Since the introduction of telemonitoring for patients with chronic heart problems (in 2016), more than 500 Zilveren Kruis policyholders have been using HartWacht (translated HeartGuard, a remote monitoring service powered by Luscii, red.). 128 patients (25% of the participants) have been using HartWacht for more than a year. Comparisons have been made between their healthcare usage for the 12 months prior to telemonitoring and the 12 months following use. The results are impressive.
The first research results show a large decrease in the use of care. Olivier Gerrits, Director of Zilveren Kruis Healthcare Purchasing: “We were already convinced that telemonitoring contributes to more control and better quality of life. Now it appears that for our policyholders, there are also fewer admissions, emergency visits and ambulance trips”.
Major decrease in emergency first aid visits on A&E
Patients guided by HartWacht for a year have experienced a decrease in the number of nursing days, the number of emergency trips and the number of emergency room visits. This reduction has been compared to the year prior to the supervision of HartWacht. The number of nursing days has dropped by more than 40% and the number of emergency trips with the ambulance has been reduced by 30% in one year. The largest decrease occurred in the number of emergency room visits: In the group of patients that began with HartWacht, the number of emergency room visits (A&E) fell by 70%, compared to the year before.
VBHC Prize 2019
HartWacht is a joint initiative of Zilveren Kruis, the Netherlands’ Cardiology Centre (CCN) and the Dutch healthcare innovation company Luscii. The number of participants is growing steadily. This breakthrough in eHealth was an international first for the Netherlands in 2016. Last month, HartWacht received the VBHC Prize for its collaboration. Igor Tulevski, cardiologist and co-founder of CCN: “A wonderful reward for increasing the quality of life for patients and reducing healthcare costs on a daily basis”.
HartWacht, the innovative healthcare concept that was set up through a collaboration of Cardiology Centers the Netherlands, Luscii and insurer Zilveren Kruis, was awarded by the Professor Porter Value Based Healthcare Collaboration Award 2019. For Luscii, this means that one of its projects wins this prestigious award the second year in a row. Last year the COPDInSight-service of NAAST, insurer Menzis and Luscii was the winner of the Professor Porter Value Based Primary Care Award 2018.
HartWacht telecardiology service
HartWacht is a revolutionary telecardiology service offered by the Cardiology Centers The Netherlands to their patients in 15 centers across the Netherlands. Patients with heart failure, hypertension and atrial fibrillation don’t need to go to the clinic anymore, unless it is needed. The eHealth service was announced in 2016 and is currently available all across the Netherlands with full reimbursement from five of the biggest Dutch insurers.
HartWacht telecardiology service
Globally, the demand for cardiovascular care is rising due to the ageing populations, increased cardiovascular risk and the quest for personalized care. However, resources are limited.
The “classic” healthcare system cannot meet these requirements. Therefore, an affordable and scalable solution is needed. The aim of HartWacht is to increase population health, improve the quality of care and lower the per capita costs by making use of new health technologies such as Luscii vitals.
Heart failure, hypertension and atrial fibrillation
Patients are selected for HartWacht by their cardiologist based on their diagnosis and protocolized inclusion and exclusion criteria. Patients can then share their data with their healthcare provider using the app and the results will be integrated in their electronic patient file. By making both the home measurements and the other relevant medical data online available to the patients, they are encouraged to participate actively in their healthcare processes. In addition, therapy and policy are focused around patient data and adapted continuously if needed. Interventions include lifestyle advice if appropriate, change in medication, education about disease and/or additional diagnostics, thereby forming an IPU.
Patients with severe hypertension and heart failure are guided by the Luscii app to do home measurements with connected measurement devices for blood pressure, heart rate and weight. Also patients with atrial fibrillation are enrolled using Kardia with EKG-monitor. All the data of patients is analyzed and securely transmitted to the the electronic patient file and is interpreted by a dedicated team supported by smart algorithms and a nationwide network of outpatient clinics which can be visited by the patients if needed. The concept is financed through bundled payment schemes. Patient value is measured through standardized questionnaires.
To continuously monitor quality and safety and patient outcome, research projects have been initiated. First results are published in scientific peer reviewed journals and demonstrate a positive effect on safety of the program and patient experience and outcome. Research shows that HartWacht results in less visits to outpatient clinics and emergency departments, thereby adding value to our healthcare system by improved health outcome with less costs. Also patients and treating physicians are satisfied: with less effort they experience faster results of success of their therapy.
