How Value-Based Care Benefits Patients

Value Based Healthcare
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Did you know that according to top professors in HealCare (Braithwaite et al.), 40% of the healthcare treatments that you receive in a “volume-based healthcare” are completely unnecessary, low value or even harmful!

  • 60% of care on average is in line with evidence- or consensus-based guidelines,
  • 30% is some form of waste or low value, and
  • 10% is harmful.

It is time to shift from volume-based to “value-based” healthcare or VBHC!

Value-base care is defined as “a healthcare delivery model in which providers, including hospitals and physicians, are paid based on patient health outcomes.” That is, providers are compensated for tangible improvements in patients’ health, decreases in chronic disease, and increases in their capability to live functional lives. Value-based care differs from fee-for-service care. In fee-for-service care, healthcare providers are paid based on the amount of healthcare services they deliver rather than the quality of those services. Generally, value-based healthcare is also defined as care that provides increased quality per dollar spent.

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Value-Based Healthcare: A Catalyst for Change

The shift to value-based healthcare will require numerous changes in the way our healthcare system is structured and in the way it operates.

  1. The transition to value-based healthcare requires healthcare systems to segment patients into groups according to health-related needs.
  2. It requires healthcare providers to reorganize into interdisciplinary teams to address the needs of these patient groups.
  3. Each integrated team will need to design ways to measure both meaningful health outcomes for their patients along with the cost of the services they provide. The idea is to use this information to help improve both quality and efficiency.
  4. The transition will also require an upgraded IT system, one that enables consistent and efficient data collection, expense tracking, and communication among healthcare providers.
  5. It requires both providers and payers to change the way they bill for patient care.
  6. Accomplishing these steps will be challenging, but at the same time, they will provide tangible benefits for every healthcare stakeholder.

Value-Based Healthcare Benefits Patients

Patients are probably the most obvious beneficiaries of value-based healthcare. In fact, value-based healthcare’s primary goal is to deliver value to patients. But what does “value-based healthcare” mean for the patient?

“Value” in value-based healthcare means care that focuses on the outcomes that matter most to patients—that is, care that is aligned to how patients experience health. An article in Academic Medicine describes value in terms of “capability, comfort, and calm.”

  • Capability refers to patients’ ability to participate in life in a way that makes them feel fully themselves.
  • Comfort refers to the relief of physical and emotional suffering.
  • Calm describes whether patients can live normal lives while they are receiving care.5

Perhaps the primary way patients benefit from value-based care is that they will experience better health outcomes, not just in one isolated area of illness, but across the full spectrum of comorbidities and side effects that accompany their illness.

Value-based healthcare encourages the healthcare system to solve patients’ needs, rather than treating only the presenting illness. For example, a patient with diabetes is likely to need the coordinated services of multiple different clinician types. In addition to diabetes, he or she may be affected by hypertension, experience kidney disfunction, or neuropathy. When the goal of healthcare shifts to solving patients’ needs, clinicians begin to identify gaps in their care and coordinate with other care team members to manage each patients’ needs. They also begin to identify nonclinical opportunities—such as weight loss and diet—that can undermine the patients’ health if left unaddressed. The result is that caregivers broaden and integrate their services, leading to better health outcomes.

Usually, under value-based care, healthcare practices can provide all these improvements to patients at lower costs. In fact, experts on the topic of healthcare transformation believe that value-based healthcare is critical for controlling the rising healthcare costs in the United States.

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It is no secret that the performance of Healthcare Systems in general has flatlined and is following the “Three numbers you need to know about healthcare: 60 30 10 Challenge” published in May 2020, by Professor Jeffrey Braithwaite, Professor Paul Glasziou and Professor Johanna Westbrook (Article). Their investigation shows:

  • ~60% of care is in line with evidence-based guidelines,
  • ~30% is wasteful or of low value to the patient, and
  • ~10% is harmful.

And these numbers have not changed for decades despite significant reform efforts.

Clearly, it is time to change our less than adequate and potentially harmful volume-based (fee-for-service) healthcare system to patient-centred value-based healthcare (VBHC).

VBHC is a healthcare delivery model in which providers, including hospitals and physicians, are remunerated based on their patients’ health outcomes. This means that under VBHC agreements, providers are rewarded for helping their patients improve their health, reduce chronic the effects and incidence of chronic diseases, and live healthier lives in a measurable and evidence-based way.

VBHC differs from the fee-for-service approach in which providers remuneration is based on the amount of healthcare service they deliver. The “value” in VBHC is derived from measuring the health outcomes based on the quality of the service i.e. VBHC is characterised by delivering better quality healthcare at a lower cost.

The benefits of a VBHC system extend to patients, providers, payers, suppliers, and society as a whole.

So how does VBHC benefit patients?

VBHC for patients means care that focuses on the outcomes that matter most to themselves. There are many definitions of “value”. For example, Academic Medicine describes value in terms of:

  • Capability - the patients ability to participate in life in a way that makes them feel fully themselves.
  • Comfort - refers to relief of physical and emotional stress and suffering.
  • Calm - describes whether patients can live normal lives while they are receiving care.

We believe that the biggest benefits to patients from VBHC is the noticeable and measurable improvements they will experience in their health generally, not just in one isolated area of illness.

VBHC encourages a focus on the patients overall needs i.e., what matters to the patient rather than treating only the presenting illness. VBHC also encourages a more preventive and healthier lifestyle approach to healthcare . This results in patients facing fewer doctor’s visits, medical tests and procedures and patients may spend less on prescription medication.

With eHealthier’s VBHC model, we put the patient at the center, giving them the opportunity to actively participate in their health outcomes and wellbeing. We provide the tools to help patients on their health improvement journey that:

  • engages them and allows them to proactively participate in the process
  • measures their health and wellbeing
  • sets health and wellbeing goals (and measure their progress)
  • lets them see how they compare to population healthcare norms

All of which has the potential to improve individual and population health, reduce occurrence of chronic disease, reduce hospitalisation, reduce health costs for the patient (and the country) and facilitate the move away from pay-for-service healthcare to VBHC.