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 !