Patients with the lung disease COPD are now able to send measurements from home directly to the outpatient clinic of pulmonary medicine. Pulmonologist Pathman Pasupathy explains the procedure: “Every week, patients fill out a questionnaire on their tablet and send in their saturation values. If their situation deteriorates, we will be notified and, if necessary, we will contact the patient via video calling (iPad)”.
Zuyderland is using Luscii for the project. The pilot is intended to gain experience in the remote monitoring of COPD patients. Monique van de Kragt, a physician assistant at the clinic, says that she is happy with the trial: “For patients who already have less energy due to their illness, it is of course fantastic that they do not have to come to the clinic every time. This pilot also strengthens our vision that we wish to manage healthcare as close to the patient as possible. It’s great that we are able to experiment with this”.
COPD is characterised by lung attacks that often lead to hospitalisation. Pasupathy: “As we have more insight into the condition of the patient through this pilot, we hope to prevent such lung attacks and, subsequently, hospital admissions”.
The pilot is being carried out in collaboration with health insurer CZ and will run for the coming six months.
The role of Luscii in Zuyderland Hospital:
Luscii provides hardware, software and patient support for the monitoring of the COPD patients in Zuyderland Hospital. The Luscii platform is used by the care teams in the hospital to monitor their patients and get notifications in case of increased health risks. Patients who are enrolled will download the Luscii vitals and Luscii contact apps to sent in their measurements and have (video)-communication with the nurses or pulmonologists. Also, after enrollment, Luscii is responsible for all logistics (sending the measurement devices), service and (installation) support for patients within the Zuyderland Telemonitoring service. Luscii implementation specialists will support Zuyderland with the implementation of the new procedures, care pathway and will together evaluation research is carried out.
The Netherlands scores well internationally in the field of healthcare. But unfortunately, spending on healthcare is rising faster than the rest of the economy. This is simply not tenable for the future. Furthermore, differences in the quality of care are often not clear. Through sound healthcare procurement, CZ hopes to contribute to future-proof healthcare in 2020.
Responsible and Close by
The common thread throughout our 2020 healthcare purchasing policy is ‘Responsible and Close By’.
- ‘Responsible’ ensures that CZ group will only contract healthcare that is both affordable and in line with our quality vision. In accordance, we apply appropriate yet ambitious standards.‘
- Close by’ is the starting point of the healthcare provision: either at home or close to home if possible. And further away if it guarantees better quality care. By ‘close by’, we also mean: in keeping with the wishes and choices of the insured in regard to their treatment. For example, through joint decision-making processes and the deployment of new (distribution) forms of diagnostics and digital support. In this way, we make treatment less stressful and much more person-orientated.
Vision of quality
CZ attaches great importance to high-quality care for its policyholders. This vision is reflected in our healthcare procurement policy and documents of value.
Vision of healthcare purchasing
Healthcare must be of good quality, affordable and accessible. Now and in the future. That is why CZ makes agreements with healthcare providers to ensure high-quality care that meets the needs of patients, is delivered in the right place, and maintains a reasonable price.
Purchasing in consultation with the healthcare field
Healthcare purchasing is not a stand-alone activity, in which we single-handedly decide what is right. Instead, we are involving and collaborating more and more with the healthcare field: patients, healthcare providers, municipalities and other stakeholders. By innovating, collaborating and continuing to work on structural progress, we can improve healthcare in the Netherlands and give substance to “Healthcare that goes further”.
This press release was first published on the website of healthcare insurer CZ (https://www.cz.nl/zorgaanbieder/zorginkoopbeleid)
Luscii and healthcare insurer CZ:
CZ supports hospitals which use Luscii in their day to day care. In these projects, their are special reimbursements for the hospitals to bring chronic care like COPD or CHF care to home. The Luscii platform is used by the care teams in the hospital to monitor their patients and get notifications in case of increased health risks. Patients who are enrolled will download the Luscii vitals and Luscii contact apps to sent in their measurements and have (video)-communication with the nurses or pulmonologists. Also, after enrollment, Luscii is responsible for all logistics (sending the measurement devices), service and (installation) support for patients within the telemonitoring services. CZ reimburses this kind of care in these situations.
