Value in Healthcare: Laying the Foundation for Health System Transformation
The World Bank estimates global population sizes of approximately 8.5 billion by 2030 and 9.2 billion by 2040. As recently as 2014, the United States and United Kingdom spent approximately 17.1% and 9.1% of Gross Domestic Product on healthcare related expenditures respectively. This is expected to grow in line with the increasing population at rates that will prove to be unsustainable in the medium to long term. Despite these predictions, the approach to healthcare delivery in most markets remains focused on volume and process guidelines rather than true value for patients. Value in this case is defined as the outcomes that matter to patients relative to the cost of delivering those outcomes (i.e. outcomes per dollar spent).
A fundamental recalibration of focus – from volume to value – is needed to ensure a system where the outcomes that matter to patients are prioritized. A value based approach starts by measuring outcomes that matter to a particular population segment and then using those measurements to tailor interventions for that population segment across the care pathway. Four game-changing enablers need to be in place to accelerate the shift towards a patient-centric value-driven approach:
· Informatics: Our ability to leverage the capabilities of advancing technologies to collect, analyze and reuse data to measure and compare value
· Benchmarking Research & Tools: Creating transparency for evidence-based comparisons that spur relevant innovation while also creating algorithms to assist clinician and physician decision making
· Payments: Compensation and reimbursement mechanisms that support value improvement rather than increased volume of care
· Delivery Organisations: Adapting the way providers, pharma, and medtech partner to collaborate across the care chain in pursuit of better patient outcomes
In addition to these enablers, the ability of policymakers to remove barriers to outcomes measurement, data sharing, innovative payments, cooperation along the care chain, and new business models will be crucial in ensuring a level playing field and ensuring a focus on value.
Elements of a value based approach to care delivery has shown significant success at the organizational level in institutions such as Kaiser Permanente, but all the critical enablers have never been fully implemented at the national level. With wider adoption, value-based healthcare has the potential to truly revolutionise healthcare delivery systems of the future.