Value-based Healthcare System Research Articles

The management of heart failure patients in a value-based healthcare system: The role of cardiac biomarkers

The management of heart failure patients in a value-based healthcare system: The role of cardiac biomarkers

Information Technology and Value-Based Healthcare Systems: A Strategy and Framework.

Value-based healthcare offers a pathway for enhancing patient satisfaction and population health and reducing healthcare costs. In addition, it provides a means to enhance physicians' perception and experience in healthcare delivery. The foundation of the said systemis the notion that community wellness can only be benefited when the health effects of many people are also addressed. The provision of healthcare services incurs costs. However, a value-based model addresses this issue by establishing teams that cater to individuals with similar needs. This approach fosters expertise and efficiency, ultimately leading to cost savings without rationing. Furthermore, entrusting decision-making authority regarding healthcare delivery to the clinical team enhances doctors' professionalism and the integrity of clinician-patient interactions, resulting in more effective and relevant treatments. Currently, various information technology (IT)-based solutions are the main focus for accomplishing the desired value-based healthcare system. The establishment of a coordinated framework that can help organizations create value-based healthcare systems is covered in the current article. Additionally listed are many IT-based solutions used to create a value-based healthcare system.

Reimbursement of interventional oncology in Australia: How it works and how it does not.

The practice of interventional oncology (IO) embodies all the qualities that one would expect to find in a modern, value-based healthcare system. A dynamic, cutting-edge specialty like IO uses highly-targeted, minimally-invasive, image-guided techniques to deliver cost-effective, personalised medicine for cancer patients. Unfortunately, thetechnical and clinical sophistication of IO is not matched by the reimbursement models and funding arrangements in Australia to fully support this critical component of patient care. Differences between state and federal funding lead to inequity of access to 'standard of care' interventions for patients across public and private hospitals. IO procedures are poorly represented in the Medicare Benefits Schedule and often inadequately funded to cover the true costs of providing care. Complex private health fund reimbursements and inconsistent rebates for prostheses and essential equipment result in inconsistent access to important services and widely variable out-of-pocket costs for patients. IO techniques must be supported by fair, consistent and equitable funding arrangements at all levels to allow for integrated contemporary patient care; only then will the full clinical and economic benefits of IO be realised.

The role of laboratory medicine in a value-based healthcare system: the example of heart failure patient management in the Italian context.

As of today, healthcare systems worldwide face severe challenges that undermine their sustainability. The value-based healthcare (VBHC) approach has been proposed as a strategic and methodological framework to ensure the delivery of the best patient outcomes with economic efficiency. Through the illustrative example of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) for heart failure (HF) patient management in the context of the Italian National Healthcare system, this article explores the role that in vitro diagnostics (IVDs) can play in enabling value-based care models. 14 healthcare professionals representing the relevant professional figures involved in HF patient management met to revise the current HF patient journey and design a new care pathway that, leveraging on BNP/NT-proBNP, reflects the VBHC principles. The literature recognizes the dosage of BNP/NT-proBNP as the gold stan-dard for diagnosing HF. However, as of today, these IVDs are not employed at their full potential regarding HF patient management. A new patient journey is proposed so that patients are diagnosed early and properly monitored in the aftermath of hospitalization, improving outcomes at contained costs. As testified by the example of HF patient management in Italy, laboratory medicine can represent a lever for adopting value-based care models. Still, large-scale adoption of VBHC will call for structural reforms that revise how healthcare delivery is organized, measured, and reimbursed.

A Social Network Analysis of Influences on Residents' Value-Based Decisions.

