Value-based care: A value proposition for patients, providers, and payors
A culture of continuous learning and improvisation, along with support from the highest levels of governance, will be necessary to establish fully value-based care. It is a long journey, but a well-developed VBC system can benefit all stakeholders by keeping the population healthy at lower costs
Value-based healthcare (VBC) is gaining increasing attention. Against the backdrop of rising global health expenditure (11 percent of the global GDP in 2020) and pressure on improving cost-efficiency, VBC offers a patient-centric solution for re-organising healthcare. Simply put, it maximises health outcomes most important to patients while controlling costs. Stakeholders in the health system have different perceptions of value based on their prioritisation of costs and benefits. Understanding the components of a VBC model and its advantages will help align the stakeholders and prepare them for the imminent transition.
For payors, key objectives include:
- Controlling costs.
- Detecting fraudulent claims and improving processing times.
- Customising health plans for better reach and services.
- Promoting preventive health.
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For patients, cost, access, quality, and experience, are deciding factors when it comes to healthcare. A VBC model incorporates patient perspectives, clinical outcomes, and overall cost considerations to achieve the best possible care. VBC strives to measure well-being and quality of life as perceived by the patient, along with patient experience across the care cycle. However, balancing patient perception with actual clinical outcomes is essential to avoid adverse health consequences. Engaging the patient, family, and community is another important aspect of value-based care, as it allows care continuity outside of a hospital setting. When patients, family members, and other caregivers in the community are provided with basic caregiving training and health management skills, it helps improve patient outcomes. This model seems to be gaining ground in low- and middle-income countries where access to health services and resources can be constrained. In addition to health improvement, such models address patient needs and experiences while reducing associated costs.
Value-based care focuses on patient centricity by emphasising physical and mental well-being, preventive and integrated care, care continuum outside hospital settings, and evidence-based practices. These components of healthcare delivery are widely discussed but not fully implemented. VBC assimilates them into a framework with the patient at the centre and costs as the yardstick. It also brings all the stakeholders back to the table with a single focus—value to the patient, while delivering benefits for the broader health system.
The move to a value-based system is a gradual process. Healthcare providers have experimented with different components of value-based care, but implementation at a health system level (national level) is another task. Also, the successful implementation of a VBC model in any type of healthcare setting will require participation from all stakeholders. Patient, provider, and payor alignment is just the starting point. Implementation of VBC at a system level would be highly contextual, and some key strategies to get started would include identifying population segments and disease areas that would benefit most from a VBC approach; identifying and agreeing to care goals; standardising care protocols; measuring outcomes and costs; integrating care and using ICT; identifying payment models (capitation/bundled); data for benchmarking and improvement. As the transition progresses, a culture of continuous learning and improvisation, along with support from the highest levels of governance, will be necessary to establish fully value-based care. It is a long journey, but a well-developed VBC system can benefit all stakeholders by keeping the population healthy at lower costs.
Ashish Sachdeva, Research Director & Adjunct Assistant Professor, Max Institute of Healthcare Management, Indian School of Business
Shivani Tyagi, Research Analyst, Max Institute of Healthcare Management, Indian School of Business
Last Updated :
August 03, 23 04:15:46 PM IST