In the coming six months, the Reinier de Graaf hospital, together with the e-health company Luscii, will conduct a pilot of home measurement for patients with the chronic lung disease COPD. With the help of these measurements, caregivers can provide medical advice remotely. Therefore, COPD patients will need to visit the hospital less often.
Prevent hospitalisations due to lung attacks
COPD is a disease in which the lungs are damaged. This makes it more difficult for patients to breathe and reduces their energy levels. Patients with COPD often suffer from lung attacks, in which they experience shortness of breath, coughing or excess mucus production. As a result, they often need to be hospitalised.
25 COPD patients are taking part in the pilot. The participants will receive a tablet, through which they use an app to complete a weekly questionnaire concerning their quality of life. They will also measure the oxygen content of their blood through a device known as a saturation meter, which is connected to the tablet.
A specialist lung nurse then examines the results in the hospital. If these exceed certain threshold values, the nurse will contact the patient via videocall. In this way, the nurse can literally see how the patient is doing and he or she can, for example, adjust the medication in consultation with the treating specialist. Therefore, the patient doesn’t need to come to the hospital as often for a check-up or treatment. This journey is a major undertaking, especially for patients with COPD. Remote care is subsequently perfectly suited for this group of patients.
Bring healthcare close to the patient
“With this pilot, we want to bring healthcare as close to the patient as possible”, says project leader René de Brouwer. “In addition, we can ensure that COPD patients gain more control over their own health. This project is a great example of how we, at Reinier de Graaf, want to provide the right care in the right place”.
Evaluation will take place during and after the pilot. The experiences of patients and caregivers are the central concern. Scientific research into the results of remote monitoring is also being carried out in collaboration with Luscii. If the pilot is successful, the Lung Diseases department wish to monitor more COPD patients remotely.
This press release was published by Reinier de Graaf Hospital on 12 March 2019
The role of Luscii in Reinier de Graaf Hospital:
Luscii provides hardware, software and patient support for the monitoring of the COPD patients in Reinier de Graaf Hospital. The Luscii platform is used by the care teams in the hospital to monitor their patients and get notifications in case of increased health risks. Patients who are enrolled will download the Luscii vitals and Luscii contact apps to sent in their measurements and have (video)-communication with the nurses or pulmonologists. Also, after enrollment, Luscii is responsible for all logistics (sending the measurement devices), service and (installation) support for patients within the Reinier de Graaf Telemonitoring service. Luscii implementation specialists will support Reinier de Graaf with the implementation of the new procedures, care pathway and will together evaluation research is carried out.
Healthcare insurer Zilveren Kruis and Isala Hospital are joining forces to further improve care quality and meet the rising demand for healthcare. To achieve this, they have once again entered into a multi-year contract. Isala and Zilveren Kruis share the vision that part of the care should be organised differently for this purpose.
Quality and safety
Rob Dillmann, Chairman of the Board of Directors at Isala: “We have a large number of challenges in the region that we can only solve together. Our vision is fully in line with that of Zilveren Kruis. We have agreed to move 10% of healthcare to the home in the coming years, whilst guaranteeing both its quality and safety”.
Dillmann continues: “By moving a part of healthcare to the home, the patient is better served. Research shows that patients are happy to receive care at home. E-health and connected care play a crucial role in this. Even from a distance, personal contact can be maintained between the patient and the healthcare professional via, for example, video calling. Above all, the patient benefits from more control over his or her own health. This in turn contributes to earlier recognition of problems, so that more hospital admissions can be prevented. And that is also a relief for the patient and his or her relatives”.
1,000 COPD patients will be telemonitored
Up until 2022, around 1,000 COPD patients will be telemonitored, so they only have to go to the hospital if they really need treating. People who are eligible for cardiac rehabilitation or who have cancer can also receive part of their treatment safely at home.
Olivier Gerrits, Director of Purchasing at Zilveren Kruis, adds: “By bringing more care to the home together, we can prevent unnecessary hospital visits and admissions. This also relieves the doctors and nurses. In the case of telemonitoring of chronic heart failure, it has now become clear that quality of life is improving, the number of hospital admissions is falling, and we are spending less on premiums. That reversal is also badly needed. A win-win situation for everyone”.
