Integrated care and value health set to soar in Europe
European politicians increasingly get the value of care which integrates social and acute or the holistic treatment of chronic diseases. They also want value healthcare models which reward operators for quality. Pilots are becoming larger and, in some cases, have been rolled out as long-term projects covering millions of people. There are plenty of opportunities for nimble private sector players. We look at what is happening across Europe.
Operators say that integrated care projects and value health initiatives are coming thick and fast in France, Sweden, Finland, Belgium, the Netherlands and the UK.
The privately-held, for-profit Ivbar Institute in Sweden specialises in developing better performance related outcomes and has developed a platform in Sweden which now covers 60% of all medical activity in the country with data from six countries, including the three largest covering the main conurbations. This allows users to compare their outcomes to others. The system takes into account pre-existing conditions, thus enabling a completely level playing field. Created in 2017, customers have just been allowed, since the start of 2018 to integrate the system and Ivbar CEO Jonas Wohlin expects a lot of feedback over the next six months. He is speaking on the subject at HBI 2018.
And we interviewed him here on Ivbar’s plans.
Wohlin also says value health initiatives are taking off in several European countries. All eyes are on France where a new reformist, and (so far) very popular healthcare minister, Agnès Buzyn, a qualified doctor, haematologist and university professor, was appointed by the Philippe government under Macron in May 2017.
French sources say that she has put outcome measurements at the heart of her strategy. Expect big pilots focused on bundled payments for hip, knee and spine in late 2018 and for this to then spread rapidly.
In Sweden, the second largest province, Västergötland, is introducing what will be the most sophisticated payment system in the country in January 2018 with bundled payments covering hips, knees, bariatric and spine. Wohlin says it combines “adjustments for case mix, innovative payments with advanced performance monitoring” and is a step up from the system of bundled payments and performance outcomes introduced in Stockholm county in 2013. Analytic tools allow operators to see how they perform and identify areas of weakness.
In the Netherlands, each of the main statutory insurers is running one or two value health pilots. Wohlin says there is interest in Belgium and Finland.
Operators say that they are also pushing on an open door when it comes to integrated care projects. Helmut Hildebrand at Optimedis hopes to start a project covering 2.2m people in the Rheinland and is running projects in the UK and Netherlands as well. He is now looking at Belgium and has a large Hamburg suburb to play with. He is presenting on integrated healthcare at HBI 2018.
And we looked at integrated business models here in more detail.
A big group active across southern and eastern Europe says that governments are generally more willing to give it bigger, more holistic projects.
“In Italy, Lombardy is using 5pc of outpatient services revenue to pay for chronic care programmes. The patient is given a sum and goes to a coordinator who offers telehealth and homecare. Even in Greece we are seeing the development of coordinated care packages.”
Meanwhile, in the UK, long-term health minister Jeremy Hunt is now in charge of social services too. That should allow for far greater integration.
Finally, initiatives in the UK (babylon) and Sweden (KRY) mean that digital health apps are starting to replace primary care and to be partly or entirely paid for by the NHS. Ali Parsa, Babylon CEO is also presenting at HBI 2018.
Our Analysis: What is new is that value health and integrated healthcare now have cross-party support among politicians in most countries (ignore statist governments like Poland or Hungary). The medical profession is also generally behind them. This means that there is a far greater consensus about the way forwards than there has been for some time.
Whether this really translates into better conditions for a pressured private sector remains to be seen. Buzyn likes value health and Macron favours capitalism. But we’d still expect French private hospital groups to see the key MCO tariffs drop 2% next year, just as it has done under governments of all complexions for nearly a decade!
But innovative operators who can demonstrate results should do well under the new order.
Of course, whether all this will actually save money is another matter. Wohlin thinks it will lead to increased costs short-term, but much better outcomes longer-term.
We would welcome your thoughts on this story. Email your views to Max Hotopf or call 0207 183 3779.
