What is value-based healthcare?
Value-based healthcare (VBH) is a concept that has been around for quite some time now, and one which is being increasingly adopted in the healthcare industry. It is a way of thinking about the process of care and health. What is value? And how does it relate to quality of health?
Value-based health is centered around three core propositions:
- Value can be measured in financial terms and capitalized into financial accounts.
- Value can be measured in terms of quality (or outcomes), by considering patient satisfaction and satisfaction with care.
- Value can be measured in terms of access to care, by considering population size, accessibility, cost, and availability.
The first two propositions aim to align economic value with individual value, using measures like price per unit or cost per person. The third proposition aims to align social value with individual value, using measures like access to care or patient satisfaction.
The idea behind VBH is that there are three kinds of value included in healthcare: economic (allowing for price per unit), social (allowing for access to care or population size), and human (allowing for patient satisfaction or satisfaction with care).
This may seem counterintuitive but the reason it works so well as a framework for thinking about the holistic well-being of individuals should not be lost on you if you try hard enough! It’s also worth noting that VBH seeks to avoid dividing up the world into two groups; instead creating a single category which encompasses all two pieces as follows:
- Accessible/affordable health care services at affordable cost
- Quality = Access = Affordability = Safety = Quality = Non-discrimination…and so forth…and so forth… And this category would encompass any kind of system capable of delivering those goods (e.g., mobile phones, internet connection etc.). Finally note that we don’t want people making decisions based on one piece alone
The benefits of value-based healthcare
Value-based healthcare is the equitable, sustainable and transparent use of the available resources to achieve better outcomes and experiences for every person. Value-based healthcare is based on value, not price alone. Value is the intangible element that grows with time and experience in a relationship between value and service. The value of healthcare is based on an emotional connection between patient and physician.
It doesn’t matter if you are a pharma company or an app that helps people get a checkup at their local pharmacy: you have to be able to somehow measure the emotional connection between patient and physician because that’s all there is to the equation . If you can’t measure it, then there’s something wrong with your product! As for anything else related to your product, it has to do something: – It has to be useful – it has to make the lives of people better – it has to improve their quality of life – it has to be fair…if you don’t measure these things then you have no idea what your product is doing or how it can be improved.
And so, while I think we can all agree on some basic principles in healthcare (and I think we should!), we also need tools which help us understand how our products can actually improve patients’ lives: metrics!
We need metrics for everything, from software, from hospitals, from health plans, because all of them can only work if they are measured. And metrics are not hard to come by for those who know what they are and where they should be measured (I do!). But metrics are hard work, so there needs to be a good reason why anyone would want them in any case.
That said, I believe one of the most important things patients could do for their doctor would be to tell him or her what they think he or she should accomplish with his or her time at hand: spending money on a doctor who doesn’t really care? Paying more than necessary? Forcing someone into work when they shouldn’t be? Spending more time than necessary because somebody else was sicker than expected? You get my point.
How to achieve value-based healthcare
The first thing to understand is the problem. The biggest problem with the healthcare system is that it’s a muddle. It’s very hard to separate the costs of different services, and doctors are often reluctant to do so because they have to work under the assumption that they are all best at whatever they do.
In order to start evolving medicine into a value-based healthcare system, there has been a growing demand for ways in which providers and patients can better understand what these costs are, so that they can make better decisions about what is right for them (and their bodies) and how best to provide solutions.
The difficulties in this transition don’t come from lack of knowledge, both patients and providers will need more info about costs if it helps them make better decisions, but from a lack of trust. As things stand, doctors aren’t able to communicate effectively with patients and patients aren’t able to communicate directly with their doctors. All of this needs fixing . Ideally, we want both of these channels (patients/providers) communicating with each other as well as doctors communicating with patients via technologies such as apps/enterprise software. Value-based care would be underpinned by communication between these and between patients and providers (or between physicians).
Challenges to implementing value-based healthcare
One of the biggest challenges to implementing value-based healthcare is defining value. How much do we actually know? How do we define what a ‘value’ is?
