2. Redesigning the Healthcare System
A prerequisite: Integrated Care
One model that focuses on value is the Integrated Care framework. This model aims to switch from fragmented care within and between sectors to coordinated services in which all care providers are involved in patient journey [18].
A good summary of what integrated care means is: “to bring together inputs, delivery, management and organisation of services as a means [of] improving access, quality, user satisfaction and efficiency.” [19] Additionally, the WHO perceives integrated care as offering a patient-centric holistic approach to patients’ needs.
The central idea of integrated care is the “Triple Aim”, which focuses on “improving patient outcomes, enhancing patient care experience and cost reduction” [20]. This shift in focus set up the foundations for the development of the Value-based Healthcare concept.
Introducing Value-based Healthcare
According to the value-based healthcare philosophy, the overarching goal of healthcare should be to deliver value that can be translated into meaningful outcomes for patients [21]. Multiple studies present the Value-based Healthcare (VBHC) model as a chance to redesign healthcare systems by focusing on patient outcomes while containing costs. For example, the World Economic Forum defines VBHC as “a patient-centric care delivery model designed to optimize value for patients”. [22]
Need for standardised outcomes
It is only possible to measure and compare outcomes worldwide if they are standardized. A non-profit organization was created with the purpose of developing such standards: the International Consortium for Health Outcomes Measurement (ICHOM) [28]. They have already curated several standard sets for different diseases.
A model to reduce costs
By focusing on measuring the results of a treatment from the patient’s perspective, it is possible to reduce costs since only those procedures that add value will take place. The Economist Intelligence Unit perceives the VBHC model as a valid approach to cut costs wherever healthcare costs are going up [29].
[18] Nolte E, Pitchforth E. What is the evidence on the economic impacts of integrated care? Copenhagen: WHO Publications; 2014.
[19] Groene, Oliver & Garcia-Barbero, M. (2001). Integrated care: a position paper of the WHO European Office for Integrated Health Care Services. International journal of integrated care. 1. e21.
[20] Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health affairs. 2008; 27(3):759-69.
[21] Kaplan RS, Porter ME. How to solve the cost crisis in health care. Harv Bus Rev. 2011; 89(9):46-52.
[22] Coalition for Value in healthcare. Laying the foundation for Health System Transformation. Switzerland: World Economic Forum; 2017.
[23] Michael P, Porter M. What is Value in Healthcare. New England Journal of Medicine, OBIO KANADA. 2010.
[24] Porter ME, Teisberg EO. Redefining health care: creating value-based competition on results: Harvard business press; 2006.
[25] Bradley EH, Canavan M, Rogan E, Talbert-Slagle K, Ndumele C, Taylor L, et al. Variation in health outcomes: the role of spending on social services, public health, and health care, 2000–09. Health Affairs. 2016;35(5):760-8.
[26] Kaplan B. Use Better Measurement of Costs and Outcomes to Align the Healthcare System around value: Master Class for Healthcare Costing for Value Institute Conference Healthcare Costing for Value Institute 2015 April
[27] Medicare Hospital Compare: Myocardial Ischaemia National Audit Project. London. 2019.
[28] Academy of Medical Royal Colleges and NHS Confederation. Decisions of Value [Internet]. United Kingdom: Academy of Medical Royal Colleges; 2014. [cited 15 Apr 2020] Available from: www.aomrc.org.uk/reports-guidance/decisions-of-value-1014/
[29] Shah A. Value-based health care, a global assessment. The Economist Intelligence Unit; 2016.
Please find all references here.