Making an impact with value-based healthcare

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.

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

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.