Getting stuck into value

Value-based healthcare needs to move into the practical delivery phase and finance teams need to be at the heart of this.

December’s vision paper for NHS finance – Designing our future: better decisions, better health, published by the HFMA, Future-Focused Finance and PwC – is littered with references to value being central to finance teams’ future role.

It talks about the finance function ‘leading the way in developing a system-wide understanding of value’ and of adopting business partnering roles ‘to focus more closely on value-adding activities’.

It also suggests that the profession needs to recognise the importance of moving to an outcome-driven approach rather than a cost-focused system.

There is wide-ranging acknowledgement that making decisions based on the value delivered – both in terms of outcomes and costs – makes sense. And there are growing examples of value-based approaches delivering real benefits in terms of improved patient pathways, better patient outcomes and savings that help services stay within budget or be reassigned to other patient care.

But value-based healthcare needs to grow its base and become the way of doing business across the whole of the NHS. That’s easier said than done, but finance teams have a major role in making it happen.

An HFMA Healthcare Costing for Value Institute roundtable in December explored progress in the collection and use of outcome data to inform value-based decision-making. It is clear that the service has made a lot of progress in addressing the cost side of the value equation – with an ongoing programme to get all NHS providers costing at the patient-level.

But there has been far less co-ordination in terms of outcomes. There is no shortage of data collected in the NHS – for outcomes frameworks, clinical audits or to fill various registries – but little finds its way back into clinicians’ hands to inform care decisions or to rethink pathways.

There is an argument for a more centrally co-ordinated approach to the collection of outcomes or to the use of outcome sets that have already been defined and developed. It is true that more of this outcome data needs to reflect the outcomes that patients want – a measure of improved mobility, for example, rather than logging a ‘successful’ hip replacement. But NHS bodies cannot afford to sit back and wait for a centrally driven solution.

Getting started – systematically looking at outcomes alongside costs – is the key. Trusts that have made progress urge others to look at the outcome data they already collect – whether clinical outcomes or patient reported outcomes. They are likely to be surprised at what they already have access to.

There will be gaps in the data and metrics that aren’t currently collected that they wish were – but there will be enough to start making more informed decisions. And it will help map out how a more comprehensive data set can be pulled together.

You might ask what the finance role is in all of this. Surely outcomes need to be defined by clinicians? That’s true, but finance professionals have good skills working with large data sets and good objectivity. And they often have a view of the whole patient pathway in an organisation, as well as contacts with many of the key stakeholders.

Experience in a number of trusts shows that most clinicians like to engage with value once they are presented with the data on outcomes and costs. But they need help getting there. They need the data presented to them in ways they can understand quickly – and again this is where finance comes in.

Finance directors and boards have another role. Value-based healthcare won’t be delivered without an organisation-wide – and ultimately system-wide – approach. This will need senior backing and investment.

That is difficult in the current financial climate. But in reality this is the solution to the current challenges – and not finding the funding will only exacerbate the current problems.