Value-Based
Healthcare
Value-Based Healthcare
At its core, VBHC is about making the best use of available resources to achieve better outcomes and experiences for each patient. The ‘value’ is derived from ensuring that patients receive the best outcome from the healthcare they receive, while doing so at the most reasonable cost.
This is achieved through shared decision-making involving both patients and clinicians, and in the process - doing less of the things that don't help patients and reinvesting that money into more things that do.
VBHC aims to shift incentives for providers from delivering more treatments to delivering better treatments. These models highlight prevention and quality, seeking to enhance quality of care and reduce healthcare expenses in the long-run [1].
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Non-communicable diseases (NCDs), including cancers, are now the number one cause of death worldwide. Breast cancer is the most common cancer in the world. In 2020, 685,000 people died due to breast cancer. Surgical care is the foundation of the treatment options for most NCDs, yet five billion people do not have access to emergency and essential surgical care.
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We facilitate locally-led initiatives that promote and advance the implementation of VBHC models in low- and middle-income countries, led by frontline implementers and developed in close collaboration with ministries of health, academic institutions, industry, civil society, and most importantly, patients.
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We are implementing two pilot projects in Rwanda and Türkiye focusing on surgical care for breast cancer. A comprehensive needs assessment will take place in each country, the results of which will inform key quality improvement interventions.
The VBHC model utilises a team-based approach that is centred around patient care, allowing for more coordinated care and more easily-measured outcomes.
The VBHC model differs from the common fee-for-service model, in which healthcare providers are compensated based on the number of services or procedures delivered, by focusing on quality over quantity.
Watch here a special introduction to high-value health systems by Professor Rifat Atun.
Patient-reported outcome measures (PROMs) are integral to establishing the VBHC model.
VBHC aims to standardise healthcare processes by collecting data and evidence to determine how to achieve the best outcome for patients. PROMs provide healthcare providers with information typically only known by the patient.
Common PROMs include quality of life, symptoms, functional status, satisfaction with treatments, and adherence to treatment. Securely sharing PROMs with healthcare providers allows the patient’s data to become actionable and supports decision-making in clinical practice.
Case Studies
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OrthoChoice: Outcome based compensation system for specialised care in Sweden
OrthoChoice bundles costs for hip and knee replacements, with patients paying a total of 3% of the fee, depending on the achievement of predefined outcome quality goals. Results showed that complication rates fell by almost 40% over the 2 years after OrthoChoice introduction and per‐patient costs were reduced by 17% due to lower payments to providers.
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Narayana Health: Utilizing methodologies to optimize operations and value in India
The Narayana Health model was implemented in India, and by leveraging economies of scale, using assembly line concepts for surgery and reducing the average length of stay, was able to half the cost of surgery at its specialist cardiac centres. In addition, implementation of the model reduced 30-day mortality rates to 1·4%, compared with 1·9% in the USA.
We are working on value-based healthcare in two countries
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Türkiye
Our two projects in Türkiye explore the barriers to early screening of breast cancer, the factors contributing to delays in diagnosis and treatment, and their effects on patient-reported outcomes.
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Rwanda
Our three projects in Rwanda aim to gather data on breast cancer surgical outcomes, evaluate gaps in general surgical training related to breast cancer, and understand stigma related to breast cancer.