Santeon's Lessons from a Decade of Implementing Value-Based Health Care

Despite growing global support for value-based health care (VBHC), there is no consensus on the best approach for the identification of improvement potential nor on the selection and implementation of improvement initiatives. In addition, varying frames of reference shape how individuals interpret the concept of value and how they implement VBHC. As a result, it is often implemented in various and fragmented ways. Santeon, a nonprofit formal alliance of seven Dutch teaching hospitals, has been working on VBHC since 2012. In this article, intended to address gaps in the literature regarding the implementation of VBHC, the authors use the new strategic agenda for value transformation to share more than 10 years of Santeon's VBHC implementation experience. The authors provide an overview of Santeon's implementation methods; describe challenges and lessons learned; and demonstrate how value transformation was achieved with tangible examples from birth care, chronic kidney disease care, and breast cancer care. In breast cancer care, for example, system-wide improvement initiatives resulted in an increase in breast-conserving surgeries on an outpatient basis (from 391 in 2014 and 2015 to 458 in 2016), and a reduction in reoperation rates owing to positive tumor margins (from 39 in 2014 and 2015 to 33 in 2016). These results were subsequently used to negotiate a collective value-based reimbursement model with insurance companies.