I think it is a bit over-simplified to say that the debate on healthcare reform is primarily ideological. The most important issue has been framed as an economic debate, with many competing economic models and concepts of value used to justify them. This means that there are two very distinct things happening at once:
At one level, there are mainly doctors (who tend to be professional economists) who try to come up with numbers that can be reliably applied to our economy. And then there are mostly consumers (who tend to be native economists) who try to come up with numbers that can be reliably applied to their lives.
An interplay evolves between them: for example, the doctor might say that X number of people are uninsured because their employer won’t cover them (one way of framing this would be as a cost problem), whereas some people might say that X number of people have given up because they don’t want or need health insurance or they already have it but only take out coverage when they visit their doctor (one way of framing this would be as a quality problem).
The point here is not so much that these two sides have different answers, but rather that they both use different sets of numbers which act as metrics for how well health insurance works for each individual. Since there are many different metrics which could be used and since each metric has its own set of assumptions about how things work (e.g., cost vs quality, risk pool vs individual contribution), it can lead us into an infinite regress where no one knows what works and no one knows what doesn’t work, or even whether it does or doesn’t work!
Value-Based Healthcare: 7 Recommendations Every Healthcare Company Should Follow
- A common terminology is needed so that patients, caregivers and other healthcare professionals can have a shared understanding of what value-based healthcare is
- As the world becomes increasingly connected, information about healthcare disparities is shared more easily and promptly than ever. But to effectively respond to this changing environment, we must identify the source of varying values in healthcare.
- Recognize barriers to implementing value-based healthcare at the individual, team and organisational level, understand what it takes to overcome these barriers, and learn how to incorporate value-based healthcare strategies into your practice.
- Building capacity and capability is hard. At the same time, it’s essential to effectively translate the best available research evidence into effective action to generate value and improve health outcomes.
- Achieving high levels of patient experience, resource utilization and outcomes is challenging; transform your organization into a value-based healthcare organization with strategies to fundamentally change the way care is delivered.
- Monitoring and evaluation is essential to ensure that programmes deliver their intended results, that they are sustainable and scalable over time, and that they improve the lives of women and girls. Monitoring and evaluation help to identify challenges or barriers along the way, which can then be addressed to increase the impact of your organisation’s work.
- Conceive and implement a communication plan to share what works on the local and national level to patients and clinicians.
The future of value-based healthcare
What does value-based healthcare (VBL) mean? Clearly, it is about clinical outcomes and costs. It is also about quality of care, which is a much more subjective concept. And it is about the difference in how we define health as well as the way we quantify it. How do you measure health? How do you know whether someone “has” or “doesn’t have” a disease? Is a patient “healthy” if they are feeling well and doing well, or are they just “feeling well”?
In short: what do we value when measuring outcomes and cost-effectiveness? What do we value when measuring quality of care? How can these be reconciled with one another? And what impact would these differences have on how we fund health care systems in the future?
There are some important implications from thinking of VBL as a set of value propositions that need to be addressed:
- When defining VBL, there needs to be a place for equity and inclusive healthcare. As long as it was not explicitly included in any of the existing values (e.g., being able to afford one’s own insurance coverage), there would be no way to make value-based healthcare work in practice.
- The definition of VBL has to accommodate conflicts between different types of healthcare providers (primary care physicians vs specialists). Care for certain patients may require an array of inputs from many specialists, whereas other patients may require only one specialist at most. The needs and interests of patients should be considered carefully when designing VBL standards and establishing ways to accommodate them across providers.
- Value-based healthcareneeds to work with other human rights including access to medicines (and complementary medications), education, information, support systems, etc.. Finding ways to reconcile all these issues will be important in making VBL work on a large scale over time. That said though: they must not interfere with each other any more than possible — too much complexity here causes problems for implementation (for example, shortening list lengths so that everyone has the same number could make things hard for physicians who want specialization).
There must also not get in the way of people being able to take advantage of basic human rights such as access to safe water or safe food; but protecting these rights should also depend on ensuring access by ensuring that all people have access to basic healthcare services regardless of where they live or their ability or willingness/interests in participating in such activities
I was inspired bt CEBM’s article. Contact us for more relevant details about value-based healthcare. To find out more about how we can help you with your Digital Healthcare Transformation, Healthcare organizational growth, or Healthcare brand positioning, please get in touch via phone +44 (0) 203 3620421 or via e-mail: info@digitalsalutem.com
