Giger Odile-Florence, Fleisch Elgar, Jovanova Mia, Kowatsch Tobias
Centre for Digital Health Interventions (CDHI), Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland.
Department of Management, Technology, and Economics, ETH Zurich, St. Gallen, Switzerland.
Digit Health. 2025 May 6;11:20552076251336322. doi: 10.1177/20552076251336322. eCollection 2025 Jan-Dec.
Global spending on diabetes care soared to $966 billion in 2021, a 316% surge over the past 15 years. This sharp increase underscores a need for more efficient and cost-effective care strategies. Value-based care (VBC), which prioritizes patient outcomes while controlling expenses, presents a promising solution. However, its real-world implementation remains challenging, particularly in diabetes care. This study examines SwissDiabeter, a proposed diabetes clinic initiative in Switzerland inspired by a Dutch VBC-based Diabeter clinic. We examine key barriers and facilitators during Diabeter's implementation in the Netherlands and assess forthcoming challenges and enablers for SwissDiabeter in Switzerland.
We employ a deep, extensive embedded single-case design conducting 27 interviews with healthcare professionals, insurers, and patient groups in Switzerland and the Netherlands. The main interview data were complemented by various secondary sources to enhance contextual comprehension, widen perspectives, and validate findings.
We identify four key factors for successful VBC adoption: leadership in driving change, financial restructuring, operational improvements, and enabling digital technologies. We next derive practical recommendations to guide the implementation of value-based diabetes care, redesigning financial incentives for healthcare providers, partnering up with key stakeholders such as insurers or policy makers, and measuring outcomes on a voluntary and anonymous basis.
This study enhances the global discourse on VBC by analyzing key barriers and facilitators in implementing SwissDiabeter, drawing insights from the Diabeter model in the Netherlands. Our findings highlight the need for strong leadership, financial incentives, digital infrastructure, and interdisciplinary collaboration to drive outcome-driven care. Beyond diabetes, these insights provide a framework for scaling VBC across chronic disease management, promoting cost-effective, high-quality healthcare.
2021年全球糖尿病护理支出激增至9660亿美元，在过去15年里激增了316%。这一急剧增长凸显了对更高效且具成本效益的护理策略的需求。基于价值的护理（VBC）在控制费用的同时将患者结局置于优先地位，是一个颇具前景的解决方案。然而，其在现实世界中的实施仍然具有挑战性，尤其是在糖尿病护理领域。本研究考察了瑞士糖尿病计划（SwissDiabeter），这是瑞士一项受荷兰基于VBC的糖尿病诊所启发而提出的糖尿病诊所倡议。我们研究了糖尿病计划在荷兰实施过程中的关键障碍和促进因素，并评估瑞士糖尿病计划在瑞士即将面临的挑战和推动因素。
我们采用深入、广泛的嵌入式单案例设计，对瑞士和荷兰的医疗保健专业人员、保险公司及患者群体进行了27次访谈。主要访谈数据辅以各种二手资料，以增强背景理解、拓宽视野并验证研究结果。
我们确定了成功采用VBC的四个关键因素：推动变革的领导力、财务重组、运营改进以及支持性数字技术。接下来，我们得出实用建议，以指导基于价值的糖尿病护理的实施，重新设计针对医疗保健提供者的财务激励措施，与保险公司或政策制定者等关键利益相关者合作，并在自愿和匿名的基础上衡量结果。
本研究通过分析实施瑞士糖尿病计划中的关键障碍和促进因素，借鉴荷兰糖尿病计划的经验，丰富了关于VBC的全球讨论。我们的研究结果强调了强大的领导力、财务激励、数字基础设施以及跨学科合作对于推动以结果为导向的护理的必要性。除糖尿病外，这些见解为在慢性疾病管理中推广VBC提供了一个框架，以促进具成本效益的高质量医疗保健。
