The practical application of value

by Catherine Mitchell

18 August 2017

During August, we are taking the opportunity to focus on some key areas of the HFMA’s policy and technical work and remind members about some of the outputs that might be useful.

Each week we are focusing on a different topic.  This week, the focus is costing and value.

Back in 2015 when the HFMA Healthcare Costing for Value Institute was launched, value-based healthcare was a relatively unknown concept to many in the NHS finance community. In the US two professors – Michael Porter and Robert Kaplan – have championed the adoption of value – measured as outcomes over costs- as the real goal for healthcare systems, and it was fitting that Professor Kaplan spoke at the Institute’s first value master class. 

It is hard to argue against the theory of value-based healthcare – it needs to become the focus for clinicians and finance alike as they look to deliver high-quality sustainable healthcare services to meet the needs of a growing and ageing population.  But how do you translate the theory of value into practice? This is what the Institute has been exploring with its members over the past two years.

Delivering value is not lowest cost – far from it. But robust cost data is intrinsic to a good understanding of value. England is admired by other countries for its comprehensive approach to patient-level costing. The Institute has showcased examples where clinical and finance staff have worked together to use the detailed information about the cost of caring for individual patients to support improvements to patient care. In a case study we describe how finance staff at Nottingham University Hospitals NHS Trust have worked collaboratively with senior clinicians to use patient-level data to support changes in clinical practice. 

Costing improvement is a journey and our Technical Costing Updates offer support to finance staff delivering this improvement, as well as offering insights into how to use patient-level costing to drive improved decision-making. And our PLICS toolkits support trusts to turn patient-level costing data into operational intelligence.

Outcomes are the other key part of the value equation. Trusts are increasingly recognising the need to take account of outcomes that matter to patients when benchmarking costing information. In a further case study, we describe the University Hospital of Coventry and Warwickshire NHS Trust’s practical approach to collecting and using health outcomes for patients receiving prostate cancer care. The trust is using the outcome framework developed by the International Consortium for Health Outcomes Measurement (ICHOM), whose standard sets of outcomes for medical conditions are freely available. 

Putting all of this into practice is the fundamental task facing the NHS and our value challenge pilot set out to test exactly how easy it would be to link costs and outcomes at a patient level. Significant challenges were encountered on the way, but the project demonstrated that it is possible to link costs to outcome data in a clinically meaningful way. 

The global interest in value-based healthcare means that there are opportunities to learn from other countries. At our first International symposium seven different countries provided a high-level view of their approach to costing and value-based healthcare.

This year’s International symposium on 4 October continues with the theme of delivering value-based healthcare, providing an international perspective on ‘Turning value theory into practice’.  Delegates will hear from six different countries on how they are embedding value-based healthcare at both the individual and population level.

Value-based healthcare is still a relatively new concept in the UK, and we are delighted to welcome the Swedish Karolinska University Hospital who are at the forefront of value-based healthcare thinking.

We are becoming increasingly aware in the UK that to drive value we need to be able to measure costs and outcomes across whole patient pathways, which are likely to cover more than one organisation. At the symposium, we will also hear from the integrated network of health and social care in Montreal where they are starting to measure value across whole systems.

Over the past two years it has become clear that translating the theory of value into practice is a real challenge, and it is clearly still ‘work-in progress’. However, the increasing awareness of value-based healthcare amongst the NHS finance community, with closer collaboration with clinical colleagues, bodes well for the future. 

Click here to find out more about the International symposium and to book your place.

Alternatively, to find out more about the Healthcare Costing for Value Institute, click here.