simple, when only we really listen to those to whom it matters the most : patients, family and informal care. Let’s a lso improve the knowledge of innovation. One of the initiatives is the Health Innovation School, a co-creation of the Ministry of Health and our Radboudumc REshape Center.

VBHC #patientsincluded : Let’s just do it !


2017-06-09T13:47:22+02:00June 9th, 2017|Categories: Blog|