To ensure a value-based health care system, it is becoming increasingly important that residents are trained in making value-based decisions. This study explored the social network influencing residents' value-based decisions. To explore the social network influencing residents' value-based decisions, the authors used a semistructured individual and mini-group interviewing approach and participatory visual mapping. In total, 17 residents across 13 different specialties were interviewed from the southeastern postgraduate medical education and training region of the Netherlands, May-November 2021. Two researchers independently coded the transcribed data using an integrated inductive thematic approach. Subsequently, social network analysis was used to visualize the results. Residents indicated that their value-based decisions were influenced by direct actors who influenced decisions related to patients and indirect actors who shaped decisions related to patients without directly modifying them. Different interaction-aspects (i.e., personal, situational, and institutional) further affected residents' ability to make value-based decisions. Thus, residents' value-based decisions were a product of the interplay between various interactions with actors and different interaction-aspects. Residents defined value-based decisions differently, even within an interview. These results suggest residents' value-based decisions are influenced by a multitude of actors, including hierarchically superior colleagues who can directly alter decisions and patients (and their families) and nurses with whom residents consider it important to maintain good relationships. In addition, more experienced actors, mainly from the medical and nursing profession, contribute most to learning. Furthermore, residents' value-based decisions are deeply underpinned by the hidden curriculum. However, many senior physicians may not have received sufficient training in the concept of value-based health care. Consequently, an approach of formally educating residents in value-based health care will likely have limited effects unless social influences in day-to-day clinical settings reinforce its importance.

Patient-reported outcomes measures in adult spinal deformity

The purpose of this paper is to discuss development of patient-reported outcomes measures (PROMs) and attributes of PROMs used in adult spinal deformity (ASD) practices. Commonly used PROMs in ASD can be dived into general measures of health (Short Form-36, EuroQol, and PROMIS) and spine-specific measures of health (Oswestry Disability Index and Scoliosis Research Society-22r). Threshold values, including minimum clinically important difference (MCID) and substantial clinical benefit (SCB), may be helpful in interpreting changes in PROM scores. Despite their limitations, PROMs are important tools in a modern spinal deformity practice and will be increasingly important as we move toward a value-based healthcare system.

Exploring patient perspectives: A qualitative inquiry into healthcare perceptions, experiences and satisfaction in Lebanon.

Patient perspectives have received increasing importance within health systems over the past four decades. Measures of patient experience and satisfaction are commonly used. However, these measures do not capture all the information that is available through engaging with patients. An improved understanding of the various types of patient perspectives and the distinctions between them is needed. The lack of such knowledge limits the usefulness of including patient perspectives as components within pay-for-performance initiatives. This study aimed to explore patient perspectives on hospital care in Lebanon. It also aimed to contribute insights that may improve the national pay-for-performance initiative and to the knowledge on engaging patients towards person-centered health systems. We conducted a qualitative study using focus group discussions with persons recently discharged after hospitalization under the coverage of the Lebanese Ministry of Public Health. This study was implemented in 2017 and involved 42 participants across eight focus groups. Qualitative content analysis was used to analyze the information provided by participants. Five overall themes supported by 17 categories were identified, capturing the meaning of the participants' perspectives: health is everything; being turned into second class citizens; money and personal connections make all the difference; wanting to be treated with dignity and respect; and tolerating letdown, for the sake of right treatment. The most frequently prioritized statement in a ranking exercise regarding patient satisfaction was regular contact with the patient's doctor. Patient perspectives include more than what is traditionally incorporated in measures of patient satisfaction and experience. Patient valuing of health and their perceptions on each of the health system, and access and quality of care should also be taken into account. Hospital pay-for-performance initiatives can be made more responsive through a broader consideration of these perspectives. More broadly, health systems would benefit from wider engagement of patients. We propose a framework relating patient perspectives to value-based healthcare and health system performance.

Patient-Reported Outcome Measures: State of the Art in Patient-Reported Outcome Measure Application in Lower Extremity Orthopaedics.