Together with patients(associations), hospitals and other partners in healthcare, Zilveren Kruis wants to have succeeded in bringing 10% of care to the home by 2021. This urgency comes from the growing patient flow and rising healthcare costs.
This press release was published by Isala Hospital on 15 February 2019
The role of Luscii in Isala Hospital:
Luscii provides hardware, software and patient support for the monitoring of the COPD patients in Isala Hospital. The Luscii platform is used by the care teams in the hospital to monitor their patients and get notifications in case of increased health risks. Patients who are enrolled will download the Luscii vitals and Luscii contact apps on their iPhone or iPad to sent in their measurements and have (video)-communication with the nurses or pulmonologists. Also, after enrollment, Luscii is responsible for all logistics (sending the measurement devices), service and (installation) support for patients within the Isala Telemonitoring service.
The Dutch Ministry of Health made a video on the first phase of this unique project:
2018 – COPD monitoring and videocare at Isala hospital using Luscii from Luscii on Vimeo.
Imagine no longer having to go to the hospital, but simply having a conversation at home with your lung nurse about how you feel. From February 2019, this will become a reality for 25 Treant patients with the chronic disorder COPD (lung disease). During this month, the healthcare group will begin a trial in which patients receive a tablet, on loan, through which they can transfer their medical information to the hospital. If this information requires further discussion, the lung nurse will contact the patient via ‘video calling’.
Treant, in collaboration with the healthcare innovation company Luscii, is starting this pilot to gain experience in monitoring COPD patients from a distance. Lung specialist, Steven Rutgers, is pleased with the new scheme: “For patients who already have less energy because of their illness, it is of course fantastic that they will no longer have to come to the clinic every time. This pilot also strengthens our vision to concentrate care as close to the patient as possible. It is great that we can experiment with this possibility.”
How does it work?
Every week, patients use the tablet to fill in their information, such as blood pressure, weight and physical activity. They also report how they are feeling. They then send this information to the hospital. A specialist nurse will take a look at the data and, if necessary, will contact the patient. Through the use of ‘video calling’, healthcare professionals can see how the patient is doing and, in consultation with the pulmonologist, can adjust the medication if necessary.
COPD is a lung disease in which the lungs are damaged. The lungs cannot absorb sufficient oxygen, leaving the patient with shortness of breath and less energy. COPD is characterised by lung attacks that often lead to hospitalisation. Rutgers: “As we receive information about the condition of the patient more often during this pilot, we hope to prevent such lung attacks and subsequent hospital admissions”.
The pilot was made possible by healthcare insurer Zilveren Kruis and will last for six months. The pilot reinforces the agreement that Treant holds with the healthcare insurer to develop initiatives that bring care closer to the patient. A good example of the right care in the right place. In collaboration with the healthcare innovation company Luscii, scientific research will also be conducted into the results of remote monitoring. To start with, remote monitoring will be available to just 25 COPD patients treated at Scheper in Emmen. If the pilot proves successful, in the future, more patients will be able to pass on information to the hospital via video calling.
This press release was published by Treant ziekenhuis on 4 December 2018 (https://bit.ly/2RhyywZ)
Healthcare organisations join forces for people with COPD
Starting today, residents of the Kennermerland region with the pulmonary disease COPD can now use the network ‘COPD in the neighbourhood’. Thanks to the dedicated App, they can monitor the course of their illness and contact healthcare professionals remotely via video calling. The advantages for people with COPD include reducing the need for hospital visits, gaining more control over their lives and improving that feeling of safety, as specialised nurses are available for contact day and night. COPD in the neighbourhood is made unique through the intensive cooperation between healthcare providers in the neighbourhood, the hospital and innovative partners that make remote care possible.
“COPD in the neighbourhood”
‘COPD in the neighbourhood’ is a collaboration between healthcare organisations that want to improve care for people with COPD. One of the initiators is Peter Paardekooper, from Huisartsen Centrum Zandvoort. “For people with COPD, hospital visits are strenuous because of their limited lung capacity. In addition, the checks are arranged at fixed times, meaning we are not always there when the care is really needed. Thanks to our new remote monitoring service, that is now possible; patients can securely exchange information with doctors and nurses, and make video calls on a tablet via the dedicated Luscii app. In this way, patients gain insight into their lifestyle and its influence upon their health. Then, we only need to make appointments in the hospital if it is necessary”.
