Maarten Akkerman, Medtronic: Improving the healthcare system must be a joint effort of healthcare operators, government and industry

05.06.2019 ZF English

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Medtronic, a global medical technology provider, which has been operating in Romania since 2013, set out to change the traditional way patients receive care in Romania, by introducing the Value Based Healthcare (VBHC) concept, which puts the patient at the center of the health system.

The VBHC concept entails measuring and paying for medical services depending on the patient outcomes of those procedures after a while. The concept has already been implemented in several clinics in such countries as Netherlands  and Sweden, and the experience of those countries can be a starting point for the development of the concept in Romania, as well.

“The Value Based Healthcare concept looks at improving patient outcomes, at minimal costs. When we talk about traditional health systems around the world, they rely on health care, surgeries that are paid, but no one looks at the outcome of the surgery for the patient. This is something new in healthcare, a concept that will have everyone working around the patient. Is it easy? No, otherwise it would be done everywhere in the world, but it is a change and change in healthcare does not come easy,” said Maarten Akkerman, Vice President Medical Affairs & Value-Based Healthcare EMEA at Medtronic. He was in Bucharest for a conference about the future of Romania’s healthcare system.

The power of example

The countries where the VBHC model is already working, such as Netherlands and Sweden, can be examples for the local authorities, since the Romanian healthcare system is still in the development phase, Maarten Akkerman feels. This is an opportunity because Romania can only apply those concepts that work in other countries and lead to lower costs for patients, thus avoiding the mistakes already made. In Netherlands for instance, the concept was first implemented ten years ago.

Moreover, the development of this concept can be accelerated in countries such as Romania, which could use the expertise of the other countries in applying VBHC. To that end, Medtronic comes with its knowledge base, with research it did in Romania about various high-incidence diseases such as cardiovascular diseases and diabetes.

“It takes leadership and a culture for these changes and one needs to show the first results in this regard. We can already see the first examples of this concept in the Netherlands, in the Scandinavian countries. They are small examples, because wherever we focus on outcomes, healthcare improves and becomes cheaper, it is something we need for the future,” Maarten Akkerman added.

Material losses stand at about 30% in hospitals, as research has shown, and lead to the inefficiency of the system, generating costs for both the government and physicians, as well as for patients, he said.

“The disadvantage is that most healthcare systems rely on payment per service and the more you do, regardless of quality, the more you get paid. You have a knee surgery, an infection develops, you have to get back to the hospital. It’s not beneficial to you, but it is good for the healthcare operator because it gets paid again,” the Medtronic official added.

What is new about the patient outcome-based system is that the hospital is paid when the respective surgery led to the improvement of the patient’s quality of life, such as being able to walk after an orthopedic procedure, for instance, and being able to go back to their life.

How are patient outcomes measured?

Sets of outcomes have been established for every country where the VBHC model has been implemented, which are analyzed for payment after surgery. The lack of pain after a procedure, the days spent in the hospital, resuming normal life are but some of the indicators, which, once fulfilled, bring the rest of the money for that particular surgery.

“Sets of outcomes and indicators for breast cancer, orthopedic surgeries, but not for all conditions, have been developed in the past ten years. After a knee surgery I ask the patient after two or three days if they can use their knee; how long the patient stays in the hospital is also important,” Maarten Akkerman said.

In Netherlands, for instance, the authorities set as their target to have 15% of the total revenue in healthcare based on patient outcomes.

“The most important lesson is that improving the healthcare system must be a joint effort of healthcare operators, government and industry. They must work together and try things that worked. One must use every penny in the most efficient way for the patient,” Akkerman said.

In Sweden, patients make partial payments under the VBHC system for hip and knee replacement surgeries, the authorities monitor those patients for two years and if they no longer experience any pain, the hospital gets the rest of the money.

Sweden is therefore seeing the first results: a decline in follow-up surgeries by 20% and lower procedure costs by 25%.

Romania could model the VBHC concept on its own needs, depending on the disease incidence (cardiovascular or chronic diseases).

Three recommendations for the implementation of the VBHC system

An important issue when adopting this concept is that it must not be implemented suddenly in the entire healthcare system.

“Because change in the healthcare system in any country is done in small steps, the concept of patient outcome-based care must follow every step,” Maarten Akkerman says.

It is important to focus on certain diseases, which is the best approach when it comes to heart attacks, to cardiovascular care – the main causes of death in Romania.

Romania should not copy ineffective systems, which do not solve patient healthcare access issues such as those in Spain and Italy. One of the worst problems of the Romanian healthcare system is the lack of patient access to medical investigations and lab tests due to the underfunding of the sector.

“Romania has opportunities because you are still developing your healthcare system and can look at systems that work, at those that failed, which you should not copy, but you can learn the lesson,” Maarten Akkerman added.

From theory to practice

Although a concept created by Michael Porter more than a decade ago, Value Based Healthcare’s first practical implementation was the steps taken by healthcare professionals towards a complete medical care, with low costs, Akkerman explains.

Medtronic, the largest medical technology company, can provide clinics and hospitals with software to measure outcomes, research for authorities to identify issues to address and expertise in this field.

“Medtronic has the expertise, we are the largest technology company in the world, with a presence in 160 countries, we have in-house expertise but have been working with healthcare operators for 60 years,” Maarten Akkerman said.

The reason why Romania is on Medtronic’s map of VBHC concept development is that its healthcare system is still evolving and needs to spend the money efficiently now. Romania allocates less than 5% of GDP for healthcare, while other countries allocate as much as 10%.

Medtronic is a world leading provider of medical technology, services and solutions and has been present in Romania and the Republic of Moldova since 2013. Medtronic makes available treatment for almost 70 conditions, among which chronic diseases such as diabetes, obesity, cancer and heart diseases.

Maarten Akkerman is Vice President Medical Affairs & Value-Based Healthcare Europe, Middle East and Africa at Medtronic. He has an over ten-year experience in the medical industry, having previously worked on securing medical resources for the largest insurance company in the Netherlands.

Simona Brana, Country Manager Medtronic Romania, Bulgaria and Moldova
“The increase in the healthcare investment budget is good news for Romania. We hope to see this budget increase complemented by healthcare policies that put the patient and the outcome of care at the center of the system, so the patient outcomes are better and the medical care more efficient in all respects, including financially.”