With an increasing shift toward a value-based and outcome-driven healthcare system, patient-reported outcome measures (PROMs) will continue to play a prominent role in assessing performance, making clinical decisions, shared decision making, and determining the comparative effectiveness of procedures such as total joint arthroplasty for lower extremity conditions, such as ankle, hip, and knee osteoarthritis. As the application of PROMs in evaluating surgical outcomes has evolved from that of a research setting to that of a clinical setting, their use in the decision-making process has become more prevalent. As a result, preoperative optimization, surgical indications, and improved outcomes after surgery have been greatly enhanced. To enable benchmarking, quality reporting, and performance measurement at an aggregate level, it is crucial to have a comprehensive PROM collection system. However, achieving this goal is contingent upon addressing the variability in reported PROMs and the patient-centered benchmarks used to analyze clinical significance.

From electronic health records to clinical management systems: how the digital transformation can support healthcare services.

Healthcare systems worldwide are currently undergoing significant transformations in response to increasing costs, a shortage of healthcare professionals and the growing complexity of medical needs among the population. Value-based healthcare reimbursement systems are emerging as an attempt to incentivize patient-centricity and cost containment. From a technological perspective, the transition to digitalized services is intended to support these transformations. A Health Information System (HIS) is a technological solution designed to govern the data flow generated and consumed by healthcare professionals and administrative staff during the delivery of healthcare services. However, the exponential growth of digital capabilities and applied advanced analytics has expanded their traditional functionalities and brought the promise of automating administrative procedures and simple repetitive tasks, while enhancing the efficiency and outcomes of healthcare services by incorporating decision support tools for clinical management. The future of HIS is headed towards modular architectures that can facilitate implementation and adaptation to different environments and systems, as well as the integration of various tools, such as artificial intelligence (AI) models, in a seamless way. As an example, we present the experience and future developments of the European Clinical Database (EuCliD®). EuCliD is a multilingual HIS used by 20000 nurses and physicians on a daily basis to manage 105000 patients treated in 1100 clinics in 43 different countries. EuCliD encompasses patients' follow-up, automatic reporting and mobile applications while enabling efficient management of clinical processes. It is also designed to incorporate multiagent systems to automate repetitive tasks, AI modules and advanced dynamic dashboards.

Implementation of risk-sharing agreements in Saudi Arabia: Comparison and reflection on the NICE Model

In recent years, healthcare spending has increased, due to factors such as aging population, lifestylebased diseases, and high-cost health technologies. These factors have put enormous pressure on policymakers to curtail costs and shift towards value-based healthcare system. In this system, drug companies must demonstrate the value of their products in real-world settings. However, evidence may not be available at the time of product launch, leading to delays in reimbursement decisions and access of patients to products. To address this gap, risk-sharing agreements (RSA) have been introduced between manufacturers and payers. The most common type of RSA is the financial-based agreement which may take various forms such as annual sales caps, price-volume agreements, and comparator rebates. These agreements allow for rapid access to innovative medications. Another type of RSA is the outcome-based agreement which ties reimbursement to the real-world outcomes of products. These agreements are more complex, but they are expected to grow rapidly with the availability of real-world data. In the Middle East, the use of RSA is limited, although it is expected to increase with the ongoing shift towards a value-based healthcare system and introduction of health technology assessment. Saudi Arabia is leading these efforts in the region. This study was aimed at describing the current status of RSAs, trends in utilization of RSAs, and challenges of RSA implementation in Saudi Arabia (KSA). Real-world examples of RSAs in various healthcare sectors are also provided. Overall, the use of RSA facilitates access to innovative medications while ensuring value for money and efficient utilization of limited healthcare resources

Value-Based Executive Medicine: Future Practice, Ethics, and Impact

Taking care of Very Important Persons (VIPs) has always been a contentious area of medicine. Access to private healthcare in privileged classes is often linked to socioeconomic status, and the concept role of executive health medicine has emerged. The provision of care for VIP patients requires innovative approaches to assure that their status does not influence the quality of care they receive, and this is precisely what physicians should aim for while providing Executive VIP care. This review intends to highlight the important characteristics of Executive Medicine and the future of VIP Executive Medicine operating within a Value-Based Healthcare system. We have proposed a model of value-based executive medicine in this review in an attempt to describe the basic concept of executive medicine and its various dimensions. This model is inspired by the value-based healthcare delivery framework of Michael Porter and various executive health programs offered by academic medical centers in the United States of America.