What makes the project special is that all parties involved in the care for people with COPD have joined forces: general practitioners cooperative Zuid-Kennemerland, network of physiotherapists FysiQ, healthcare organisations Kennemerhart and Zorgbalans, the Spaarne Gasthuis, health insurer Zilveren Kruis and innovative partners that make ‘remote care’ a reality. In an initial pilot scheme, the idea of ‘COPD in the neighbourhood’ proved to be successful: now the time has come for the next step. Paardekooper: “What’s new is that we can now offer 24/7 care through video calling and use of the Compaan, a user-friendly tablet. With remote monitoring, we bring second-line care to the ‘zero-line’, at home with the patient. That gives him or her much more freedom”.
The 24/7 remote care is carried out by the nurses of Medisch Service Centrum NAAST. If necessary, they can call in one of the other healthcare professionals, for example, for a home visit. René Baljon, director of NAAST: “Our years of experience with remote care for hospitals can now benefit general practitioners. We stand beside the healthcare professional and the patient, and that gives them a safe feeling. With remote care, the actual care becomes a less prominent part of your life and that makes it incredibly valuable”.Fast information exchangeAll healthcare providers, such as the district nurse, practice assistant, lung nurse and the physiotherapist, remain informed over the course of the disease via the communication platform OZOverbindzorg.
Paardekooper: “Together, we give the patient control, he or she determines which care providers receive access. They can exchange information as quickly as possible and take action when necessary”. COPD in the neighbourhood will begin, in this new set-up, with 50 patients. Paardekooper: “In 2019, we wish to expand this further and make remote monitoring possible for all people with COPD in the Kennemerland region”.
Baljon supports that ambition. “It has recently been agreed in Parliament that remote care is to be made available for everyone with COPD and heart failure, across the Netherlands, within the next three years. That is where the collaboration in Kennemerland fits in seamlessly. We are ready to scale up together”.
Made possible by
The project “COPD in the neighbourhood” is made possible by the uniting parties: GPs Cooperative Zuid Kennemerland, Spaarne Gasthuis, FysiQ network, Luscii, Kennemerhart, Medisch Service Centrum NAAST, Compaan, Zorgbalans, OZOverbindzorg and Zilveren Kruis.
The role of Luscii in “COPD in the neighbourhoud”:
Luscii provides software and patient support in the remote monitoring service in Kennemerland. Therefore, Luscii contact (secure video calling) and Luscii vitals (remote monitoring) was integrated into “Uw Compaan” (senior friendly tablet, www.uwcompaan.nl) and connected to the nurses of the medical service centre NAAST (24/7 medical service centre, www.naast.je), the care professionals in the neighbourhood (GPs, homecare, physiotherapists) and the Spaarne Gasthuis Hospital. Patients can send their values using Luscii on the Compaan-tablet, which will be diagnosed in Luscii’s platform by the nurses at the medical service centre NAAST. In case of deterioration, NAAST or one of the local care professionals will directly contact the patient via videocall. If needed, home care nurses will visit the patient at home or the patient will be asked to visit the GP or hospital.
This press release was published by NAAST on 11 November 2018 in Dutch (https://www.icthealth.nl/nieuws/zorgorganisaties-bundelen-krachten-voor-mensen-met-copd/)
Today there is good news for thousands of Dutch heart patients. After the largest insurer Zilveren Kruis announced to fully reimburse the e-health service HeartGuard, four other major healthcare insurers (VGZ, DSW, ONVZ, De Friesland) will also follow and reimburse HeartGuard in 2017. Cardiology Centers The Netherlands (CCN), together with Luscii, founding partner of HeartGuard, announced this news today.
HeartGuard enables continuous monitoring of cardiovascular patients suffering from heart failure, hypertension or atrial fibrillation. Patients can measure their vital signs at home with the Vitals App (formerly cVitals), developed by the Dutch healthcare innovation company Luscii.
