Finance’s valued role

No-one would argue that value-based healthcare is now mainstream in the NHS. But there are signs that the NHS is moving in the right direction.

A packed value summit – organised by the Healthcare Costing for Value Institute and Future-Focused Finance – suggests there is growing interest among clinicians, finance professionals and operational colleagues. And presentations from the stage indicate that there are organisations and systems starting to put value theory into very real practice.

But it also underlined that this is a major undertaking. While it is essential – and arguably the only solution to meeting growing patient demand and living within an affordable budget – it is far from straightforward. It will require wholesale change to the way services are run and new ways of paying for those services.

The summit showcased how organisations at different scales are redesigning pathways to address variation in clinical processes and eliminate waste and unnecessary steps.

There were lots of common messages: the central role of data; the need for trust, across systems and between professions and in the robustness of that data; ensuring patients are a core part of any redesign.

Technology also has a part to play – for example, using electronic patient records and decision support systems to digitise pathways and support clinicians to sustain revised treatment protocols.

What also came across was the continuing importance of the finance profession to the delivery of value – while recognising that clinicians need to be front and centre as the agenda takes hold.

Finance staff have been central to work so far – as demonstrated by the championing role taken by the institute and Future-Focused Finance in recent years. Without finance’s work to date, the value agenda would not be as advanced as it is. And it will continue to be at the heart of the value movement.

Finance staff are crucial to the compilation of cost data that is fundamental to the value equation as defined by Porter. They are also best placed to support clinicians in using this data to shine a light on existing pathways and opportunities to address variation and improve services.

Variation in practice could be compared without attaching pound signs. But the simple truth is that it is often the linkage with costs that really underlines the impact of that variation (see Costing: community progress) It is also worth saying that finance staff are motivated by exactly the same things as their clinical colleagues. They may not have direct patient-facing roles, but they are just as committed to improving outcomes for patients.

Finance staff will also be crucial as the value agenda moves into new territory. While delivering value-based healthcare is challenging enough across pathways within individual organisations, it needs to start being applied to whole pathways and at the population level.

The question needs to be not simply ‘how does my organisation deliver value for the patients we treat?’ but also ‘how do we deliver value for the patient overall?’.

Undertaking the best and most cost-effective hip replacement is not delivering value if, for example, physiotherapy further upstream could have prevented the need for a hip replacement altogether.

And even more difficult, value means challenging exactly how resources are currently allocated to different programmes of care – population value. People will look to the finance profession to design payment systems to facilitate these changes and to model the impact of potential changes in funding flows.

The value summit suggests the journey to value-based healthcare is under way. Speakers were clear. Don’t expect changes to be made overnight. Quality improvement needs to be rigorous and methodical and it takes time. But finance professionals look set to retain a fundamental role in its delivery alongside clinicians.