Working on value-based healthcare with the Rainbow model: from start-up to scale-up

More health for less money, that’s the core of value-based healthcare in a nutshell. In practice, however, it turns out this is not that easy. Start-ups, eHealth tools and other innovations are constantly being launched with a promise to improve healthcare and lower costs. All based on the best of intentions, but nine out of ten times this doesn’t lead to the desired result. Health care costs continue to rise (partially because of all these innovations) and it is difficult to get an idea of the potential results. In addition, they are rarely implemented successfully.

Fragmentation is the biggest show stopper. Fragmented services, fragmented data sources, fragmented financing systems and fragmented healthcare policies. Something we can all relate to. This does not make realizing really valuable innovations and improvement projects any better. The solution is as old as the hills: cooperation. But how do you go about it? By using the Rainbow model! Everyone is using their innovations to find the proverbial pot of gold. By using the Rainbow model (Valentijn et al. 2013) this will be within reach. In this blog we translate the theory of the Rainbow model to practice. We give you practical tools to transition from a start-up to a winning scale-up formula. That way anyone can find the pot of gold at the end of the rainbow.

The Rainbow model: from theory to practice

What it boils down to, is that value-based healthcare depends on people; people that can cooperate in teams and outside of their organisations in a context of innovation and trust. To realize this, you need a good balance between functional ‘hard’ conditions (such as data management and business modelling) and normative ‘soft’ conditions (such as vision development and storytelling). This balance determines whether an approach will be successful in practice. The Rainbow model model combines the domains of value-based healthcare and the hard and soft conditions into one model. In the model we can see that value-based healthcare needs cooperation at different levels, see image 1.

Rainbow Model

  1. In the model we separate three levels:
  2. 1) Microlevel: the cooperation between client/patient and health care professional (clinical integration),
  3. 2) Mesolevel: the cooperation between professionals and organisations (professional and organizational integration), and
  4. 3) Macrolevel: the laws and regulations (system integration) that influence all the forms of cooperation.

The patient’s needs are central to the Rainbow model. Based on the needs of a group of patients (the population) different types of clinical, professional and organizational cooperation can be initiated. The right balance between ‘soft’ culture and ‘hard’ structural aspects determines whether the cooperation is effective and if the intended clinical, health related and cost related outcomes will be achieved. Laws and regulations (the system) is often a given. It’s still good to map this in advance, however. Is it possible to achieve the cooperation you have envisioned? Maybe you need to lobby first.

On the road to success in four steps

To make it a little bit easier, there are four steps to successfully put the theory of the Rainbow model into practice.

Step 1: Determine the needs of your patients

What type of care do the patients in your area need? Check what people need at a personal level. You should also try to use any available clinical and cost-related data to predict the (unwanted) health-related results, so you can map out future needs. This is essential to be able to make interventions that are future-proof as well. In your interventions, focus on participation and prevention. In an ideal situation you collect all patient data in once place.

Step 2: Determine your desired result(s)

Which results do you want to achieve in relation to patient needs? It is important to determine the envisioned goals using Triple Aim. You can do that based on the quality the patient has experienced, such as patient reported experience measures (PREMS), but you can also use patient reported outcome measures (PROMS). In addition, you should consider clinical and cost-related indicators.

Step 3: Determine the form and level of cooperation

Which forms of cooperation do you need to achieve the desired result? Go through all the dimensions of the Rainbow model. How can you design the cooperation at a micro level between the patient and the health care professional? For example, by making an individual health care plan or Patient Health app. What can you do at a mesolevel to improve the cooperation between health care professionals and between them and healthcare organisations? You can think of options like a multidisciplinary team, or a interoperable Electronic Health Record (EHR). Finally, it is important to look at the macrolevel to determine what the politico-administrative developments are that could either lead to a cooperation or not. The value-based healthcare models ‘Patient Centred Medical Home’ (PCMH) and the ‘Accountable Care Organisation’ (ACO) can be used as inspiration for your governance model or legal structure. Within these models, healthcare is provided for the entire chain of prevention, healthcare and wellbeing at a district and regional level. For both models it has been scientifically proven that they bring about significant improvements when it comes to quality and cost-saving.

Step 4: Set the right conditions

Which structural and cultural conditions are necessary to reach the desired outcomes? Map out the cost-criteria for the cooperation, make clear agreements about them and put them in writing. Determine all involved stakeholder’s willingness to change and create a communal culture that is open to change.

The Rainbow model makes value-based healthcare possible

It is important to set out your goals as an organization first, before you start working on new projects and interventions as part of things like value-based healthcare, triple aim or eHealth. Make targeted choices and choose the right partners to work with. By using the Rainbow model, you can do this in a structured way. Have faith that this will work for you. Many have gone before you and the model has been scientifically proven. Value-based healthcare or Triple Aim is not an illusion as long as you do it for the right reasons and in the right way.

Do you want to know more about this and get started on it right away? Download our whitepaper “Value-based healthcare: A call for integrated action” to learn what further steps are needed to scale-up value-based healthcare.

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dr. Pim Valentijn

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