A look at bottlenecks - Outcome-based financing enables care transition

Preventive healthcare encompasses all care where (still) no medical diagnosis has been made and that aims to prevent illnesses. Think of lifestyle interventions, programmes to eat healthily or stop smoking, and the so-called prehabilitation, which is intended to ensure that people undergo surgery in the best possible shape.

Preventive healthcare can prevent the development of medical complaints or the worsening of a disease, and avoid unnecessarily high healthcare costs. ‘But in the current system, no one is responsible for this,’ says Louise Blankensteijn, business development manager at Invest-NL and medic. ‘Care typically only begins once there is a complaint and a diagnosis. General practitioners can do some prevention, but people only seek help when they approach us themselves. In the current system, care providers are paid when they treat someone, but not for prevention and advice in the pre-disease stage.’ An additional problem is that care is organised into silos with their own departments and funding streams, and for prevention, these boundaries need to be crossed, sometimes even across different ‘domains’. Louise: ‘Someone can develop medical complaints caused by stress, for example, about debts or unemployment. In the health domain, the hospital treats the medical complaints, but it cannot address the root cause. That lies in the social domain, where the municipality could help.’ Due to these kinds of barriers, preventive and cross-domain care is still insufficiently developed. Yet, it could help relieve the pressure on a sector facing rising costs and staff shortages. Louise: ‘The ball remains in play and no one picks it up.’ 

Overarching perspective 

An excellent example of how results-based financing can work is GelijkGezond, a not-for-profit initiative supported by Invest-NL. GelijkGezond adopts a cross-sectoral approach: working with GPs and mental health services from the healthcare sector as well as social district teams and municipalities from the social sector. The goal is to improve the quality of life for people from the lowest income groups while also reducing healthcare costs.

Data shows a significant gap in healthy life expectancy between people from the highest and lowest income groups. Due to the complexity of multiple issues, individuals with low incomes often lack the mental capacity or knowledge to escape a distressing situation. This impacts their health.

It is precisely here that a cross-sectoral care provider can help by viewing the whole life of the individual from a comprehensive perspective, enabling them to tackle the problems. Here, the municipality can also act as the results-based payer: after all, it benefits from helping people out of financial difficulties. 

In addition to GelijkGezond, Invest-NL is involved with the Beweeghuis, a cross-sectoral care network for people with movement complaints. "In this business case, every euro invested results in a savings of nearly four euros," says Louise. Both GelijkGezond and the Beweeghuis benefit from Invest-NL's support to develop a sustainable, fundable proposition, with the aim of scaling such initiatives to create an impact across the entire healthcare sector. "We leverage our knowledge, skills, and network for parties in healthcare and for potential investors. We assist with formulating results-based financing agreements. Who pays whom, how results will be measured; these are quite complex agreements you need to set up." 

Care transition 

Invest-NL is doing even more to promote results-based financing in healthcare. A model agreement is in development for the collaboration between investors and result payers. This also makes results-based financing accessible to large institutional investors. ‘We are also working on a roadmap. Everything we learn is included, so that not every party has to reinvent the wheel.’  

According to Louise, results-based financing can play an essential role in enabling preventative care, and thus the care transition. ‘Care costs are rising, waiting lists are increasing, and the shortage of healthcare workers is also becoming greater. Current projections indicate that healthcare costs will double by 2040. To keep care affordable, we absolutely need to change the system. Not just focusing on curing disease, but also on promoting health.’