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
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”.
Zilveren Kruis
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”.
Unique collaboration
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”.
Safe feeling
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.
Bundled payments
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”.
Background Information
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.
Good news for more than 600,000 COPD patients in the Netherlands: more hospitals across the country are introducing the measurement of vital COPD values at home. This means that COPD patients no longer have to go to the hospital to get these values measured. “It also prevents hospitalisations, which is a great development”, says Emiel Rolink, director of Long Alliantie Nederland (LAN, the Dutch Lung Alliance).
Fewer hospital visits, with continuous supervision
A visit to the hospital is not only taxing on COPD patients who already have reduced energy because of their disease, but because the nature of the disease also causes stress. Patients can feel insecure and worry about ‘lung attacks’. Mr. Bremer, a COPD patient, explains: “I no longer have to go to the hospital as often as I used to, which really was an intense exertion for me. Now I have my values measured twice a week, which really gives me and my family peace of mind”.
Health measurements at home
Measuring the values of COPD patients at home is made possible by Luscii Vitals (formerly cVitals), an eHealth solution designed by the Dutch health care innovation company Luscii, a spin-out brand of FocusCura. Patients submit their measurements twice a week, which are then monitored at a distance. If the system detects an increased risk or if the patient has questions of their own regarding certain measurements, they can contact a healthcare professional immediately by video chat. In doing so, the care provider can give instant medical attention and prevent hospitalisations.
“We need to reduce hospitalisations by 25%”
In the Netherlands, COPD attacks equate to 30,000 hospitalisations every year, half of which are re-admissions. Rolink notes that, “The LAN wants to reduce the number of hospitalisations by 25% across the Netherlands in the context of the Nationaal Actieprogramma Chronische Longziekten (National action programme for chronic lung disease patients), while maintaining or improving the quality of life of patients. Finland and pilot areas in the Netherlands have shown that it is possible, provided you use a systematic approach that monitors the patient closely”.
Hospitals across the Netherlands
“We are working with Luscii to make this kind of modern COPD care available to patients across the Netherlands”, states Joris van Eijck, director of Health Care for Menzis. “This follows multiple successful projects in Slingeland Hospital, Isala, and MC Slotervaart”. To help hospitals achieve this ambition, they will be receiving a book from Erik Gerritsen, the Secretary-General of the Ministry of Health, Welfare and Sport, during the national e-health week. This book contains lessons learned, experiences, and a plan of action to make digital COPD care available.
Luscii provides hardware, software and patient support for a growing number of hospital systems using Luscii for their COPD monitoring programmes. The Luscii platform is embedded as a button inside the EMR of the pulmonologist. 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 pulmonologists. Also, after enrolment, Luscii is responsible for all logistics (sending the measurement devices), service and (installation) support for patients within the monitoring programmes of the hospitals.
This press release was published by Menzis during the Dutch eHealth week in 2018.
Slingeland Ziekenhuis (Slingeland Hospital), Sensire, and Menzis have optimised how they work together, so that they can provide even better remote care to people suffering from heart failure. Patients can now send information about their heart rate, blood pressure, and weight every two weeks using an iPad, improving how their health is monitored and reducing the frequency of in-hospital check-ups. Health insurer Menzis now fully covers the cost of this new style of digital care.
The hospital, healthcare provider, and health insurer teamed up some time ago as part of the project ‘InBeeld’ (‘bringing into vision’), to provide remote care to people with Chronic Obstructive Pulmonary Disease (COPD). This enables patients, nursing staff, and doctors to use the ‘Vitals’ app (formerly cVitals) – a product designed by the Dutch company Luscii – on their iPad and other digital devices in order to exchange information and video-call via a secure connection. If required, patients can contact the nurse directly or schedule an appointment at the hospital.
This application seamlessly brings together the cardiologist’s specialist knowledge at Slingeland Hospital, Sensire’s nursing expertise, and Menzis’ financial support. This has boosted the quality of life of patients living in more rural areas of the Netherlands: The control they have over their health means they no longer need to go to the hospital as often. It’s a step towards a healthier life.
John Diederik from Hengelo is one of the enthusiastic users of this remote care. The time that John and his girlfriend would have spent at the hospital can now be used for their hobbies and leisure. He tells us about his experiences: “Today’s technology really has no limits. I stay in contact with friends and family via Facebook, and I also use Maps. It’s great to see how many solutions we now have for day-to-day things. Now we can add health care to that list”.
The role of Luscii in HeartGuard:
Luscii provides hardware, software and patient support in ‘In Sight’, the telemonitoring service of NAAST, Sensire Homecare and Slingeland Hospital in the east of the Netherlands. The Luscii platform is embedded into the EMR at the NAAST Medical Center, which is responsible for triage of the alarms triggered by Luscii after patients have taken their measurements. Patients are mostly elderly and are guided by Luscii during the onboarding process (installation at home and permanent service desk for questions).
This press release was published by our partners Sensire, Slingeland and NAAST Medical Center.