The vital signs, like blood pressure or weight, are sent in remotely through the Vitals App on the patient’s iPhone or iPad to the cardiology centres and are automatically added to the Electronic Medical Record of the patient. Doctors and nurses will be alerted in case of detection of an increased health risk. Following that alarm, the staff will reach out to the patient and/or general practitioner. Hospital admissions and outpatient clinic visits are reduced by the HeartGuard service.
Fast scale up possible because of reimbursement
”Contracting with any of these four insurances companies makes it possible to offer the service to thousands of patients”, according to Cecile Goldman, VP of Operations at CCN. ”Now we can offer the service to patients insured at these insurers as well. This number can grow even further, when insurers CZ and Menzis will start reimbursing HeartGuard too. ”We are in dialogue with them to offer HeartGuard as well”.
CCN: “Dutch insurers are setting an example”
By reimbursing HeartGuard, Dutch insurers are setting an example. They are showing that they are not only retaining traditional care delivery, but are willing to support innovation. ”HeartGuard is at the forefront of further evolution in healthcare and by opening up the service to these new patients, we can increase our insights into the effects of this innovative healthcare service on an even larger scale”, says Cecile Goldman.
Insurer ONVZ: “enthusiastic about possibilities of eHealth”
Chairman of the Board of insurer ONVZ Jean-Paul van Haarlem is enthusiastic about the possibilities of HeartGuard for its clients: ”This is an innovation that provides patients with personalised care. HeartGuard will have a positive impact on quality of care and on efficient use of resources. Because it monitors the patient’s health remotely, HeartGuard will lead to a reduced number of hospital visits. This is a major improvement for the patient. Reimbursing HeartGuard is an important step for heart patients insured at ONVZ.
Insurer Zilveren Kruis: “good that others are following”
“We are very happy with the fact that we have realised this breakthrough last summer with Luscii and CCN to bring chronic cardiovascular care close to our clients. The fact that others follow this example towards innovative care, making it available to more patients is great”, says Erik-Jan Wilhelm, VP of Strategy and Innovation of Zilveren Kruis.
Dutch Patients Federation: “positive development”
The Dutch Patient Federation is happy that more and more insurers reimburse eHealth. ”We are glad that other insurers are following the example of Zilveren Kruis”, says Director Dianda Veldman. ”I hope more of these eHealth initiatives will be developed so all patients can enjoy this modern form of healthcare.”
Collaboration with hospitals and GPs
At this moment, only patients of Cardiology Centers the Netherlands are eligible to use HeartGuard, but, according to Cecile Goldman, this will change soon: ”We are already having conversations with GPs and hospitals to offer HeartGuard from their own locations to their own patients. We will monitor the patients in that case in commission of their own doctor. Scale is an important factor to eHealth, sharing our resources and expertise reduces the need for every hospital to reinvent the wheel“.
The role of Luscii in HeartGuard:
Luscii provides hardware, software and patient support in HeartGuard. As a spin-out brand of FocusCura, Luscii is co-initiator of the HeartGuard service, together with Cardiologist Center the Netherlands and insurer Zilveren Kruis. These three partners joined in a mutual innovation team to create the HeartGuard service. The Luscii platform is embedded as a button inside the EMR of the cardiologist (CardioPortal). Patients can download the Luscii Vitals and Luscii Contact apps on their iPhone or iPad, send in their measurements and have (video)-communication with the nurses or cardiologists. Also, after enrolment, Luscii is responsible for all logistics (sending the measurement devices), service and (installation) support for patients within HeartGuard.
This press release was published by Cardiology Centers The Netherlands and Luscii (previously FocusCura) on 6th March 2017.
In the midst of the summer holidays, healthcare insurer Zilveren Kruis introduced a unique financing model for hospitals who want to offer telemonitoring at home for their patients. The news is a breakthrough for thousands of citizens that suffer from heart disease. Together with Menzis – who previously introduced unique funding for COPD monitoring – the insurers show that this innovation is not just a whim for them. Now, what does this mean for hospitals and patients?
Financial paradox for eHealth
Despite all the promises, eHealth is not widely available for every patient. A major cause being the current funding system. Though VBHC (Value Based HealthCare) sounds inspirational, nowadays reimbursements for specialist medical care are based on the number of actions that have been carried out. In short; a hospital gets paid when patients visit the doctor or the outpatient clinic, or are admitted. In contradiction, many eHealth solutions – including home measurement – aim to prevent care. And that’s a catch 22; Costs to the hospital increase when introducing home measurement tools, while turnover decreases because fewer interventions or admittances are needed. From an insurer or payer or citizen perspective this is a win (we all pay taxes and fees for insurance). But this does not work for the hospital and the doctor… What now?
