The results of this study could provide some important recommendations, to assure the future of the InBeeld project. The most important recommendation is to create more feeling of ownership of the contract by healthcare professionals. In the design of the InBeeld contract, the healthcare professionals had to little influence and participation on the financial aspect of the contract. Their opinion and participation were mostly on the aspect of proving the care
74 and in which way this should be done, and less in the financial incentives. Since the
healthcare professionals had too little influence on this, they do not have the feeling of ownership of the financial incentives. By not having the feeling of ownership, they do not act upon the financial incentives, and therefore the effectiveness of the financial incentives is lower than it could be. InBeeld is already a success on the aspect of proving care for patients, but if insurance companies would make this financially a success, they must create more feeling of ownership on the financial aspect by the healthcare professionals. The healthcare professionals must make it a success by acting upon the incentives, and nowadays they have the feeling that InBeeld is a management contract.
The second recommendation is to extend the scope of InBeeld. InBeeld is primarily used to prevent hospital admissions by COPD and heart failure patients, while InBeeld could also be used to shorten the duration of hospital admissions for patients who are already in the hospital. The focus should stay preventing hospital admission, but when this isn’t possible, InBeeld could also be used as a tool to shorten the duration of an hospital admission. By using the infrastructure of the InBeeld project, the patient could be sent home earlier with the
support of InBeeld. If the patient only needs a few check-ups a day by a nurse, the patient could be sent home with providing the telemonitoring of InBeeld. By doing this it is possible to reduce the duration of hospital admission, for example, from five days to three days. Because healthcare professionals mention that these last two days at the hospital aren’t necessary in a lot of cases. The last two days, the patient could be monitored at home with InBeeld. This isn’t possible nowadays and could prevent a lot of unnecessary days at the hospital. This solution will save a lot of cost, because monitoring the patient at home with InBeeld is less expensive than a patient who is in the hospital. This could be a relatively easy solution for enhancing the scope of InBeeld, because all the infrastructure necessary for this is already available with InBeeld care.
The third recommendation is to create a bigger scale for InBeeld. If insurance companies could create a bigger scale for InBeeld, there would be more urgency and professionals will step out of their routine. This is needed to make InBeeld an success, because nowadays InBeeld is more something next to other care for COPD and heart failure patients, instead of the standard for these patients. Creating a bigger scale could be done in several ways. It could be done by treating more patients with InBeeld. Nowadays there are approximately 100 patients who receive InBeeld care, which isn’t enough to create a feeling of urgency by professionals to change their working process. When there are more COPD and
75 heart failure patients included in InBeeld, professionals will change their routine and working activities, because there is more urgency. Another solution for creating a bigger scale for InBeeld is to provide InBeeld for other chronical diseases. Several interviewees mention that according to them, InBeeld could be used for almost every chronical disease. When InBeeld could be used by, for example, diabetes and asthma, then the population will grow, and this will have the same effect as mentioned before. When the scale of InBeeld is bigger, this could also create the option of clustering all the InBeeld care into one department. This so called “InBeeld centrum” could be an optimal solution for the problems of professionals who are holding on to their routine and working pressure of treating patients. With an “InBeeld
centrum” professionals will only treat InBeeld patients, and do not have their other routines or something else. This will have a lot of benefits, for example more efficiency and specialised healthcare professionals for the best care. An “InBeeld centrum” is more something for the future, but it is important to create a bigger scale for InBeeld, because this will diminish a lot of obstructive factors for InBeeld.
The fourth and last recommendation is about the role of insurance companies regarding InBeeld. As it is today, the different stakeholders have the feeling that insurance companies falls back in their role of insurance company controlling other organisations. InBeeld is promoted as a co-creation of insurance companies with the other organisations, but the different stakeholders have the feeling that insurance companies sometimes doesn’t
participate enough. One aspect mentioned is that insurance companies could benchmark more. By sharing figures and data on how the different stakeholders perform, it could be possible to create an image of how they perform compared to others. The results of InBeeld are not as high as expected, on the side of hospital admissions and cost reduction, but the different stakeholders do not know how they perform compared to others. Maybe they perform less than expected, but better than others. When insurance companies shares this information with everyone, they show that they are transparent and willing to find the solution why InBeeld is less successful than expected. This will give the different stakeholders the feeling that it is more a co-creation and will have a positive influence on InBeeld. The way it is now, it is a bit of a missed changed for insurance companies to change the paradigm of an insurance
company controlling healthcare organisations. Insurance companies could create this feeling of co-creation by sharing data with the stakeholders, but also by facilitating further
innovations regarding InBeeld. A big obstructive factor is the information exchange. This could be resolved when the different stakeholders would have one dossier around the care for
76 a patient. There are several pilots for this, for example PGO. Every stakeholder is positive about this pilot, so insurance companies could financially support these pilots as well, to diminish the obstructive factor on the information exchange.