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Cost Reduction in Mental Health Care by a New Regional Approach
Leiden, The Netherlands
Dr. L. van Londen, Psychiatrist, MD, PhD.
Transparant, Mental Health Centre, Leiden, The NetherlandsTransparant Next, Foundation for Collaborative Care
No disclosures
Background
1. Rising costs of Mental Health Care in The Netherlands
2. Reduction of psychiatric beds numbers
3. Deinstitutionalisation, but without increasing capacity of outpatient clinics
4. Payment incentives
5. Outcome-based mental health care pricing and reform
6. Aim to enhance efficacy and quality of care
7. Reduce costs
GP’s struggle
• How to know psychiatric complaints from psychiatric disorders
• Gatekeeper
• Indicate care burden
• Uniform referral policy
• Treatment in GP’s office
• Take care of chronic patients
• Prevention
Transparant Next
Centre of Knowledge on Integrated Care
Develops:
1. Networks of Collaboration
2. Products (decision supportive screening,
consultation)
3. Services (for GP’s, GP-based nurses,
patients)
Aim: boosted support for GP’sMethod
1. Consultation Service by Psychiatric Consultation Team (“we are right here”)
Ask question
Send in patient for psychiatric evaluation
Get patient back with advice
2. Web-based Decision Supportive Screening
To support decision making about referral (yes or no) in primary care
3. Integration of ICT systems
4. Test population
In Midwest region of The Netherlands: almost 260.000 citizens
Selfhelp
Social
Worker
GP/nurse
Psychologist
shortterm
Psychologist
medium
Psychologist
intensive
Specialized
Care
Resilience, Self-motivationSocial Support
Grading UpGrading Down
Regional integration Mental Health with GP-systems
CHM/e-Health platform
CHM
Integration Mental Health Hospital
GP-sys
GP & GP based nurse
Lab
Meds
Medical Information
Discharge letters
Routine Outcome Monitoring (PROM)
Present
Mr. De Vries
ResultsPSYCHIATRIC CONSULTATION
500
DECISION TOOL
1000
010203040506070
According to tool
Referrals
Estimated Cost Reduction by 500 consultationsTotal costs of Consultation Team:
± 130.000 euro in 2,5 years
Savings:
± 500.000 euro (250 x 2000)
50 % of patients stayed for treatment in GP practice with advice from Psychiatrist
Saving costs of referral and treatment in Specialized Care: 2000 euro per patient (mean)
Netto result:
± 370.000 euro
Thank you very much
With many thanks to:
Iris Hoes, Lucas van Gerwen, Wim Meertens (LVE)
Erik van der Put & Martin Douma (Psyalite)
Albert Blom (Rivierduinen)
Eva van Steenbergen & Henkjan de Jong (REOS)
Johan Maat & Erik Kramer (Zorg en Zekerheid)
Gerbrand van de Beek & Arjan Karens (VitalHealthSoftware)
Adriaan Timmers & Emmy Blaakman (Gezondheidscentrum Wantveld)
Bert van Hemert (Vakgroep Psychiatrie RUL)
Willem van der Does (Vakgroep Psychologie RUL)
Mattijs Numans (Vakgroep Huisartsgeneeskunde RUL)
De huisartspraktijk-pilotpraktijken !