Optimizing Patient Safety and Financial Sustainability: Unraveling the Economic Dimensions of Nursing Practice in a Value-Based Healthcare System

This research explores the intersection of nursing practice, economics, and patient safety within the framework of a value-based healthcare system. By examining the economic implications of nursing interventions on patient safety outcomes, the study aims to contribute to the ongoing discourse on optimizing healthcare delivery. A mixed-methods approach is employed, integrating quantitative analysis of cost-effectiveness with qualitative insights from nursing professionals. The results illuminate the intricate relationship between nursing practices, financial considerations, and enhanced patient safety. This research provides valuable insights for healthcare policymakers, administrators, and practitioners seeking to align nursing practices with economic sustainability and improved patient care.

Bilateral Federalism, Value-Based Healthcare and the Future of Canadian Intergovernmental Diplomacy on Health.

The COVID-19 pandemic has laid bare some profound challenges facing the preservation of Canada's single-payer, publicly administered healthcare system. At the same time, it may have presented an opportunity to take bold action on system reform. Part of that opportunity may lie in linking recent developments in intergovernmental diplomacy (termed bilateral federalism) with the growing emphasis on value-based healthcare initiatives coming out of some of the provinces. Bilateralism may be a means to steer reform efforts toward a value-based healthcare system that can articulate pan-Canadian values while accommodating provincial asymmetry in a highly decentralized federation like Canada.

Transforming Health Care Delivery towards Value-Based Health Care in Germany: A Delphi Survey among Stakeholders.

Value-based healthcare (VBC) represents one strategy to meet growing challenges in healthcare systems. To date, VBC is not implemented broadly in the German healthcare system. A Delphi survey was conducted to explore stakeholders' perspectives on the relevance and feasibility of actions and practices related to the implementation of VBC in the German healthcare system. Panellists were selected using purposive sampling. Two iterative online survey rounds were conducted which were preceded by a literature search and semi-structured interviews. After two survey rounds, a consensus was reached on 95% of the items in terms of relevance and on 89% of the items regarding feasibility. The expert panels' responses were in favor of the presented actions and practices of VBC in 98% of items for which consensus was found (n = 101). Opposition was present regarding the relevance of health care being provided preferably in one location for each indication. Additionally, the panel considered inter-sectoral joint budgets contingent on treatment outcomes achieved as not feasible. When planning the next steps in moving towards a value-based healthcare system, policymakers should take into account this study's results on stakeholders' perceptions of the relative importance and feasibility of VBC components. This ensures that regulatory changes are aligned with stakeholder values, facilitating greater acceptance and more successful implementation.

Prices and Clinical Benefit of National Price-Negotiated Anticancer Medicines in China.

BackgroundHigh prices of anticancer medicines have increased the economic burden for both patients and health insurance systems. Since 2017, China has implemented national price negotiations for medicines, relying on evidence from health technology assessments. We aim to assess the relation between negotiated price and value of anticancer medicines listed in China’s National Reimbursement Drug List (NRDL).MethodsFor all price-negotiated anticancer medicines and corresponding indications listed in the latest NRDL between 2017 and 2020, we collected their clinical outcomes data, including overall survival (OS) and progression-free survival (PFS), in supporting trials. Pearson correlation coefficient was calculated to estimate the association between the daily cost and clinical benefit of each indication.ResultsIn total, 75 indications of 46 branded anticancer medicines were included for analysis. The median daily costs for the anticancer therapies that had gone through negotiation in 2017–2020 were US$87.6, US$71.8, US$58.9, and US$39.7, respectively. For indications supported by randomized trials, no correlation between daily costs and OS and PFS benefit of the price-negotiated cancer therapies was observed (N = 41, r = −0.05, and N = 49, r = 0.04, respectively). For cancer indications newly listed in NRDL in 2020, the association between their daily cost and OS benefit was −0.78 (N = 4, p = 0.221) and 0.01 (N = 8, p = 0.986) before and after the price negotiation.ConclusionThough the negotiation policy decreased prices of anticancer medicines in China, no statistically significant correlation was observed between their daily costs and clinical benefits. A more transparent and credible pricing approach needs to be established to promote value-based anticancer medicines and healthcare system efficiency.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40273-022-01161-7.

