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Health insurance company makes healthcare quality measurable

  • Insurance companies
  • Quality
  • Patient journey

What is good quality healthcare? How can you measure it? And why is that useful? In today’s world, quality matters. Society expects healthcare providers to prove their quality, patients choose their healthcare providers based on quality, and health insurers need to source quality healthcare. So understanding the quality of the care provided is a must. One health insurance company noticed that outcome indictors were missing for many major diseases. Gupta helped to develop them.

Healthcare quality is measured with outcome indicators that show the results of the care provided. For example, you can measure if childbirth or an operation went well, or to what extent someone with depression has improved after treatment. In 2013, these outcome indicators were still missing for many conditions, which meant there were very few objective insights into the quality of treatment. Therefore, in collaboration with a major health insurance company, we set up the Healthcare Quality Program. For this program, in collaboration with leaders in the field, we developed, measured, compared and improved outcome indicators for 21 diseases. These conditions represent about 40% of the total healthcare costs in the Netherlands. The ultimate goal was to make healthcare quality transparent, and to improve the overall value of healthcare. With these insights, healthcare providers can improve their care, patients can make better decisions, and health insurers can improve their sourcing.

Strategy & approach

Gupta developed the strategy and approach for this multi-year program and supported its implementation. For each disease, they first determined which healthcare providers were leading their field in terms of measuring quality, scientific research and their ambitions to improve healthcare. Together with these innovators, we assembled pilot groups of healthcare providers who shared the ambition of measuring and improving healthcare outcomes. We followed a standard approach of developing, measuring, knowing and doing. The pilot groups discussed which outcomes were relevant to patients and how they could be measured. Once the outcome indicators were established, the pilot group began actually measuring them – starting first on a small scale within the pilot project, and later refining them for nationwide rollout. Of course, for every disease there were different outcomes.

For healthcare providers as well as patients

Throughout the entire program, Gupta supported the client’s program team in creating the strategy, facilitating the pilot projects, developing skills within the team, implementing the findings in line with the client’s procurement policy, designing the quality reports and initiating value-based improvement cycles with healthcare providers. During the pilot project meetings, the providers shared their results with each other. For many of the diseases, the indicators and lessons learned from the pilot phase were used to improve existing national quality records, and healthcare providers have adapted their care processes to further improve outcomes. Finally, patients can also use these outcomes when they need to make decisions about their treatment.

Gupta team

Niels Hagenaars' experience

Img Niels Hagenaars
It was very cool to be a part of this and to work intensively with a close-knit client team to improve the quality of healthcare.”

“In 2013, our client was really ahead of the curve. Value-based healthcare and being transparent about outcomes was new, ambitious and exciting. This program opened the door for value-based agreements between healthcare providers and health insurers, and accelerated the shift towards making healthcare quality more transparent. Being able to work on this gave me a real kick. It was very cool to be a part of this and to work intensively with a close-knit client team to improve the quality of healthcare. But being ahead of the game also has a downside, and I learned a lot from that as well. It wasn’t always easy to build trust and to develop and share sensitive information about quality with so many stakeholders. It was also challenging to get everyone on board with the idea of value-based healthcare. I still use the knowledge I gained about outcomes and quality, and the lessons that I learned from the pilot projects and handover almost every day. Putting patient value at the center of all our assignments and coming up with new, creative ways to increase value for our clients still gives me great satisfaction. When we recently had a reunion for this program, it was clear that the whole team looks back fondly on this enjoyable time and collaboration, and is proud of what we’ve achieved together.”

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