The value in getting together
by Catherine Mitchell
06 October 2017
This week’s HFMA international symposium demonstrated that value-based healthcare is already a practical solution to current healthcare challenges.
So what conclusions can we draw from the HFMA Healthcare Costing for Value Institute's second international symposium on value-based healthcare? Many systems are pursuing similar goals - healthcare services that are built around patients and delivering outcomes that matter to patients. But there's no single approach that can be parachuted into existing, differently structured health systems.
However there is a growing consensus that making value the aim of all decision making (rather than looking at quality and cost improvements in isolation) is the right thing to do. In fact it is probably the only solution to the growing demand facing all health systems.
And while there may not be a ‘one size fits all’ solution, there is huge benefit from being in a room of like-minded people excited about the potential of refocusing healthcare management on the delivery of value and sharing ideas. There were certainly plenty of examples of where value-based approaches have already delivered tangible results.
Different international health systems are at different stages in their value journeys. In most of these systems, this progress is concentrated in specific leading-edge health systems rather than being across the whole country. And there were some clear common features.
For example, both the Karolinska University Hospital in Sweden and the Santeon group of hospitals in the Netherlands, talked about scorecards created around patient pathways. These scorecards – pulling together key metrics on outcomes, costs and processes – were at the heart of regular multidisciplinary team meetings looking specifically at variation and spreading best practice.
For most organisations, the focus is on looking at past outcomes and costs to understand opportunities for improvement, although in some places data is refreshed almost in real time. But the Karolinska is also starting to use its detailed data to support future planning. A new multi-resource planning tool will help services establish the resources they will need to meet required activity and outcome targets.
An approach like that in the UK could take discussions about what is realistic in terms of cost improvement into a completely different place.
Value-based approaches are built on data – data about outcomes and costs. And collecting the right data and getting the data right were more common themes. The outcomes have to be the ones that matter most to patients – and you can’t do that without involving patients.
Lessons from the HFMA’s own value challenge pilot – which also featured at the symposium – make it clear that even where we think we have outcome data already, there can be holes. Registry data for example is often incomplete and there tends to be much less of a focus on collecting ‘outcome’ data post discharge from hospital. The message from many speakers was to start with what you’ve got and get better.
There was agreement that outcome measures need to be kept under review and refreshed as appropriate to ensure they reflect good practice and are relevant.
Robust patient level cost data that clinicians recognize as reflecting the care given is the other side of the data equation. In New South Wales in Australia, an activity-based management portal provides detailed patient cost data to support benchmarking across hospitals and health systems. With costing standards underpinning core cost data, it now also has a detailed audit programme – involving internal audit. It says that debates are now around what to do on the back of the data rather than arguing about the data itself.
In England, NHS Improvement's Costing Transformation Programme is aiming to establish the service’s own robust patient-level cost foundation to inform value-based decision making. That data is starting to be fed back to those that have taken part in voluntary submission of patient cost data using the programme’s new costing standards.
This will provide similar opportunities to benchmark as those provided by the New South Wales portal and there are big hopes for linking the data to NHS Improvement’s Model Hospital initiative.
Value-based healthcare means taking account of a range of outcomes and cost. It is a concept that few would argue with – but turning it into practice is far harder. There are major issues still to crack – ensuring value is viewed across populations not simply within a part of the patient pathway for example. Nobody has all the right answers and there are huge opportunities for practitioners and organisations to learn from each other within and across health systems.
The HFMA’s international symposium provides the perfect platform to showcase developments across the world. Long may it continue.
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