Working with the Rainbow Model on Value-based Healthcare: from start-up to success formula
More health for less money: in a nutshell, that is the essence of value-based healthcare. In practice, however, this is not so simple. Start-ups, eHealth tools and other innovations are constantly being launched with the promise of improving care and reducing costs. All with the best intentions, but nine times out of ten the desired net result is not achieved. Healthcare costs continue to rise merrily (partly due to all these innovations) and visibility on outcomes is often lacking. Let alone that such innovations are successfully implemented.
The big show-stopper is fragmentation. Fragmented supervision, fragmented data sources, fragmented funding and fragmented care, we all know it. This makes the realization of really valuable innovations and improvement projects not easy. The solution is as old as the hills: working together. But how do you go about it? With the Rainbow Model! Everyone’s innovations are looking for the proverbial pot of gold. The Rainbow Model (Valentine et al. 2013) puts that pot at your fingertips. In this blog we translate the theory of the Rainbow Model into practice. In addition, we provide practical tools for making the transition from start-up to success formula. That way, at the end of the Rainbow Model, everyone can really find that pot of gold.
The Rainbow Model: from theory to practice
The bottom line is that value-driven care stands or falls with people; people who can work together in teams and outside their organisation in a context of innovation and trust. To achieve this, the right balance is needed between functional ‘hard’ preconditions (such as data management and business modelling) and normative ‘soft’ preconditions (such as vision development and storytelling). This balance determines whether an approach will be successful in practice. The Rainbow Model summarizes the various domains of value-driven care and the hard and soft preconditions in one model. The model shows that value-driven care requires integral cooperation at various levels, see the following figure.
In the model we distinguish three levels:
1) micro level: the collaboration between client/patient and health care provider (clinical integration),
2) meso level: the collaboration between professionals and organisations (professional and organisational integration), and
3) macro level: the legislation and regulations (system integration) that affect all forms of cooperation.
In the Rainbow Model, the needs of the patient are central. Based on the needs of a group of patients, or a population, various forms of clinical, professional and organizational collaboration can be initiated. The right balance between ‘soft’ cultural and ‘hard’ structural aspects determines whether the collaboration is effective and whether the intended clinical, health, and cost outcomes are achieved. Laws and regulations (the system) are often a given. Nevertheless, it is good to map this out in advance as well. Is it at all possible to achieve the cooperation you envisage? Perhaps a lobby in The Hague is necessary first.
Together on the road to success in four steps
To make it a little easier, there are four steps to successfully applying the theory of the Rainbow Model in practice.
Step 1: Determine the needs of your patients
What care do the patients in your area need? To do this, you look at people’s needs on a personal level. In addition, you try to predict (undesirable) health outcomes using available clinical and cost data, so that you can also identify future needs. This is essential to be able to make the right interventions that are also future-proof. Your interventions will focus on participation and prevention. In an ideal situation, you would collect all of the patients’ data in one place.
Step 2: Determine your desired outcome(s)
What outcomes do you want to achieve with respect to patient needs? It is important that you set the intended goals using the Triple Aim. This can be in the area of patient perceived quality, such as patient reported experience (PREMS), but it can also be patient reported outcome measures (PROMS). In addition, clinical and cost indicators are important.
Step 3: Determine the form and degree of cooperation
What forms of collaboration do you need to achieve the desired outcomes? Go through all the dimensions of the Rainbow Model. How can you design the collaboration on a micro level between the patient and the healthcare provider? For example by making an individual care plan. What can be done at the meso level to improve collaboration between healthcare professionals and healthcare organisations? This could include multidisciplinary consultation, chain care or having a joint EPD. Finally, it is important to look at the macro level to see what political-administrative developments may or may not lead to cooperation. The value-driven care models ‘Patient Centred Medical Home’ (PCMH) and the ‘Accountable Care Organisation’ (ACO) can serve as inspiration here. Within these models, care is provided across the entire chain of prevention, care and welfare at district and regional level. Both models have been scientifically proven to bring about significant improvements in quality and cost savings.
Step 4: Organise the right preconditions
What conditions in terms of structure and culture are needed to achieve the desired outcomes? List the criteria for funding the collaboration, make clear agreements about them and record them. Identify the willingness to change of all stakeholders involved and create a shared culture that is open to change.
The Rainbow Model makes value-driven care possible
It is important that an organisation first focuses on its goals before embarking on new projects and interventions in the context of value-driven care, for example. Make targeted choices based on the needs of the patient population in your region. Don’t go doing things that no one is really waiting for, no matter how beautiful and innovative they are. If you don’t match your offer to the demand, the patient won’t be better or happier and your investments won’t pay off at all. In fact, it’s a waste of money. So avoid a proliferation of innovations, start-ups and projects. Make well-founded choices and enter into cooperation with the right partners. By using the Rainbow Model, you can do this in a structured and methodical way. Have faith that it will help you. Many have gone before you and the model has been scientifically proven. Value-driven care is not an illusion as long as you organize it for the right reasons and in the right way.
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