• Esmée K J van der Poort, Martha Kidanemariam, Christopher Moriates, Margot M Rakers, Joel Tsevat, Marielle Schroijen, Douwe E Atsma, M Elske van den Akker-van Marle, BosWillem Jan WWJWDepartment of Internal Medicine, Section of Nephrology, Leiden University Medical Center, Leiden, The Netherlands.Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands., and Wilbert B van den Hout.
• Department of Biomedical Data Sciences, Section of Medical Decision-Making, Leiden University Medical Center, Leiden, The Netherlands. e.k.j.van_der_poort@lumc.nl.
• J Gen Intern Med. 2024 Mar 1; 39 (4): 683689683-689.

BackgroundHealthcare organizations measure costs for business operations but do not routinely incorporate costs in decision-making on the value of care.AimProvide guidance on how to use costs in value-based healthcare (VBHC) delivery at different levels of the healthcare system.Setting And ParticipantsIntegrated practice units (IPUs) for diabetes mellitus (DM) and for acute myocardial infarction (AMI) at the Leiden University Medical Center and a collaboration of seven breast cancer IPUs of the Santeon group, all in the Netherlands.Program Description And EvaluationVBHC aims to optimize care delivery to the patient by understanding how costs relate to outcomes. At the level of shared decision-making between patient and clinician, yearly check-up consultations for DM type I were analyzed for patient-relevant costs. In benchmarking among providers, quantities of cost drivers for breast cancer care were assessed in scorecards. In continuous learning, cost-effectiveness analysis was compared with radar chart analysis to assess the value of telemonitoring in outpatient follow-up.DiscussionCosts vary among providers in healthcare, but also between provider and patient. The joint analysis of outcomes and costs using appropriate methods helps identify and optimize the aspects of care that drive desired outcomes and value.© 2023. The Author(s).

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