Diabetes Care in The Netherlands: - Novo Nordisk

11Recommendation 1: Refine economic incentives to encourageintegratedRecommendationcare and1:qualityRefineimprovementeconomic incentives to encourageintegrated care and quality improvementBarrierCurrenteconomicincentives donot encouragequalityimprovementand innovationDiagnosis• Insurers are supporting quality improvement, but theyare confronted with (perceived) financial disincentives- High quality care is perceived to only delay complications andcost (however, an indicative analysis suggest ~25% life timecost reduction if complications are delayed with 3 years)- Differences in risk exposure for specialist and primary care- Higher quality diabetes care may attract more loss-makingpatients for the insurer- (Hospital) capacity that is freed up by quality improvementstends to fill up with other patients (leading to double cost)• Limited collaboration incentive for primary care andspecialist care• Quality improvement initiatives are frustrated byfragmented budgeting (and ad hoc budget cuts)• Individual quality incentives are lacking for Primary Care,Specialists and Patient• Significant evidence gaps in basic statistics and intreatment evidence suggest insufficient supportingincentives for critical researchRecommendationInsurer• Integrate contracting of primarycare and specialist care in networks• Provide patient incentive forcompliance (bonus miles, gainsharing)• Enable research funding fromregular budgetGovernment• Adjust risk equalization scheme toensure small profit margin ondiabetes patients for insurers• Create an integrated funding modelfor primary and specialist carenetworksBooz & Company 14 November 2011Prepared for Novo Nordisk714