François Schellevis, Head of Research Department, Netherlands Institute for Health Services Research (NIVEL)
At the 18th European Health Forum Gastein, I caught up with Professor François Schellevis from the NIVEL institute in the Netherlands. Professor Schellevis spoke during the panel session on 1 October, during the forum on Facing the Challenge of Multimorbidity, with a focus on how well our health and social systems are adapting to the specific challenges of treating multimorbid patients.
Why is multimorbidity relevant to this year’s theme of Securing Health in Europe: Balancing Priorities, Sharing Responsibilities?
We must consider that patients in Europe today are increasingly elderly, with complex and more comprehensive healthcare needs. For instance, the majority of hospitalized patients and patients in waiting rooms today are elderly, often 70 years of age or more. This is a reflection of how far modern healthcare has come in helping us live longer, but at the same time we are living longer with more diseases. Since the risk of multimorbidity increases with age, there is a real challenge to healthcare systems to deal with the increasing number of patients with complex healthcare needs. This trend contributes to a broader sense of urgency in Europe for us to secure the same level of healthcare in the future that we enjoy today. Meeting this urgent challenge is important not just for the health of Europe but also for our broader economic sustainability.
A recurring theme in today’s session on Facing the Challenges of Multimorbidity was that we need more good-quality data on multimorbidity in order for policy-makers to devise solutions. Most clinical research, for instance, is still conducted on only one disease group, with multimorbid patients deliberately excluded from clinical studies into innovative therapies. Building quality data specifically on multimorbidity will remain an important challenge at national level. Nonetheless, you drew the audience’s attention to ongoing initiatives at local and regional level that we could leverage to help the national authorities out. Could you expand a little on these initiatives and why they’re important?
We at the NIVEL institute are a leading partner in ICARE4EU: Innovating Care for People with Multiple Chronic Conditions. Through this project, we and other organizations are mapping multidisciplinary care programmes across Europe that address multimorbidity and we found that these are mainly locally or regionally-based. The work will conclude in 2016 but we have already been pleasantly surprised to find that 101 of these projects provide multidisciplinary care to multimorbid patients at a high level of quality. So far, no single project has been found to be perfect, however one could take the good elements from these initiatives and combine them into a virtual, ideal project for the future. Before deploying such a project at national level, of course, policy-makers would still need to adapt the project design to the specific needs and characteristics of the national healthcare system. Nonetheless, I am optimistic that the policy-makers could leverage the best ideas from ICARE4EU in order to devise powerful national solutions to the challenges posed by multimorbidity.
Since ICARE4EU will be finalized in the coming months, what would you like to see happen next in terms of bringing this work to the attention of national policy-makers?
We’re already doing a lot to disseminate information about this project among the EU Member States, and our main drive to raise awareness will be on 22 March, at the final ICARE4EU symposium in Brussels. At that conference, we plan to invite representatives from all Ministries of Health in Europe, as well as stakeholders such as healthcare insurers, patient advocacy groups, and professional organizations. During that conference, and even beforehand, we plan to intensify our external communication. Once the project’s data-collection phase is complete and we feel ready to start drawing conclusion from the work, we would like to build a toolbox of ‘success factors’ from the 101 projects being analyzed. Again, national policy-makers should be able to use this toolbox, choosing the elements that they feel are likely to work in their country. I hope that they will find it useful in developing national solutions.
If we imagine that all this goes to plan and the Member States find the toolbox useful, how might that look in concrete terms in the countries?
I think this will depend a lot on each national situation. Some countries, for instance, have already introduced bundled payment systems for coordinated care systems, funding case managers and so on. Others do not, so it will really depend on which solutions in the toolbox a given country is already using.
Understood, but if you had to picture this already, for example in your home country?
Well, I think the Dutch healthcare system could potentially benefit from the elements in the toolbox related to coordination of care. Policy-makers could use these elements to devise new models, for example, for more closely coordinating primary and secondary care in the Netherlands. Another area that might benefit is the level of coordination between social and medical care. Multimorbid patients have not only complex medical needs, but also often depend to some extent on social care, like home health nurses and other services including volunteers, help with transport and so on. In my opinion, the management of these services is too divided from the traditional healthcare system, especially the management of financing, insurance and so on. Integration of these areas could potentially deliver real benefits for multimorbid patients and the system itself.
The drive to continue building quality data on multimorbidity will continue well into the future. Given that multimorbid patients can perhaps be in special need of continuous monitoring, do you feel that today’s innovations in eHealth and telemedicine could help enrich the data we have on specific multimorbid patients?
Sure, and in fact this is already part of the ICARE4EU project. The project looks at 4 main domains when comparing multimorbidity care programs: Patient centeredness, how the programs are financed, how they are managed, and finally, the extent to which they leverage eHealth as a component. So we are already paying special attention to this area, and we have already found a number of nice examples that will be part of the toolbox. One finding we’ve already reached, however, is that today’s population of elderly multimorbid patients is not literate enough to use these tools to their full potential. I feel that this is simply a generational issue. I’m 62 now, and if I become multimorbid when I’m 75, I would hope that I can use my smartphone or tablet to make the most of these eHealth solutions. Today’s multimorbid patients in their 70s or 80s, tend to struggle just a bit too much with the technology, but watch this space because I think it’s only a matter of time before this changes.
This interview was conducted by the Young Gasteiner Oliver Bisazza