28 March 2018
If you work in healthcare you have most likely come across the acronym VBHC, or value-based healthcare. But would you be able to explain what VBHC is to your child, sister or grandpa in a way that they would understand? And, most importantly, could you reflect on the contribution it makes and the potential it has to support the delivery of healthcare in practice? An increasing number of us are discussing the principle of VBHC, but how many are pondering the challenge of consistency in definition and transition from theory to practice within the changing healthcare landscape? If you find it difficult, you are not alone.
An “unhealthy” situation
Over the last decade, health systems all over the world have faced a growing number of common challenges. The media has been full of stories about the increasing cost of healthcare, ageing populations, the rise in chronic diseases and multi-morbidity, shortages, waste and uneven distribution of health professionals, health inequalities and inequities in access, to name just a few. Definitely not a rosy situation.
More dramatically, an evident and growing mismatch has developed between what is considered proof of success in healthcare delivery, versus what is actually valuable to patients. Not surprisingly, it has generated rising dissatisfaction among both healthcare providers and receivers.
Conventional healthcare metrics measure outcomes that include the number of clinical admissions, length of stay in hospital and number of interventions. By contrast, patients are more focused on factors such as quality of life, functional ability and emotional well-being. Honestly, can you blame them?
What adds value to care?
In this context, the need for healthcare reform has become increasingly evident and the concept of VBHC has emerged as a potential answer. In fact, while traditional ways of defining value in healthcare are mainly based on economic efficiency, VBHC promotes a model that adds quality and patients experience into the equation. In short, VBHC is the art of improving healthcare delivery, while at the same time reducing costs where inefficiencies exist.
Sounds nice, doesn’t it? But how exactly can this still relatively abstract concept become more a part of our everyday lives? While notable case studies of organisations and institutions embracing VBHC models already exist1, there is not yet a clearly defined and harmonised vision or policy framework for VBHC.
In particular, there is still a general uncertainty when it comes to identifying enablers that would fully realise VBHC. This is made even more complicated by the fact that VBHC touches upon so many areas and phases of healthcare delivery. It involves a massive diversity of players including hospitals, healthcare providers, reimburses and insurers. So, what can be done?
VBHC needs to be more clearly linked to existing and future policy developments. This can occur by bridging its broad principles established by Prof. Michael Porter of Harvard Business School, the International Consortium for Health Outcomes Measurement, The Economist Intelligence Unit and the VBHC Center Europe (to name just a few) to concrete models and case studies that reward performance over volume2. Until this happens, VBHC cannot fully materialise.
An effort has to be made by the medical community, industry and policy-makers to clarify the measures and factors that would facilitate and enable VBHC. There are many EU policy areas where VBHC could play a crucial role. For example, within the current debates on EU cooperation on Health Technology Assessment (HTA), Healthcare Systems Performance Assessment (HSPA), sustainability and strategic investment in healthcare, procurement legislation, big data, funding projects and more.
VBHC should not be treated with a typical empirical approach and we believe its success will depend on a comprehensive course of action, combining top-down and bottom-up methods. This would allow for best practices to be systemically collected and incorporated in health policies, which in turn would provide the clear framework to enable more VBHC in the future. If, as a community, we help VBHC to keep its promises, we will have finally brought back the human factor to what could truly be called patient-centric care.
By Barbara Ghizzoni, Senior Consultant
 Some existing examples are the OECD work on Patients Reported Outcomes (PaRIS), the Karolinska Institute (Sweden), the Martini Klinik (Germany).
 Some existing examples include programmes like the Patient Choice Porgramme (Sweden), Meetbaar Beter, Diabeter, ClaudicatioNet (the Netherlands) or activities carried out by the Ribera Hospital (Spain) and the Martini Klinik (Germany).