How to Use Costs in Value-Based Healthcare: Learning from Real-life Examples

Esmée K J van der Poort; Martha Kidanemariam; Christopher Moriates; Margot M Rakers; Joel Tsevat; Marielle Schroijen; Douwe E Atsma; M Elske van den Akker-van Marle; Willem Jan W Bos; Wilbert B van den Hout

doi:10.1007/s11606-023-08423-w

How to Use Costs in Value-Based Healthcare: Learning from Real-life Examples

J Gen Intern Med. 2024 Mar;39(4):683-689. doi: 10.1007/s11606-023-08423-w. Epub 2023 Dec 22.

Authors

Affiliations

¹ Department of Biomedical Data Sciences, Section of Medical Decision-Making, Leiden University Medical Center, Leiden, The Netherlands. e.k.j.van_der_poort@lumc.nl.
² Department of Biomedical Data Sciences, Section of Medical Decision-Making, Leiden University Medical Center, Leiden, The Netherlands.
³ Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA.
⁴ Department of Medical Education, Dell Medical School, University of Texas, Austin, TX, USA.
⁵ National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands.
⁶ Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
⁷ Department of Medicine and ReACH Center, Joe R. & Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
⁸ Department of Internal Medicine, Section of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands.
⁹ Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
¹⁰ Department of Internal Medicine, Section of Nephrology, Leiden University Medical Center, Leiden, The Netherlands.
¹¹ Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands.

Abstract

Background: Healthcare organizations measure costs for business operations but do not routinely incorporate costs in decision-making on the value of care.

Aim: Provide guidance on how to use costs in value-based healthcare (VBHC) delivery at different levels of the healthcare system.

Setting and participants: Integrated practice units (IPUs) for diabetes mellitus (DM) and for acute myocardial infarction (AMI) at the Leiden University Medical Center and a collaboration of seven breast cancer IPUs of the Santeon group, all in the Netherlands.

Program description and evaluation: VBHC aims to optimize care delivery to the patient by understanding how costs relate to outcomes. At the level of shared decision-making between patient and clinician, yearly check-up consultations for DM type I were analyzed for patient-relevant costs. In benchmarking among providers, quantities of cost drivers for breast cancer care were assessed in scorecards. In continuous learning, cost-effectiveness analysis was compared with radar chart analysis to assess the value of telemonitoring in outpatient follow-up.

Discussion: Costs vary among providers in healthcare, but also between provider and patient. The joint analysis of outcomes and costs using appropriate methods helps identify and optimize the aspects of care that drive desired outcomes and value.

Keywords: benchmarking; continuous improvement; costs; shared decision-making; value-based healthcare.

MeSH terms

Benchmarking
Breast Neoplasms*
Delivery of Health Care
Female
Humans
Netherlands
Value-Based Health Care*