The start of new financial models for home monitoring
In 2016, Zilveren Kruis, Cardiology Centers the Netherlands (CCN) and FocusCura entered into a long-term partnership to bring as much hospital care as possible to the homes of patients. They launched the “HeartGuard” concept, watching over patients with heart failure, hypertension and atrial fibrillation. Part of this concept would also include a completely new way of funding, and that was easier said than done…
Over the course of nine months, an innovation team representing all three parties worked on the concept. They shared the vision that care should be delivered tailor-made to the patient’s needs, and while monitored safely at home with technology, a hospital visit would only be necessary in case of urgency. This approach improved the patients’ service-experience tremendously, while at the same time, the cost of care was reduced: Admissions are prevented and outpatient care is partially substituted. The calculation model of the innovation team was tested at CCN, and after testing the ‘Hartwacht fee’, would be made widely available by Zilveren Kruis. And that moment is now.
The concept is based on the principle of ‘bundled payments’. An insurer pays the hospital a bundled price per care pathway. The price being determined upon the historical price of the mix of healthcare products in the concerned care pathway. Though this seems complicated, basically it comes down to the hospital always receiving a guaranteed rate per pathway. Regardless of whether the patients visit the outpatient clinic, are hospitalised or are monitored remotely through home monitoring and videocare. Caregivers can thus determine, without financial consequences, in consultation with their patients, what is best for them. And if they decide to use the home monitoring, there are no additional costs for the patient, since they are paid for in the bundle price.
Does it work for the patients?
From my own experience, I can tell what this means for patients. Kor: “Someone in my immediate family has heart problems. He had to go to the hospital very regularly. Sometimes for a routine check-up, even though he had no complaints. Another time in panic to the emergency room. Fortunately, he has a modern cardiologist who prescribed ‘HeartGuard’”.
Kor received measuring equipment at home and the Vitals app was installed on his phone. During the first ‘setting week’, a personal measurement protocol was set up. Now he sends in his measurements weekly and he no longer has to visit the clinic. “I remember how ‘happily surprised’ he was after being ‘videocalled’ by the HeartGuard Centre, when it appeared that there were strange values in his measurements. His medication was adjusted and altogether this gave him such peace of mind. Not only for him, but also for us, as his direct family”.
More time for cardiologists
And besides, his own cardiologist was extremely satisfied. He now has insight into all home measurement data in the EMR and remains Kor’s regular point of contact for those moments when something is really off. According to a jointly agreed protocol, home measurements are treated in the HeartGuard Centre in Dokkum. The HeartGuard data shows that less than one in ten measurements have to be forwarded to the cardiologist. The rest of the home measurements are handled by the Vitals app itself or the HeartGuard team in Dokkum.
For Kor’s cardiologist, this means that many urgent questions popping up in his busy schedule, now belong in the past, while patients immediately have clarity about their condition and possible risks. He can thus have more patients under his supervision. And his own work is more pleasant, he said, because he can do his job even better by intervening proactively and by using the data for the benefit of his patients.
2019: Extra financial incentive
To make this widely available, Zilveren Kruis goes a step further; they commit to a fixed bundle price for three years. So hospitals will receive the same bundle price over the next three years, regardless of how their operational costs of the outpatient clinic decrease or the number of admissions decreases. Hospitals are allowed to keep the margins themselves and are given the time to adjust to the new way of care. A huge incentive!
Sharing knowledge to better care
It is very cool to be able to contribute to this movement with our team. We are happy to share our knowledge gained through various channels, such as in this blog. Because I hope that other hospitals will now also take the step. Since not only my Kor, but all heart patients, deserve the best care that fits their needs. VBHC then becomes a practice.
Or like my inspiration Florence Nightingale stated:
“Were there none who were discontented with what they had, the world would never reach anything better.”
This blog was published in Dutch on the website of Qruxx about Value Based Healthcare in August 2018.
