Value-based healthcare delivery
What is value-based healthcare delivery? It is a framework that recognizes patient values as the core driver of quality and performance improvement. In the developed world it has taken on the meaning of dealing with matters of cost and quality of care and how these can be improved.
As an aside, an interesting notion to introduce at this point that should be explored more fully elsewhere is one of ‘positive competition’ between hospitals and healthcare institutions. Value-based healthcare is of major importance, which sounds simple to implement, but those with experience of running hospitals know how difficult it is. Put simply: if you can measure patient value, then you can set negotiations with insurance companies, doctors and health administrators, toward a goal of improving health outcomes that minimizes costs while optimizing collaboration in the care cycle.
The aim is to establish a dialogue that can allow insurance companies to be able to buy optimum services from hospitals, as judged by both patients and care-providers. Therefore, the focus is on what is the value for the patient and how the value for the patient is measured in terms of the health improvement or the health outcomes, while at the same time the costs, of course, are also central to the planning.
Full cycle of care
The key to the process working at its best is basically to consider the full cycle of care, from diagnosis to discharge. While it may be true that a particular intervention, for instance, a knee or hip replacement, may be an unqualified success that does not mean that over the full cycle of care that the end result is very good for the patient or that it was cost-effective. Progress in adding value has been made in applying this concept in hip and knee replacement, in cardiology and in some types of oncology (prostate and breast).
The take-home message is: if you do not focus on measuring patient value (that is, health outcome divided by cost) in the care cycle, you are really navigating in the dark. And patient value data are derived from patient-reported outcomes measures (PROMs) that capture patient satisfaction and overall quality of care, which are discussed in more detail below.
Obviously managing the full cycle of care within a hospital is not easy: there are many barriers that impinge on good management. For example, the disempowerment of the choice of implant by the surgeon, an administrative overload, the shortage of manpower, or the lack of good structured processes. But, of course, cost pressure also plays a big role, and managing patient outcomes has an additional effect on cost and implementing new technologies to collect these data may be a solution for this problem.
Patient-reported Outcomes Measures
PROMs is a new trend in the medical field that includes patient opinion in the outcome of the medical procedures. It follows legal requirements in some countries, for instance, the UK and the Netherlands, to incorporate this information into the process, but it comes with the additional stress and strain of collating these data. A way of measuring patient-reported outcomes is to be found in the data collection tool Personal Fit PROMs. What are its compelling features and benefits?
- It is, first and foremost, designed for very easy use for the patient
- It is easy to install
- It is cost efficient compared with conventional ways (paper and pen) of collecting the data
- It follows legal requirements
- It is web based
- It enables you to register and process patient information per clinical pathway continuously, automatically, swiftly, and correctly
- It interfaces with your hospital information system, to allow easy data transfer
- It can be customized to design or adapt questionnaires to meet your needs
An example of process optimization in joint replacement in one of the largest academic hospitals in Northern Europe has shown an increase in case load of 10% and a cumulative cost saving in the operating room (OR) of €110,000, plus additional increased margins, from 50 cases.1 This is a perfect example of how to maximize patient value while reducing cost: value creation for both parties.
Time-driven-based activity costing
After in-depth analysis, it was found that the biggest cost, in an OR, for instance, was in fact the periods of time when the OR was not in use. Different approaches to the same procedure were included in the analysis. Questions asked included: When does the analysis start? When the operating procedure begins or when the surgeon arrives and starts dressing for theatre? Does cleaning up time get included, or not?
The purpose of such a costing, of considering matters of structure, allocating doctors, offering different surgical operations is to discern a better way of operating, then there may be capacity to have one or two more people in the OR per day. Increased patient turnover may save a lot of money and positively affects capacity load and may lead to a better outcome for the patient as well as for the hospital. So, per patient, the cost should go down. Per patient the profit should go up. Per patient a better overall outcome is achieved.
Accelero Health Partners Whitepaper, 2014. Accelero Identifies Perioperative Savings for European Hospital. http://accelerohealth.com/orthopedicinsights/success-stories/(accessed 27 August 2014).