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Diabetes Today 3/5: How a diabetes clinic gets better outcomes for patients at lower costs

A Dutch diabetes clinic with top-rated glucose control and fewer hospitalisations has won the Value-Based Healthcare Prize

Managing the growing numbers of people with diabetes is one of the biggest challenges facing Europe’s health systems. But a network of Dutch clinics has embraced a new model which improves outcomes for patients, reduces hospitalisations rates and contains costs. Their secret? Striving for value.

The Diabeter clinic was founded by Dr Henk Veeze and Dr Henk-Jan Aanstoot in 2006. They embraced a new model of specialist care which put the patient at the centre of everything they do. Their team of doctors, nurses, dieticians and other professionals are all specialists in diabetes – something Dr Veeze says has helped to deliver efficiency and excellent results.

Thanks to the clinic’s customised IT system which reduces the administrative burden on staff, nurses and doctors are free to concentrate on patient care – which makes for a happier workforce. “Nurses can take on twice the patient load,” he says. “This also means our staff get twice as much experience, helping them to become highly specialised – which further improves outcomes.”

Value-based healthcare

This specialist model echoes the Integrated Practice Unit advocated by Harvard’s Michael Porter in his landmark book on value-based healthcare. Porter’s vision for patient-centred, data-driven care delivered by specialist clinics is reflected in the Diabeter clinics but Drs Veeze and Aanstoot had concluded that specialisation was key even before Porter’s value-based revolution began to take hold. However, they were so taken with Porter’s book that they bought a copy for every health insurer in the Netherlands!

Porter’s theory and Diabeter’s practice are delivering real results for patients and payers. Achieving good diabetes care means controlling patients’ blood glucose levels. This is key to reducing hospitalisation and long-term complications. The target in children is to keep HbA1c – the standard proxy measure for blood glucose – below 7.5% (58 mmol/mol). 

At Diabeter, 55% of children under the age of 18 reach the target, which makes it the best performing clinic in the Netherlands. The clinic’s willingness to adopt new technologies such as insulin pumps with sensors enables them to monitor patients and adapt treatment quickly.

Diabeter’s IT system features dashboards that allow them to track results for each patient. It also facilitates comparisons between clinics, doctors and therapies. This attention to outcomes has driven improvements across the Diabeter network of clinics.

One of the biggest benefits to the health system is that good glucose control reduces the risk of hospitalisation and complications. “When we started, the hospital admission rate was between 20% and 30%. Now most clinics can get to around 10% while we have rates of between 1% and 3%,” says Veeze. “That’s a real benefit for patients and a big cost-saver.”

One of the Netherlands’ largest insurers evaluated all the costs of caring for diabetes patients and found that the Diabeter clinics were in the 25th percentile range – meaning that just 25% had lower costs while 75% had higher costs.

Global recognition

These results have caught the attention of experts around the world who are keen to embrace the Diabeter philosophy. Last month, Harvard’s Michael Porter presented Drs Veeze and Aanstoot with the VBHC Prize 2017 for value-based healthcare. Explaining the judges’ decision to recognise Diabeter, Porter said the clinic was an example of how to implement the value-based healthcare model.

“What we saw here is all aspects of value-based healthcare rolled together,” says Porter. It’s not just trying to be great in the Netherlands; it’s trying to be great globally….Hopefully [they] can take over the world.”

Accepting the award, Dr Aanstoot said it was recognition of the Diabeter team’s focus on “linking excellent clinical outcomes to acceptable costs, innovative patient-friendly processes and high-quality integrated care”.

In a paper by Boston Consulting Group (BCG) commissioned by Medtronic who acquired the clinic in 2015, Diabeter is cited as a model that benefits patients and payers and could reduce huge inequality in diabetes outcomes.

“Diabeter offers a novel care model – one that is focused on diabetes patients, value-based e-health solutions, and a unique patient experience,” write BCG’s Jens Deerberg-Wittram and Laura Lüdtke. “The Diabeter patient population has exemplary clinical outcomes without increasing costs.”

For Drs Veese and Aanstoot, this recognition is just reward for a huge investment of time – and the risk they took when they left steady jobs to start their first clinic a decade ago. The next step is to bring their model to more patients. There is no shortage of interest from specialists, governments and insurers.

“We are investigating a number of possibilities in other countries and regularly have visitors to our Rotterdam clinic,” he says. “It was a big risk and a lot of hard work but, in the end, it has been worth it.”

 

ABOUT HENK VEEZE

Henk worked as a paediatrician from 1985 up until 1998 at the Erasmus University Rotterdam/ Sophia Children’s hospital, dept. paediatrics and dept. of clinical genetics.

From 1998 up until 2006 he worked at the IJsselland Hospital. Besides paediatrician chairman dept. Paediatrics, also Vice President of the Medical Staff and member of the hospital management team.

In 2006 Henk started in Rotterdam together with, paediatrician Henk Jan Aanstoot, Diabeter a specialised centre for diabetes care for children and young adults. One of the main topics of Diabeter is the design and all programming tasks of a multidisciplinary Patient Care Database system (Vcare), a complete paperless patient record system securing the patients and centre quality of care, import and monitoring of all data form patient devices at home and implement steps toward cloud care for diabetes.