Driving Towards Value-Based Care

Tim Morris, VP Go-to-Market for Elsevier Clinical Solutions

What is value-based care and why is it important?

The concept of value-based care is not new, however, it has come to the forefront of healthcare systems globally in recent years. The value-based care model rewards healthcare providers with incentives based on the quality of care they provide to patients and has been shown to improve healthcare outcomes and cost efficiencies.

Healthcare delivery is at a crossroads. In many circumstances, costs are rising but are not necessarily leading to a higher quality of care. As healthcare providers look ahead, they need to prioritise a broader shift from treating a condition, to solving a patient’s health needs.

Has COVID-19 impacted the transition to value-based healthcare?

COVID-19 undoubtedly had a huge impact on healthcare systems globally and affected performance in regard to value-based practice. Many patients fell behind on care, avoiding visiting their healthcare professional (HCP), which added significant risk to those with pre-existing conditions. In tandem, inpatient numbers increased at overwhelming rates, and cancer screenings and elective surgeries were delayed.

The disruption caused by COVID-19 has accelerated the focus on costs, equity of access to care and the need to reduce variability in healthcare outcomes. This has prompted healthcare leaders and policymakers to rethink how care is delivered to improve patient outcomes in the most cost-effective way.

The key learnings from the COVID-19 pandemic are aligned with the transition to value-based care and include the need for:

• Transparent measurements of key outcomes
• More robust IT systems, benchmarking, and research tools
• The delivery of digital healthcare
• Increased use of digital tools

What are the main barriers preventing the adoption and implementation of value-based care and how can healthcare organisations overcome them?

While the value-based care model is gaining momentum, there are still several implementation barriers such as fragmentation of care delivery, lack of measurement of outcomes, interoperability challenges and lack of resources.

Globally, the traditional fee-for-service reimbursement model has been most commonly used in recent years. Through this model, healthcare providers charge based on the number of appointments supplied, treatments administered, tests ordered, and prescriptions given. This has resulted in many healthcare providers placing an emphasis on rewarding volume over value, focusing on the number of services they can provide to their patients rather than improving outcomes.

In such cases, value-based care, which reimburses based on the quality of care provided and patient outcomes, is often harder to implement as clinicians may not see the overall value of the patient outcome. Clinicians may view the shift to value-based care as a loss of income. This results in a division between healthcare providers wanting to move to value-based care, and healthcare professionals being unable to see the immediate benefit.

Providing access to outcomes data will help to overcome these barriers. A key step in the implementation and evolution of value-based health care is the identification of the outcomes that define value for a specific population. Strengthening the orientation of healthcare systems for the provision of value-based healthcare by linking payments to outcomes, rather than care processes, will help to drive transformation.

Outline the importance of taking a patient-centric approach to value-based care

Implementing a value-based care model with a patient-centric view is not just about reducing the cost of care for the patient, but also using an evidence-based approach to improve healthcare outcomes. If you’re only reducing cost, using that to improve patient value is not necessarily the same thing.

It’s essential to always put the patient front and centre when driving transformation. Healthcare providers must shift away from thinking of the patient as a customer as treating patients with the most expensive drug, does not always lead to the best outcomes.

Why should healthcare providers adopt an interdisciplinary approach to value-based care?

Value-based healthcare implementation and effectiveness can benefit from an interdisciplinary collaboration between healthcare, management, and extended venues of care. This combines the knowledge and experience of the clinician within the hospital, primary care healthcare professionals, nurses in the community and the patient themselves.

Interdisciplinary care aligns with how patients experience their health and empowers them to contribute to decision-making. Improved collaboration can lead to improved patient care as it encourages HCPs to think differently about their roles within the larger care team and about the services that the team provides, facilitating a more holistic approach to care.

Measuring the associated healthcare outcomes across all healthcare elements will help to drive ongoing improvements. Unless healthcare providers look at the cost across all areas of care delivery, they will not fully understand the total cost of care.