The Right Care in the Right Place: A step-by-Step implementation plan

The Right Care in the Right Place: A step-by-Step implementation plan

 

The Right Care in the Right Place is becoming the new buzzword in the healthcare sector. Understandable, because fundamentally the Right Care in the Right Place is a

fantastic way to achieve the principles of Value-based Healthcare or Triple Aim. Yet the implementation isn’t working, according to recent studies. Not surprisingly, because we know that the implementation of such complex programs fails 70% of the time. The consequence is that the objectives aren’t achieved, time and money is lost, and it leaves frustrated professionals and disappointed patients. What it boils down to is that the Right Care in the Right Place – the way it’s being implemented now – is doomed to fail. We need a different approach. The key to success is a good implementation model and the great thing is: it exists! In this blog we will show you how you can implement the Right Care in the Right Place successfully.

Why the Right Care in the Right Place?

The composition of our population is changing, which means the demand for healthcare is too. For example, in 2030 the number of people 65 and over will have doubled to about 4.25 million in the Netherlands. That is why we don’t just need more healthcare, but different healthcare. A large percentage of elderly is dealing with multimorbidity, so their healthcare demands are complex. But multimorbidity will increase in the entire population because of an unhealthy lifestyle. In addition, there are an increasing amount of treatment options. This all leads to a giant increase in cost. The expectation is that the average healthcare costs per person will rise from over 5,000€ now to 9,600€ in 2040 in the Netherlands, unless we intervene on time. And that’s possible by providing the Right Care in the Right Place.

What is the Right Care in the Right Place?

Before we explain how to successfully implement the Right Care in the Right Place, it’s good to give you a definition, because a solid definition is missing. This is how the Dutch Ministry of Health defines it: ‘The Right Care in the Right Place is a healthcare providers’ initiative. This philosophy centers around the daily functioning of people. That is the starting point to look for ways to move care (closer to people’s homes), prevent (more expensive) healthcare and replace healthcare by for example eHealth. This helps people live with their disease or disability more easily. The ministry of Health, Welfare and Sport supports this movement where possible and facilitates parties to learn from each other and come in contact with one another.’

To sum, the Right Care in the Right Place is care that is close to the patient, where different healthcare providers cooperate and where we increasingly use digital channels. You might think: ‘But isn’t that integrated care or care coordination?’ Yes, Right Care in the Right Place is a synonym for integrated care. Yet, it’s also a synonym for care networks, Triple Aim, care pathways, outreach clinic and substitution of care. We aren’t telling you this to make it even more complicated, but because you will run into all of these terms at one point or another without being able to see the overall picture – the whole elephant.

Figure 1: The land of the blind

Right Care in the Right Place: Recipe for disaster?!

Why is the Right Care in the Right Place, the way we’re approaching it in the Netherlands at the moment, doomed to fail? Aside from the fact that everyone has different definitions of and ideas for the concept of the Right Care in the Right Place, we don’t meet the necessary implementation criteria. We are lacking structural, integrated financing and a cohesive, evidence-based policy agenda. We don’t have an integrated approach to healthcare, but choose to initiate stand-alone projects and subsidy programs (like the Right Care in the Right Place) as a countermeasure to our fragmented financing and policy agenda. All purely palliative without any sort of cohesion. Because of this, the desired effects – quality improvement and cost reduction – aren’t being achieved. It’s not that healthcare providers aren’t willing, but the current policies and financial incentives aren’t really encouraging them to really integrate health and social care for people with complex needs. This means Right Care in the Right Place initiatives are having trouble taking off, let alone becoming a sustainable part of practice. The problem is higher up the ladder. Policies are fragmented at a government level and there is no evidence-based policy agenda.

What needs to be done?

We’ve been muddling around in the Netherlands, while there are successful initiatives in other countries like the US, England and Germany. The reason is that they have their policies and finances in order (see Figure 2).

Figure 2: International best practices

However, a solution is within reach for the Dutch situation in the shape of a scientifically proven implementation model: the Rainbow model.

Figure 3: The Rainbow model

Within the Rainbow Model, the needs of the patient are the starting point for different types of clinical, professional and organizational cooperation. These cooperations can take place at the: 1) micro level: between client/patient and healthcare provider, 2) meso level: between professionals and organizations, and 3) macro level: laws and regulations that apply to all forms of cooperation.

Cooperation, that’s what it’s all about. The Right Care in the Right Place’s success is dependent on the people – patients, healthcare professionals and managers – that can and want to cooperate beyond the walls of their own organizational intrest. And that can be done in four ‘simple’ steps:

Step 1: Map your patients’ needs.

Do this at a regional level, share field data. Try to predict what the future needs of your patient population will be. You can do this based on clinical and cost data. This will help you figure out which interventions your patient population needs now and in the future.

Step 2: Determine the outcome(s) you want to achieve.

At a clinical as well as at a patient experience and cost level. Use the Triple Aim principles. PROMs (patient reported outcome measures) and PREMs (patient reported experience measures) can be useful.

Step 3: Determine which types of cooperation you need to reach those outcomes.

The Rainbow Model is a good guideline for this. Determine what types of cooperation you could use at the micro, meso and macro level.

Step 4: Map and organize structural and cultural conditions.

Determine what you need to make the Right Care in the Right Place a long-term success. For example, look at financing and whether the culture within your organization means people want to implement changes.

Toward evidence-based policy

The fact that most Right Care in the Right Place projects don’t make it, has nothing to do with the concept’s potential, but with the way it’s put in practice in the Netherlands. Instead of an integrated policy approach, we choose to finance stand-alone projects. Using grants as a quick fix, when it comes down to it. We really need to stop and ensure that we create the right conditions to make the Right Care in the Right Place the success it deserves to be. This means we agree on integrated payment models at the macro level, that we design our policies based on evidence and that we create conditions for proper sharing of patient data. Use the needs of your patient population and the desired outcomes as a starting point. And very important: cooperate! With patients, with other healthcare professionals and other care organizations. That will make the success rate of Right Care in the Right Place skyrocket.