The Right Care in the Right Place: Roadmap for a successful implementation

The Right Care in the Right Place is the new hype in healthcare. We see the term popping up everywhere and the memorandum ‘Proper Care in the Right Place’ forms the basis of all the mainline administrative agreements that have been concluded.

This is understandable, because in essence the Right Care in the Right Place is a fantastic way to realise the principles of Value-based Healthcare or Triple Aim in a region. However, a recent report by the NZA shows that the implementation has not got off the ground. We also know that implementation of such complex grant programs fails 70% of the time. As a result, stated goals are not achieved, time and money are wasted, and frustrated professionals and disappointed patients are left behind. The bottom line is that the Right Care in the Right Place – as it is currently designed – is doomed to failure. A different approach is needed. The key to success is a good implementation model and the great thing is: it exists! In this blog we will show you how to successfully implement the Right Care in the Right Place.

Why the right care in the right place?

The composition of our population is changing and with it the demand for and intensity of care. Compared to the year 2000, the number of people in the Netherlands aged 65 and over will double to approximately 4.25 million by 2030. As a result, not only is more care required, but other care as well. A large proportion of these elderly people have to contend with multi-morbidity and therefore a complex demand for care. But also in the population as a whole, multimorbidity will increase as a result of an unhealthier lifestyle. On top of that, there are more and more treatment options. All this will lead to an enormous increase in costs. It is expected that the average healthcare costs per person per year will rise from over 5,000 euros now to 9,600 euros in 2040, unless we intervene in time. This can be done by implementing the right care in the right place in the right way.

What is Proper Care in the Right Place?

Before we explain how to successfully implement Just Right Care in the Just Right Place, it’s a good idea to give it a definition, as this is often lacking. The national government formulates it as follows: ‘De Juiste Zorg op de Juiste Plek is an initiative of care providers. In this philosophy, the daily functioning of people is central. From there, they look for ways to relocate care (closer to people’s homes), prevent more expensive care and replace it with eHealth, for example. This helps people to live better with their illness or disability. The Ministry of Health, Welfare and Sport supports this movement where possible and facilitates parties to learn from each other and to get in touch with each other. Juist Zorg op de Juist plek is therefore care close to the patient, with various care and assistance providers working together and with increasing use of digital channels. Now you may be thinking, “Isn’t that network care? That’s right, Proper Care in the Right Place is a synonym for network care. And also for care network, sensible care, care pathway, 1.5-line care and substitution of care. We do not say this to make things even more complicated, but because these terms are also used all the time without us being able to see the whole picture – the entire elephant (figure 1).

Figure 1: The land of the blind

Better care for the land of the blind Essenburgh Training & Consulting

Right Care in the Right Place: a recipe for failure!

Why is the Right Care in the Right Place, as we are now approaching it in the Netherlands, doomed to fail? Apart from the fact that everyone has different definitions and images of the concept Proper Care in the Right Place, we do not meet the necessary preconditions. There is a lack of structural, integral funding and a coherent, evidence-based policy agenda. We do not regulate the care in an integrated way, but choose to start up separate projects and subsidy programs (like Juiste Zorg op de Juist Plek) as a countermeasure for our fragmented financing. They are all just a bunch of excuses with no coherence. As a result, the desired effects of quality improvement and cost reduction will not be achieved. The care providers do want to, but are not really stimulated by the current financial incentives to work integrally. As a result, the Right Care in the Right Place initiatives are struggling to get off the ground, let alone becoming embedded in practice. The problem is higher up in the tree. At the government level, policy is fragmented and not based on an evidence-based policy agenda. This makes the Dutch healthcare system inefficient. And who will suffer as a result?

The Subsidy Frustration Carousel (SFC)

  1. Patient:

The patient who keeps getting stuck in the system because the Proper Care in the Right Place project he is using is due to expire after three years.

  1. Healthcare professional:

The healthcare professional who becomes frustrated because his efforts are not continued in practice after those three years by means of a contract with the healthcare insurer.

  1. Driver:

The director who cannot bring about structural changes due to a lack of a structural, integrated purchasing policy and a long-term contract with the health insurer.

  1. Policy maker:

The policy maker who, time after time, has the difficult/impossible task of successfully implementing a new ‘hype’ because the field suffers from SFC syndrome.

In fact, the only ‘winner’ is the consultant who has his hands full trying to find the possibilities within the depths of the system. Incidentally, in most cases without long-term success. By now, it’s probably obvious why….

How can the Right Care in the Right Place be successful?

For about 15 years we have been muddling along in the Netherlands, while in other countries, such as America, England and Germany, successful initiatives have been launched. The reason is that they have arranged their financing properly (see figure 2).

Figure 2: International examples

Examples of value driven care Essenburgh Training & Advice

However, there is also a solution within reach for the Dutch situation in the form of a scientifically substantiated implementation model: the Rainbow Model.

Figure 3: The Rainbow Model

The Rainbow Model Essenburgh Training & Consulting

In the Rainbow Model, the needs of the patient are the starting point for various forms of clinical, professional and organizational collaboration. Such cooperation can take place at: 1) micro level: between client/patient and care provider, 2) meso level: between professionals and organisations, and 3) macro level: laws and regulations affecting all forms of cooperation.

Collaboration, that’s what it’s all about. The right care in the right place depends on people – patients, healthcare professionals and administrators – who are willing and able to work together, even beyond the walls of their organisations. And you can achieve this in four ‘simple’ steps:

Step 1: Map out your patients’ needs.

Do this at a regional level, so share practice data. Also, try to predict the future needs of your patient population. You can do this using clinical and cost data. This way you know what interventions are needed for your patient population now and in the future.

Step 2: Determine what outcomes you want to achieve.

Both clinically and in terms of patient experience and cost. Use the principles of Triple Aim for this. PROMs (patient reported outcome measures) and PREMs (patient reported experience measures) can be useful here.

Step 3: Determine what forms of collaboration you need to achieve those outcomes.

The Rainbow Model serves as a guideline for this. Look at the micro-, meso- and macro-level to see which forms of cooperation you could use.

Step 4: Identify and organise structural and cultural preconditions.

List what you need to make the Right Care in the Right Place a success in the long term. For example, look at funding and whether there is a culture within your organisation where people are prepared to make changes.

Towards evidence-based policy

The fact that most Proper Care in the Right Place projects fail has nothing to do with the potential of the concept, but with the way it is put into practice in the Netherlands. Instead of an integrated policy approach, we choose to finance separate projects. Subsidy money as a stopgap measure, that’s what it comes down to. We really need to stop doing that and make sure that we create the right preconditions to make the Right Care in the Right Place the success it deserves. This means that we make agreements at macro level about integrated financing, that we shape our policy on the basis of evidence and that we create conditions for information exchange. Use the needs of your patient population and the desired outcomes of your care as the starting point for care improvement. And very important: work together! With patients, with other care providers and with other care organisations. If so, the success rate of ‘Juiste Zorg op de Juiste Plek’ will increase by leaps and bounds.

Would you like to know more about successfully implementing Just Right Care in the Just Right Place? Register for our masterclass Network Care. Or read more in our eBook Care networks that work: The key to better outcomes.

Pim Valentijn

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