What is the role of prevention in value-based care? Is it playing enough of a role?
AJ: Preventative care can help to reduce demand – but prevention is not free and does require investment. Given the incentive structure of many health systems built around fee for service models, there isn’t enough incentive to invest in preventative healthcare.
Insurance-based systems like Germany or the Netherlands are better incentivised to invest in preventing ill-health and keeping people healthy to reduce costs of care.
Taking a longer term view on what a provider is paid to deliver can help. Preventative healthcare measures may only start demonstrating their value over 5-10 years. Commissioning cycles need to reflect this – single year cycles just aren’t equipped to deliver these kind of preventative population level results.
What advice do you have for stakeholders in other countries aiming to adopt this approach?
AJ: Start with a clear understanding of what the system is trying to achieve and to whom you are ultimately accountable and what are you holding yourself accountable for. Accountability is where outcomes come into play – are they process outcomes, population outcomes, patient outcomes? Then layered across all of that is good resource (finance, time, space) stewardship. In Decisions with Value we are putting together a conceptual framework that cuts across whatever systems and processes are currently in vogue to focus on what is eternal in healthcare – patients and their clinical conditions/needs.
What learnings did you draw from participating in Decisions with Value?
AJ: A sense of hope, as there are so many fantastic people. Talking with the fellow steering group members working on projects as diverse as COPD services and eating disorder interventions it is consistent that it can take 2-3 years to get a good initiative off the ground.
These are the heroes of the healthcare system who are going above and beyond to get these things done. It really needs a proactive nature and the sense of responsibility to put patients at the heart to make these value-based approaches happen. These people aren’t waiting for opportunities to arrive – they are going out and creating their own opportunities because they are holding themselves accountable to the patients and populations they serve.
There are people like this across Europe. We did a value based healthcare congress in Germany in 2016 and we are working with the HPI Potsdam to help design thinking around healthcare innovation. In Italy we are working with the National Institutes of Health there on value-based healthcare. In Netherlands and Madrid we are working with universities on value-based approaches to clinical genetics. Decisions with Value will find an eager audience across the continent – the appetite for this thinking and approach is already there.
Quality and evidence-based medicine took a long time to get off the ground but is now everyday practice. The more we do, the quicker we will deliver value-based healthcare so I am hopeful that the momentum is building.
Ultimately, value-based healthcare is common sense – why wouldn’t we want to improve outcomes and optimise resource use?