Disciplinary Intersection of Medicine and Business: A Novel Population Health Management Premedical Pathway for Medicine and Other Health Care Professions.

Premedical students typically pursue undergraduate specialization in basic biological and other sciences, learning to understand living systems at a microscopic, genetic, or molecular level. However, curricula in the basic sciences do not traditionally include courses that enable students to learn about living systems at the macro level-understanding individuals within their environment, as well as understanding and managing the health of populations, especially those with underlying conditions or the underserved. This disconnect can be bridged by creating novel curricular programs intersecting medicine and business. Population health management is a multidisciplinary field that aims to improve the patient experience, reduce health care costs, and improve treatment outcomes. Though related to public health, the 2 fields differ in significant ways. Population health management emphasizes health outcomes and their measurements and seeks to improve health outcomes based on a full understanding of risk, behaviors, lifestyle, environment, and all social determinants of health. A shift in premedical education that connects the medical sciences with business requires curricular reform with the emerging field of population health management at their intersection, allowing students to be better prepared for future medical practices and to understand expectations, benchmarks, business, and economics in a new value-based health care system.

The Trauma of Disregard

The Trauma of Disregard

Patient-reported outcome measures and value-based medicine in paediatrics: a timely review.

Healthcare delivery is moving towards a more personalised and patient-centric approach. There is now an appropriate emphasis on providing value in our healthcare system. Patient-reported outcome measures (PROMs) assess our patients' perceptions of the status of their health and quality of life, measured over a period of time. PROM is an integral component of a value-driven and value-based healthcare system and is key if we want to practise value-based medicine. In paediatrics and child health, PROMs, if implemented well with appropriate measurement tools that are regularly updated and validated in a self-learning healthcare ecosystem, will help to enhance personalised healthcare delivery and collectively improve the health of the community at large. This review covers the role of PROMs in paediatrics, as well as their role in value-based medicine.

Patient-Reported Outcome Measures and Clinical Outcomes in Children with Foregut Anomalies.

Increasing numbers of children and adults with chronic disease status highlight the need for a value-based healthcare system. Patient-reported outcome measures (PROMs) are essential to value-based healthcare, yet it remains unclear how they relate to clinical outcomes such as health and daily functioning. We aimed to assess the added value of self-reported PROMs for health status (HS) and quality of life (QoL) in the long-term follow-up of children with foregut anomalies. We evaluated data of PROMs for HS and/or QoL among eight-year-olds born with congenital diaphragmatic hernia (CDH), esophageal atresia (EA), or congenital lung malformations (CLM), collected within the infrastructure of a multidisciplinary, longitudinal follow-up program. Clinical outcomes were categorized into different outcome domains, and their relationships with self-reported HS and QoL were assessed through multivariable linear regression analyses. A total of 220 children completed HS and/or QoL self-reports. In children with CDH and EA, lower cognition was significantly associated with lower self-reported HS. Due to the low number of cases, multivariable linear regression analysis was not possible in children with CLM. HS, QoL, and clinical outcomes represent different aspects of a child’s wellbeing and should be measured simultaneously to facilitate a more holistic approach to clinical decision making.

Quality Improvement Education: Redesigning Intermountain Healthcare's Advanced Training Program for a Value-Based Learning Health Care System.

Quality Improvement Education: Redesigning Intermountain Healthcare's Advanced Training Program for a Value-Based Learning Health Care System.