Value-based healthcare (VBH) is a healthcare delivery model in which providers are rewarded for helping patients improve their health, reduce the effects and incidence of chronic disease, and live healthier lives in an evidence-based way.
Value-based care differs from a fee-for-service or capitated approach. The ‘value’ in value-based healthcare is derived from measuring health outcomes against the cost of delivering the outcomes.
Value-based healthcare is a framework that encourages healthcare providers to focus on quality of care than quantity. The value in such a model is derived from measuring health outcomes against the cost of delivering the outcomes. The providers’ rewards are linked to patient health outcomes using evidence-based approach, where outcomes may be better overall health, reduced adverse effects or prevention of chronic diseases.
The fundamental principle is ‘pay-per-outcome’, rather than ‘pay-per-pill’. Value-based pricing is determining the price of a therapeutic intervention based on the therapeutic value (TV), including its effectiveness, and health outcomes. Value beyond clinical and economic outcomes may also be included, such as equity, quality of life for caregivers, or better patient adherence. The therapeutic value, and value-based pricing is determined in comparison with other available treatment options.
Two main barriers to adopting and implementing VBH are fragmented delivery of care by specialty, and disconnected data systems. Institutions could overcome these by looking to set up integrated practice units around disease conditions and have well connected data systems that are not siloed and can interact with each other seamlessly – this means having a good technology platform that ensures up-to-date patient data are readily available to all healthcare providers enabling them to make well-informed decisions keeping patient health at the core.
Physicians/providers possibly have the biggest role to play in VBH, but for the system to be successful every stakeholder needs to contribute including patients, employers, insurers, governments/policy makers.
For VBH to work, all stakeholders need to be in alignment to ensure a collaborative promotion of the concept of health system value – this is easier said than done. But if accomplished, it has something for everyone: would help systems become efficient, remove unnecessary costs, and ultimately lead to patients spending less time in hospitals and being healthier. This in turn will result in patient loyalty, patients would want to return to a set-up that brings value and is coordinated. From the payer’s perspective too, it would lower the risks, as such systems inherently would try to reduce errors, re-hospitalizations, and incorrect/inefficient treatments and procedures, thereby improving cost-efficiency. From the manufacture’s perspective, it would mean a fair price for the drug by alignment of prices with patient outcomes.
Since VBH keeps patients’ health at the core of everything, it ensures providers and system work in an integrated manner, striving for better overall health of patients at all times. This inherently reduces errors and incorrect treatments thereby lowering the chances of complications and negligence.
Availability of complete and up-to-date patient data is key for providers to come up with the most appropriate treatment regimen. The data need to flow seamlessly within the system, should not be siloed, and should be easy to enter and track. Investing in a good technology platform that enables interaction and integration of data across departments and locations could tremendously improve data availability at the individual and institutional level, and ensure a successful VBH set-up.
Actu-Real offers solutions and services to help payers, providers and pharmaceutical companies optimize objectives of access, quality and cost of healthcare, with the backbone of a fit-for-purpose, all-in-one technology platform for data integration, advanced analytics, reporting and visualization.