Article

Making an impact with value-based healthcare

Making an impact with value-based healthcare

01.11.2021

With healthcare costs continuing to rise, traditional volume-based systems urgently need to be replaced with patient-centric, outcomes-focused value-based healthcare (VBHC). By working with all stakeholders – including physicians, payers, providers, patients, industry partners, policymakers and governmental healthcare bodies – the adoption of VBHC will lead to a more globally sustainable and healthier population.

“The ambition of VBHC is to provide patients with a holistic care programme that includes consultation, diagnostics and treatments personalised for the patient. Physicians would be compensated not on specific services but on positive health outcomes,” said Cindy Perettie, Head of Molecular Lab, Customer Area, Roche Diagnostics.

What is VBHC trying to solve?

 

Rising cost puts systems under severe pressure while not necessarily achieving expected patient outcomes.

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Cost1

Aging populations have increasing healthcare needs

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Healthcare expenditure is growing at more than twice the rate of GDP*.

*GDP: Gross Domestic Product

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Expenditure2 - Outcome

No strong correlation of health expenditure with outcomes

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Top 2 spending OECD** countries are spread across top 30 in life expenctancy.

**OECD: Organisation for Economic Co-operation and development

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Variation3 in outcome

Significant variation in healthcare outcomes between and within country.

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In the US, patients in poorest performing hospitals are 13x more likely to experience complications.

Ageing populations worldwide contribute significantly to increasing healthcare expenditures. But in some cases, this increase in spending does not correlate with the hoped-for benefits.4 Shifting towards a reward system that incentivises and incorporates sustainable innovation will help surmount accessibility and standardization issues, optimise costs and bring greater patient benefits.

The success of this shift depends on understanding patient needs and engaging in shared decision-making. In return, this could transform the current healthcare system, which has commonly been a “fee-for-service” approach, into an outcomes-based incentive approach.

 

VBHC brings value for all HC system stakeholders

Patients

Improvements in health outcomes that matter to them as well as lower costs - avoid therapies unlikely to benefit them, get care from clinicians/teams with better outcomes.

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Payers

Better "value for money" as patient relevant outcomes and savings are delivered due to more effective use of resources, avoiding low value care.

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Patient and HCP

Providerss

Better evidence to guide treatment choices, organized care around patients, higher patient satisfaction and greater effeciencies.

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Industry

Rewarded for solutions that improve outcomes - opportunity to differentiate from competitors as a partner for HC ecosystem, drive synergies with other business models and become more patient-centric.

Organisations such as the International Consortium for Health Outcomes Measurement (ICHOM) are pushing for ways to identify what matters most to patients, helping to standardise protocols globally. To define health outcomes for a specific condition, the ICHOM team’s approach is to include patient representatives who have been treated for the condition or have cared for someone who has lived with the disease and then bring together specialised physicians who are treating it. The ICHOM team facilitates as physicians and patients discuss and align on the most important care objectives.5

 

VBHC and diagnostics

 

A key element in VBHC is understanding the role of diagnostics in preventing diseases. While medicines are critical to improving people’s lives when they are sick, diagnostics contribute to helping patients remain healthy, avoiding the need for treatment and reducing overall healthcare costs. Screening programmes, for example, can detect early changes in the body and indicate those who need more careful follow-up to keep the disease from developing. Additionally, diagnostics have enabled providers to improve care for patients, aiding in reliable, clinically-informed decision-making that helps them determine how best to treat their patients.

Tellingly, while 66% of clinical-based decisions are made using in vitro diagnostics (IVDs), they account for only 2% of total healthcare spending.6 IVDs are valuable, relatively-low cost tools with minimal risk to patients that can provide critical information on disease progression and personalised treatment options. They can also help lead to reductions in future compounding healthcare costs for patients.

“We at Roche understand the importance of VBHC and the value diagnostics provide to positively impact patient outcomes. More specifically, VBHC can affect the many touchpoints along the patient journey through the healthcare system from screening to early detection, diagnosis, treatment management and monitoring,” reflected Wolfgang Mueller, Leader of the Roche Diagnostics Value-Based Healthcare Initiative.

 

Implementing patient-centric solutions through partnerships

 

Roche is committed to improving the outcomes that matter most to patients across the entire care continuum.

"The increasing focus and importance of VBHC present a unique opportunity for industry to strengthen collaborations with healthcare systems around a joint vision of improving patient outcomes and system efficiency," said Etienne Lainé, Global Value Based Healthcare Lead, Roche Pharmaceuticals. "We are combining our expertise in pharmaceuticals, diagnostics and personalised healthcare through partnerships aimed at improving the full care pathways and delivering on the promise of VBHC."

Collaborating with all partners within the healthcare hierarchy and moving away from the conventional “fee-for-service” reimbursement model can provide patients with better care and improve results. 

VBHC focuses on results first and costs second. This means that if care both improves outcomes and increases costs, this would still be a win. The cost of care must be evaluated along the entire patient journey, and reimbursement should be aligned with the measurable impact(s) on patient(s), not services provided.

Healthcare providers are leading the way in VBHC implementation and have adopted several steps to help ensure success:7

  • Focus on what matters most to patients
  • Employ standardisation 
  • Invest in informatics systems to capture results
  • Establish outcome-centred incentives and reimbursement

“Integrating care through partnerships with our most important stakeholders to define value-based needs is key in our progress towards more preventative healthcare and to reduce resource spending,” commented Cindy Perettie. 

Defining outcomes early and implementing new reimbursement models for VBHC will ultimately lead to better care for patients and long-term financial rewards for those providing that care. Patient and caregiver partnerships are an important element to help ensure that patients have the right information and level of understanding around diagnosis and diagnostics.

At Roche, we believe that patient-centred VBHC will lead to better use of healthcare resources, increased access to diagnostics and treatment, greater sustainability and most importantly, improved outcomes for patients and society as a whole. 

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References

  1. Organisation for Economic Co-operation and Development (OECD). https://www.oecd.org/els/health-system [Accessed August 2021]
  2. OECD. https://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_STAT [Accessed August 2021]
  3. World Economic Forum. http://www3.weforum.org/docs/WEF_Insight_Report_Value_Healthcare_Laying_Foundation.pdf [Accessed August 2021]
  4. Tikkanen R & Abrams MK. The Commonwealth Fund. U.S. Health Care from a Global Perspective, 2019: Higher Spending, Worse Outcomes? January 2020. Available at https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019 [Accessed August 2021]
  5. International Consortium for Health Outcomes Measurement (ICHOM). https://www.ichom.org/standard-sets/#methodology [Accessed September 2021]
  6. Rohr UP, Binder C, Dieterle T, et al. The Value of In Vitro Diagnostic Testing in Medical Practice: A Status Report [published correction appears in PLoS One. 2016;11(4):e0154008]. PLoS One. 2016;11(3):e0149856. Published 2016 Mar 4. doi:10.1371/journal.pone.0149856
  7. Akerman, C. (2020). Healthcare Transformers. Value-based health care: Why patient outcomes are the true north to achieve high-value care. Article available at https://healthcaretransformers.com/patient-experience/value-based-healthcare-delivery/   [Accessed August 2021]