Moving to a High-Value Healthcare Delivery System


Part 2 of a three-part series about Medtronic and Diabeter. In part 1, we discussed our acquisition of Diabeter as part of our overall value-based health care strategy. In part 2, we highlight the components of a value-based healthcare system and how Diabeter exemplifies them.

In a value-based healthcare system, the overarching goal for providers, as well as every other stakeholder, should be to improve the value of health care for patients. Michael E. Porter, professor of strategy at Harvard Business School, defines value as “the health outcomes achieved that matter to patients relative to the cost of achieving those outcomes.”

According to Porter, a high-value healthcare delivery system has six components – all of which Diabeter, a Medtronic-owned chain of innovative, independent Netherlands-based diabetes clinic and research centers, exemplifies:

  1. Organize into integrated practice units (IPUs). Diabeter clinics are each organized as an IPU: a multidisciplinary team of clinical and nonclinical personnel—including medical doctors, nurses, dieticians, psychologists and administrative staff—focuses solely on diabetes care for children and adolescents and takes joint responsibility for the full cycle of care.
  2. Measure outcomes and costs for every patient. Diabeter uses three tiers of outcomes measurement: health status achieved or retained, including quality of life (QOL); care process and complications; and sustainability of health. It also regularly investigates cost per patient, which has been relatively stable over the years.
  3. Move to bundled payments for care cycles. Diabeter sets an annual bundled price with Dutch health insurance companies, not including medicines and consumables.
  4. Integrate care delivery between separate facilities. Diabeter was founded with the objectives of providing specialized care outside the traditional university hospitals, and its clinics are geographically separated from other care facilities.
  5. Expand excellent services geographically. Diabeter has expanded from one clinic in Rotterdam to five clinics throughout the Netherlands, and all clinics apply the same procedures, digital tools and administrative organization.
  6. Build an enabling IT platform. Diabeter collects real-time patient data via its VCare IT system, which electronically uploads data from a patient’s insulin pump or glucose meter to a server that instantly displays the patient’s real-time health status on a dashboard; sends an extended report to Diabeter, where the data is analyzed by a nurse; generates a “Ther@pie mail” email for the patient with information on trends, target settings, treatment plans and next contacts with Diabeter; and sends an alert to one of the medical doctors for immediate action if there are large deviations in the data.

By systematically following the six steps of the value agenda, Diabeter has been able to demonstrate that its superior outcomes led to lower direct annual costs to type 1 diabetes patients. The clinic’s percentage of children reaching the HbA1c target of less than 7.5% (58 mmol/mol) is 55%, making Diabeter one of the best performing clinic in the Netherlands. As a result, Diabeter has a much lower patient hospitalization rate than that of other Dutch pediatric diabetes clinics (3% versus 8%), resulting in a cost savings of 8.6 percent for patients.*

* Diabeter: Value-Based Healthcare Delivery in Diabetes by Jens Deerberg-Wittram and Laura Lüdtke from The Boston Consulting Group, September 2016

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  1. Andrea Grammatico

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