How Maastricht UMC+ is moving towards population health management

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Max Hotopf
March 15, 2022

Population health management is the new mantra of many health systems. Maastricht UMC+ in the Netherlands has been doing this for years, building a stronger primary healthcare network called Primary 1.5. We chat with Helen Mertens, CEO of UMC+.

By launching prevention programs, ensuring that the chronically ill are less likely to visit the emergency room, UMC can also invest more in tertiary health care. And he has the results to prove that the new models work.

Helen Mertens would like to take stock of the inhabitants of Maastricht and its province of Limburg. “Especially in the south of the province, people have the worst health compared to the rest of the country, the shortest life expectancy and the highest incidence of chronic diseases in the country. Worse still, young people are leaving for the big coastal cities like Amsterdam, Rotterdam and Utrecht, leaving a rapidly aging population that will only get sicker.

Thus, for 15 years Maastricht UMC+, the university hospital and its twin research institute have focused on this topic. The objective is to achieve a 30% improvement in the life expectancy of the lowest decile within five years.

Primary 1.5

More than a decade ago, Maastricht came up with the idea of ​​strengthening primary care to ensure that far fewer patients end up in emergency departments, occupying hospital beds and attending outpatient clinics.

This covers a number of strategies: specialist doctors see patients alongside family doctors in the so-called “Stadspoli” (City Outpatient), the introduction of apps to monitor chronic diseases and enable patients and their families to take better care of themselves.

At its core is the idea that specialist physicians from the University Hospital will visit primary care practices and see patients alongside their primary care physicians. Mertens says “most departments” do this today.

And the results are impressive. “It allows us to educate primary care physicians so they can do more. It also means that patients enjoy greater continuity and can remain under the care of their family doctor. And most importantly, it meant fewer retention interventions.

Mertens says initially there was resistance. “The doctors said it was more convenient for them if the patient came to them. And that also meant that we received less money as a hospital, because there would be fewer patients. But, on the other hand, there is a financial advantage for individual Dutch patients, because they have to pay an initial fee (“own fee”) when they go to the hospital, which they don’t have to pay the family doctor. In addition, waiting times are often shorter at the general practitioner.

1.5 also saw Maastricht roll out apps to give patients more control over their condition. For example, patients with irritable bowel syndrome have an app that monitors their health. “We used to see every IBS patient every three months. The app means we can eliminate that and only see the patient at the right time. Using the app reduced hospital admissions and outpatient visits A Lancet article showed this reduction in admissions Nieky

A month ago, Dutch legal insurers also approved the use of telemonitoring for patients with arrhythmia. And the Dutch Care Authority has recognized this form of e-health.

Maastricht has also done more to empower patients and their loved ones to take care of themselves, reduce hospital stays and pressure on home care organisations. For example, they are shown how to handle dressings and injections and how to apply eye drops.

All of this led to some interesting results. One study showed a major reduction in healthcare costs per patient and shorter waiting lists, as well as an increase in patient satisfaction without adverse effects on health outcomes.

Use data

Mertens says Maastricht have a big advantage. “We don’t have another general hospital in our city, so we are the only university hospital in the Netherlands that takes care of all secondary and tertiary care.” This means that Maastricht can capture a total data set.

But that doesn’t mean there aren’t data silos. Mertens says each hospital district has so far been allowed to choose its own patient record system. And primary health care records are kept separately.

Maastricht, however, is working hard on how best to share clinical data, both with primary care networks and with other providers by connecting data pools.

Maastricht has also developed what it calls a FAIR (Findable, Accessible, Interoperable and Reusable) federated learning and data sharing infrastructure that does not require data to leave the hospital – called Personal Health Train (www.personal healthtrain.nl). This has reduced many of the ethical and other barriers to sharing health data. Users can then ask questions such as “Which data elements are the most predictive of lung cancer survival given all the data in the Netherlands?” or more specifically ‘Which data stations contain data about me?’

Prevention

For Mertens, the key word is prevention. “We need to do a lot more across the spectrum, from educating patients following early diagnosis about diet and exercise to more general smoking and alcohol cessation programs.” It is an area that Maastricht already knows well, thanks to a cohort study of 10,000 Maastricht citizens, which is still being followed up a decade later. “We’re also developing lifestyle interventions with, say, diabetes where we can see and measure the impact of, say, giving patients a smartwatch.” Maastricht also launched a unique healthy breakfast program at school which assessed the health and educational level of children in care.

Here, she says the ministry has also asked UMCs to take a lead role in setting up the regional health networks. “In our region, we have set up a knowledge and innovation agenda. Together with partners in our network (other hospitals, local governments, insurers and industry), we looked at the future challenges of population health management and how we should address them. »

What about the future?

To what extent is what Maastricht does shared across the Netherlands?

She says the Department of Health is taking a keen interest in it, as are insurers. But, ultimately, whether Maastricht’s best practices are shared depends on other university hospital groups in the Netherlands.

Mertens is optimistic: “Our goal is to assess what we are doing and share it with the rest of the country and the world. We work closely with the other six UMCs in the Netherlands and we all adopt and share. For example, other hospitals are deploying our IBS app and we have adopted a home pregnant monitoring system from Utrecht UMC. »

But ask Mertens about the cost savings and she sighs. “Our biggest problem is the very large number of patients who come to see us. The truth is that bed occupancy has not gone down. Yes, we can keep the chronic disease cohort in better conditions and with fewer hospital visits, but the beds are now occupied by other patients. Due to demographics, I can see a lot of additional demand in the next decade. We will therefore continue to invest in prevention and promote a healthy lifestyle and, on the other hand, add smart innovations and medical technologies to improve our healthcare while keeping an eye on profitability.

We would like your opinion on this story. Email your views to Max Hotopf or call 0207 183 3779.



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