Placement: Partners Healthcare
Mentor: Gregg Meyer, M.D. (Chief Clinical Officer, Partners Healthcare)
Co-Mentor: Ashish Jha, M.D. (Director, Harvard Global Health Institute and K.T. Li Professor of International Health and Health Policy, Harvard T.H. Chan School of Public Health)
Project Title: A Cross-country Mixed Method Approach to Understand Differences in Characteristics and Health Care Use of High-Cost, High-Need Patients
Marit Tanke, M.D., Ph.D., is a 2016-17 Dutch Harkness/VWS Fellow in Health Care Policy and Practice. She currently serves as deputy chief of the Celsus Academy of Sustainable Health Care, a collaboration of the VWS Dutch Ministry of Health, Welfare and Sport and Radboud University Medical Center Nijmegen. Her research portfolio includes outcome measurement and value-based purchasing strategies, health policy, healthcare reform, reimbursement design, and large-scale healthcare transformations. Tanke is also responsible for Celsus’ educational program. In this role, she has co-developed an interactive online master course on ‘value’ in health care for medical specialists and residents; an intensive seminar on sustainable health care systems for the National Academy, a training institution for the Dutch ministries; as well as several conferences. Tanke founded the coassistentmonitor (internmonitor), a web-based tool to promote leadership and improve feedback culture in hospitals. From 2010-2015, she was a Manager at KPMG Healthcare NL and the KPMG Global Center of Excellence, where she worked on a number of large-scale initiatives, including the development of a nation-wide program on outcome based measurements using Patient-Reported Outcome Measures. She was member of the Dutch National ThinkTank in 2008 and worked at the pediatric department of the Haga-hospital in The Hague. Tanke received a medical degree, as well as a Ph.D. in biological psychiatry in a joint program at the University Medical Center Groningen.
Five percent of patients make up approximately 50 percent of all health care costs. These high-cost patients often suffer from a combination of multiple physical, behavioral and social problems, and their needs are not effectively addressed by the traditional organization of health care. Both patients and providers feel that the care process is chaotic and wasteful, often resulting in low-quality care and unnecessary costs. Strategies to redesign care to better meet the needs of high-cost patients and increase value is, therefore, high on the policy agenda in many countries, though there remains a lack of clarity about what care is modifiable, which patients to target, and what policies should be prioritized.
Cross-national comparisons offer a valuable tool to evaluate the performance of health care systems on a specific topic, prioritize policies, and promote learning. Through this mixed method study, a cross-national examination of the characteristics and health care utilization of high cost-patients in Massachusetts and the Netherlands will be performed. These locations have different ways of organizing health care, including differing integration between acute care, long term care and social services, and varying administrative structures. This study will use administrative (claims) data to assess differences and similarities among high-cost patients. The results will be interpreted using qualitative information from document research and interviews, to help determine the underlying causes of the observed differences and inform potential interventions to improve care and reduce costs.
Harkness Related Publications:
M. Tanke and T. Lee. “Going Dutch: Using Social Capital in Health Care,” NEJM Catalyst. 2017.