Transforming care delivery in the spirit of value-based healthcare: how can a community of practice give inspiration?

29 September 2022

On 19 September 2022 in collaboration with Abbott and the UNIVANTS of Healthcare Excellence Award, we organised the webinar ‘Transforming care delivery in the spirit of value-based healthcare: how can a community of practice give inspiration?’ with a view to inspire health leaders and managers to embrace the value-based healthcare shift. The webinar featured Prof Federico Lega, Professor of Health Administration and Head of the Research Centre in Health Administration at the University of Milan, Italy and Dr Colleen Strain, Manager of Scientific Leadership and Education at Abbott, Canada.

Prof Lega outlined what value-based healthcare means and explained why it is worth to adopt value-based healthcare frameworks to sustain transformational efforts that can generate best experiences for patients and more efficient settings where professionals can deliver the best possible care. Prof Lega explained that value-based healthcare – in the definition given by Prof Michael E. Porter – is based on six components that are equally important and that only combined enable the implementation of VBHC frameworks. These principles are:

  • Structure healthcare organisations into Integrated Practice Units (IPUs). Care units should be created around specific medical conditions, cohorts or segments of patients, the so called ‘care-lines’. Organisations should not follow the typical vertical speciality silos, but horizontal structures with professionals from different specialities that can collaborate to generate the best clinical pathways.
  • Measure outcomes and costs for every patient. Instead of measuring inputs and outputs, VBHC moves from volume to outcomes measured around the single patient or the segment of patients. Measuring outcomes also requires a complete new set of Key Performance Indicators (KPIs).
  • Move to bundle payments for conditions. Once new KPIs have been established, it is possible to move to different funding systems that align behaviours to expectations, while also creating new incentives to foster vertical and horizontal integration across health systems.
  • Integrate multi-site care delivery systems. Logistics is crucial to create integration as it enables specialists and healthcare professionals to share the same spaces, to have a system to exchange structured messages and information avoiding working in silos.
  • Expand geographic reach. Developing reference networks allows to identify where is the most advanced technology or specific expertise and to refer patients where the most effective care can be provided and the best possible outcomes obtained.
  • Build an integrated information technology platform to have a good flow of information among specialists and further integration.

Prof Lega continued describing the four types of values that are generated when applying value-based healthcare frameworks:

  • Personal value which refers to ensuring that patients get the most appropriate and effective care that is outcome centred and cost conscious.
  • Technical and professional value that refers to the possibility to improve resources, practices and competences of specialists and HCPs through the development of multidisciplinary teams and VBHC guidelines.
  • Allocative value which is developed when patients can be referred to the best place where they can receive the best care and benefit from the most specialised care teams and advanced resources.
  • Societal value which implies achieving better quality of life and wellbeing for as many citizens and patients as possible.

Prof Lega then presented an aspirational agenda for health managers for the implementation of value-based healthcare frameworks. This agenda includes:

  • Paying for value: mechanisms for health service delivery that look at pay for performance, pay for outcomes, and pay for health.
  • Buying for value: procuring technologies or devices that have better impact on outcomes.
  • Right task to the right staff: rethinking ways to assign tasks to different health professionals.
  • Innovation follows value: how to reward and pay better for true innovations.
  • Design a patient-centred and robust organisation: treat patients as ‘clients’ ensuring they are treated timely, efficiently, and given the right attention.
  • Building the continuum of care
  • Improving the patient experience through co-production and co-creation
  • Team that are multidisciplinary and multi-professional.

For Prof Lega this agenda touches upon two transversal topics: firstly, the shift to outcomes and measuring what is relevant; as well as the shift from curing to preventing, managing risk factors in a different way so that prevention and not treatment becomes the focus.

Dr Colleen Strain presented the UNIVANTS of Healthcare Excellence Award program, which is a global award that looks to recognise, inspire and celebrate integrated clinical care teams who took the opportunity to measure their value and showcase their outcomes. UNIVANTS is an application-based award where applicants submit their best practices and KPIs that outline how they have unified across disciplines to do something different to provide better outcomes. The name UNIVANTS comes from UNITY – teams working across the care continuum – and VANTS for avant-garde – teams doing something novel also using laboratory data.

She shared that the successes submitted by the winners of the past 4 editions highlight how change in healthcare systems can come in any form. Among the recognised projects 25% implemented a new test method; 22.2% focused on using informatics for decision-making, and 52,8% introduced new processes. Dr Strain concluded sharing that UNIVANTS is currently accepting applications for best practices until 15 November 2022.

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