The outcomes that matter

by Yolima Cossio Gil

05 September 2018


Adopting a value-based strategy requires innovation in the traditional management system, innovation in the way things are done and innovation in the relationship with patients, professionals and commissioners and providers.

Providers play a key role in the transformation of healthcare towards a value-based system. It’s actually the place where value is delivered.

For many years, healthcare providers have tried to put the patient at the centre, while trying to keep the system efficient and sustainable at the same time. However, these multiple goals did not seem to be compatible due to budget constraints, an increase in demand, fragmented goals and a lack of change in management methods.

Value-based healthcare puts the health outcomes of individuals at the very heart of care delivery and aligns the stakeholders with the same objective, resulting in a paradigm shift of result measures and payment. This people-centred approach emphasises the delivery of health outcomes that matter to patients in a financially sustainable manner.

Providing healthcare that is focused on value for the patient in an efficient way is no longer a theoretical concept – it is a reality that is happening now in Europe.  The HFMA International Symposium on value-based healthcare – which comes to London in October for its third annual event – has showcased evidence of this transformation.

My organisation – the The Vall d'Hebron Hospital in Barcelona – is one institution that is pioneering work in this area.  Our strategy is based on the slogan ‘the patient always comes first’, because the results that matter to the patient, matter for all of us.

Adopting this value-based strategy requires innovation in the traditional management system, innovation in the way things are done and innovation in the relationship with patients, professionals and commissioners and providers.

Innovation in management and delivery requires a transformation in the existing hierarchy and in the vertical structures within medical departments. It also demands a reorganisation of care around the needs of patients with similar clinical conditions.  With new horizontal structures, the frontline professionals are the leaders and can implement solutions to improve patient outcomes.

Creating multidisciplinary teams (providing integrated care for patients with the same clinical condition and with a common goal of improving patient outcomes) has given practitioners a full care cycle perspective and makes them feel committed to the outcomes.  This has resulted in more accurate diagnoses, fewer treatment errors, lower complication rates and faster recovery and has minimised the use of non-evidence-based treatment and the duplication of tests.

Innovation in patient interactions is also a key pillar in this transformation. Patient-centred care means an end to passive patients simply receiving what the rest of the system thinks is better for them.  In Vall d’Hebron’s new model, the patient participates in the decision making of how to reorganise the process.  They consider the outcomes that matter to them, which influences the outcomes that are measured.  And they help to develop ideas about how to improve these outcomes and the experience in general.

Working on the basis that ‘the patient always comes first’ also means discussing the therapeutic options with patients and letting them share in the decision-making process.

In an innovative approach with providers and payers, we’re pursuing value-based purchasing, sharing risk based on the outcomes that matter to the patient.  This means all stakeholders are aligned with the same goal – improving outcomes for patients and reducing costs. 

Getting everybody working together – clinical teams, patients, commissioners and providers – to deliver these common goals is the best way to address current challenges in the delivery of healthcare. And it provides the best environment to support innovation across the whole system.


Dr Vicenç Martinez Ibañez, chief executive officer and Maria Gutierrez San Miguel, process engineer, nurse and clinical pathways project manager from Vall d’Hebron are speaking at the Healthcare Costing for Value Institute international symposium on 3 October. Please contact charlie.dolan@hfma.org.uk to book your place.