'Trust and the willingness to continuously wanting and daring to learn from each other to realize better outcomes.'
That's what Maarten Akkerman cited as 'perhaps the most important' success factor of Diabeter, part of Medtronic since 2015. Akkerman is a member of the board of directors of Diabeter and also responsible for Medical Affairs & Value-Based Healthcare (VBHC) within Medtronic. He spoke on October 12 during a webinar organized by the Dutch healthcare authority (NZa) on the topic of "tailored care." In the five Diabeter centers, some 3,000 patients with type 1 diabetes are treated each year.
There's still a lot of room for improvement
Using a series of facts, Akkerman showed why a good outcome of diabetes care is so important. The Netherlands has 1 million diabetes patients, 100,000 of whom have type 1. On average, they live 12 years shorter than other people. They perform less at school and have lower work productivity. After 40 years of type 1 diabetes, 10% of patients already have a serious complication such as heart attack, amputation or stroke (CVA). Mortality - depending on the quality of care - is 3 to 9 times higher. So, there is still a lot of room for improvement," Akkerman concluded.
Relatively small population costs more than 2 billion annually
Also in terms of costs, major improvements are possible and required, he outlined. For the 100,000 type 1 patients, 500 million euros in costs are claimed annually from the health insurer. In terms of care and social costs, the disease costs 1 billion in the longer term. The capitalized loss of life years adds another 700 million. This means that a relatively small population costs more than 2 billion annually. With value-based healthcare you can create more value and the costs go down. Because improving healthcare outcomes goes hand in hand with reducing healthcare costs. In this way, you create value for several stakeholders, above all for the patient.
Care is organized around the patient
Akkerman then explained how the principles of value-based healthcare are applied at Diabeter. The first element he mentioned was IPU, Integrated Practice Units. With an apology for the masculine nature of his example, Akkerman compared the IPU to the pit lane during a car race: a car drives in and out as quickly as possible thanks to a well-oiled team of professionals who know exactly what to do. At Diabeter, we do the same: the care is organized around the patient. The patient comes in, is seen by a multidisciplinary team and is well supported, back out as quickly as possible.'
250 parameters per patient per day
The second VBHC element Akkerman highlighted is the continuous measurement of outcomes and costs per patient. 'We measure 250 parameters per patient per day, of most of our 3,200 patients. With this, we know a lot about them, but especially what is important to them. We use this data to continuously improve patient outcomes and alert the patients in a timely manner if we see that something is in danger of going wrong.'
Fixed, integral price for ten years
The third topic that Akkerman touched on, was: bundled payment for care. With Dutch health insurer Zilveren Kruis, Diabeter has set a fixed, integral price for type 1 care in a so-called VBHC contract. The contract has a term of ten years. In it, the outcomes of care are leading for a kind of bonus-malus performance scheme. Diabeter can reinvest the savings it achieves in its care, provided the pre-agreed outcomes are realized. In the past two years, we have more than met these agreements, which is, of course, important for the patient in the first instance.
The approach and results of Diabeter, which was founded in 2006 by two Dutch pediatricians, are getting a lot of international appreciation, Akkerman told us. 'World famous outside the Netherlands,' he jested. Diabeter was allowed to contribute to a prestigious VBHC conference in Saudi Arabia in 2020 on behalf of the Netherlands, the only non-G20 country, during the G20. At the start of this year, Diabeter was also named by the World Economic Forum as one of the global examples of innovative, value-driven healthcare.
Passionate, with conviction and energy
Akkerman: "I tell all this with pride. It requires a change that you don't achieve overnight. It is a journey. It is especially important to focus on outcomes that are important to the patient and to organize the care around them. If you know how care can be improved and are convinced of that, you should do it. Passionately, with conviction and energy. Then you can overcome resistance and create support.'