Creating Patient value as a way of life; the MMC institutional approach
The oncologic care is vastly expanding and is a growing part of the health care budget. For the entire health care sector, this calls for more efficiency. More people, but also older people, are getting cancer. The survival rate is increasing and therefore additional care to increase quality of life is deemed necessary. Máxima Oncology Centre sees this as an opportunity to create value for our patients. Since 2016, Value Based Health Care is the guiding principle for care throughout the whole hospital in strategic decisions.
Since 2011 the oncologic care in MMC has been carried out in the Máxima Oncology Centre in which the care is organized around the patient. For each condition an expert team including patients has been established that annually evaluates the care process and introduces new developments and innovations in the integrated pathways of care. The attention for the patient as a person, and the care which is supplied accordingly, is what differentiates MOC from other health care providers.
Every step MOC has taken in recent years, has been aimed at offering our patients the best possible care. In order to create value for each individual patient, the MOC is now taking some gigantic steps:
- Patients became part of the expert teams responsible for the integrated pathways of care
- A patient advisory board is involved in all policy developments within MOC
- 7 specialists went to Harvard to be trained in VBHC principles
- Outcome sets were defined together with patients and will be used for improvement of care
- Every innovation or improvement project has been developed with the idea of Value Based Healthcare in mind
A good example of an improvement because of critical evaluation of the expert team colorectal cancer is the development of our prehabilitation program.
With the idea of Value Based Health Care in mind, MMC has introduced a multimodal prehabilitation program for oncologic patients undergoing colorectal surgery in 2016. With this program, developed with an international team of experts, we hope to make patients fit for surgery via high intensity training, protein and vitamin supplementation, smoke cessation and mental support. To measure the impact on outcomes, first a baseline measurement was performed and secondly a pilot was performed to test the feasibility of the program.
After prehabilitation, significant improvements were observed in condition. More importantly, we observed that more patients in the intervention group recovered to baseline functional capacity within four weeks after surgery compared to the control group. This difference was statistically significant. Motivating was the enthusiasm of the participants: ‘Because of this prehabilitation program I did have the feeling to influence my own treatment and recovery. This program made me feel more confident and way more active.’
Therefore we have started an international trial to prove that prehabilitation is an excellent example of value based healthcare, where investment in preoperative improvements leads to improved outcomes. The outcomes that are measured include Return to Normal Activities, complications and quality of life, which have been identified by our expert group including patients as relevant outcomes. Also, we have included a cost-effectiveness study and collaborate with health insurance company CZ to investigate the possibilities to make prehabilitation standard care.
In fact, for almost all oncologic conditions the expert teams have identified initiatives that will bring value to our patients and that MOC will actively join or even initiate.
MOC wants to deliver care which is indicated by our patients that is of interest to them. MOC doesn’t speak of a value based health care project but about a change program that will ensure that the ideas of professor Porter to become our ‘way of life’ enabling our patients to receive the best, most valuable care, possible.