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Value Based Health Care — are #Patientsincluded?

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 an event in Maastricht at the same time, about the role of patients in clinical trials in a techno-world. But, 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 nearly each and every one of us has done a video conference with their peers, family or friends at least once every two tweeks?

In many of the routines done IN hospitals I would argue there is little to no 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 percent mark of the ratio of virtual visits versus physical visits last year. More than six million of their 11 million members had e-visits, adding up to more than 23 million total visits in 2015.

In the Netherlands, 4 years ago we fixed the number one barrier (reimbursement) but still have not attained the expected uptake. Research being done annually by Nictiz and Nivel for four years on a row shows a gap: Over 70 percent of patients want to make use of digital tools, but say such options are not being offered by health care professionals. The same research finds that 75 percent of the professionals state that 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 reached to the internet to try to find the latest on Value Based Health Care. The principles on which Value Based Health Care is based include things like measurable processes and better outcomes on medical standards. We’ve seen beautiful formulas and often great dashboards and graphical representations. All of these have been extensively shared, described, and debated in articles on the internet in text, videos 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 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? Such values are certainly are not discussed nor written about a lot — I wonder if they are being incorporated into real-world VBHC models. 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 the events, incorporating them 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. In 2015 at Radboud University Medical Center, we incorporated these principles to the effect of having patients teaching students, sitting on the board of the curricula committees 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, from the Radboud Medical Center geriatrics department, showed that the elderly value independence over pain-treatment; physicians, although very knowledgeable, were unaware of what provided the most added value for the elderly. (sorry for Dutch image below)

I would suggest looking into the tool built 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 — actually I would say a necessary — enhancement for the principles of VBHC to emphasize the patients’ own perspectives.

Our world of healthcare innovation, so full of technologies and complexities and challenges, can become so beautiful and simple if only we really listened to those to whom it matters the most : patients, their family, and the people in their lives caring about them.

Let’s just do it !


Contributing author Lucien Engelen is the director of the Radboud University Nijmegen Medical Centre REshape Center and advisor to the Board of Directors. He is also a mentor for Rockstart’s Digital Health accelerator program. You can read more of his blog posts here. This is a republished piece from May 11th. 



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