The innovative project ‘COPD InSight’ won theVBHC Primary Care Award 2018 on April 26th. COPD InSight is an initiative of…
The initial results of the eHealth service HeartGuard are impressive, with 64% of resistant hypertension patients able to manage their high blood pressure more effectively. Zilveren Kruis began paying for its clients’ use of this modern version of heart care in 2016. Patients take their measurements themselves at home, while their cardiologist monitors remotely. “HeartGuard helps us bring care into the home safely, which is a major consideration in our view”, says Olivier Gerrits, director of care procurement at Zilveren Kruis.
HeartGuard is available to patients suffering from heart failure, cardiac arrhythmias, or resistant hypertension. Cardiologie Centra Nederland (CCN, Cardiology centres of the Netherlands) systematically monitor patients who are insured by Zilveren Kruis and are using HeartGuard, to determine the clinical effects, as well as the effects on quality of life. The initial results are very promising.
Patients who used HeartGuard showed an average decrease in blood pressure from 157/89 mmHg to 132/84 mmHg. 64% of patients with resistant hypertension have even been able to control their blood pressure. These are patients who have been referred by their family physician after various medicines failed to lower their blood pressure.
From Waiting Room to Living Room
Since the introduction of HeartGuard in 2016, hundreds of Zilveren Kruis policyholders have used the technology. “The number of applicants is shooting up. This offers good prospects for the future of telemonitoring and eHealth in general”, Gerrits explains. “By bringing healthcare into our clients’ homes in a safe manner, we improve their quality of life, prevent symptoms from getting worse, and avoid unnecessary visits to the hospital”.
The data collected over the past year also shows that patients have an increasing sense of self-management. “In the long run, this means fewer trips to the emergency room or family physician, as well as shorter waiting times in the hospital. eHealth is going to take on an ever more prominent role in Zilveren Kruis’s procurement policy”, says Gerrits.
Dr. Igor Tulevski, cardiologist and co-founder of CCN adds, “The first results show that eHealth is no longer a promise, but a practical solution that really works”. Tulevski continues, “The patients feel a greater sense of freedom and experience an improved quality of life. They also feel safer because they can be in touch with a cardiologist 24 hours a day, seven days a week. It enables them to exercise more control”.
Viable, Scalable, and Affordable
By using Luscii’s Vitals app (formerly cVitals), patients can monitor and send measurements, such as blood pressure and heart rate, to their cardiologist. “For normal treatment, we often only see the patient once a year and have to define our policy based on that. Thanks to HeartGuard, patients can send us many more measurements and vitals from the comfort of their home. This gives a very in-depth understanding of our patient’s situation”, Tulevski explains.
“If any of the patient’s measurements deviate from the norm, we can provide remote care by tweaking the prescription, so as to prevent the situation from worsening. Last year’s data shows that we can prevent sudden changes in the patient’s health status, which leads to a reduction in emergency consultations”.
The Future of Care
Gerrits explains, “By offering eHealth, we are providing the healthcare of the future, today, for our clients. With other insurers also following our example, we’re pleased to see how this kind of telemonitoring is becoming more accessible”. HeartGuard is only available for CCN patients at the moment. “All that’s left now is for other insurance companies to embrace eHealth in the coming years, so that everyone who wishes to use it is able to do so”.
HeartGuard is a joint initiative by Zilveren Kruis, Cardiologie Centra Nederland, and the Dutch healthcare innovation company Luscii (a brand of FocusCura). Since last year, Zilveren Kruis has covered the cost of HeartGuard for its policyholders, if medically prescribed. This eHealth breakthrough in the Netherlands made international headlines in 2016.
The role of Luscii in HeartGuard:
Luscii provides hardware, software and patient support in HeartGuard. As a spin-out brand of FocusCura, Luscii is co-initiator of the HeartGuard service, together with the Netherlands’ Cardiologist Centre and insurer Zilveren Kruis. These three partners joined in a mutual innovation team to create the HeartGuard service. The Luscii platform is embedded as a button inside the EMR of the cardiologist. Patients can download the Luscii Vitals and Luscii Contact apps on their iPhone or iPad, send in their measurements, and have (video)-communication with the nurses or cardiologists. Also, after enrolment, Luscii is responsible for all logistics (sending the measurement devices), service and (installation) support for patients within HeartGuard.
This press release was published by our partner Zilveren Kruis.