Value-based Healthcare Research Articles

European value-based healthcare benchmarking: moving from theory to practice.

Value-based healthcare (VBHC) is a conceptual framework to improve the value of healthcare by health, care-process and economic outcomes. Benchmarking should provide useful information to identify best practices and therefore a good instrument to improve quality across healthcare organizations. This paper aims to provide a proof-of-concept of the feasibility of an international VBHC benchmarking in breast cancer, with the ultimate aim of being used to share best practices with a data-driven approach among healthcare organizations from different health systems. In the VOICE community-a European healthcare centre cluster intending to address VBHC from theory to practice-information on patient-reported, clinical-related, care-process-related and economic-related outcomes were collected. Patient archetypes were identified using clustering techniques and an indicator set following a modified Delphi was defined. Benchmarking was performed using regression models controlling for patient archetypes and socio-demographic characteristics. Six hundred and ninety patients from six healthcare centres were included. A set of 50 health, care-process and economic indicators was distilled for benchmarking. Statistically significant differences across sites have been found in most health outcomes, half of the care-process indicators, and all economic indicators, allowing for identifying the best and worst performers. To the best of our knowledge, this is the first international experience providing evidence to be used with VBHC benchmarking intention. Differences in indicators across healthcare centres should be used to identify best practices and improve healthcare quality following further research. Applied methods might help to move forward with VBHC benchmarking in other medical conditions.

Improving health outcomes of patients with myocardial infarction with value based methodology

Abstract Digital technologies have the potential to support the implementation of value-based healthcare by enabling personalised patient care and improving health outcomes. The ValueCare project (H2020, No. 875215) aims to deliver personalised integrated (health and social) care services, better outcomes for older people and an improved care experience and is being tested in 7 pilot sites across Europe. The Rijeka pilot site focuses on older patients who have suffered a myocardial infarction (MI), which is a leading cause of morbidity and mortality worldwide. The study will assess the impact of the ValueCare approach on improving health outcomes for older people who have suffered a MI. A total of 240 older people (120 intervention and 120 control subjects) will take part in the study. The intervention group will receive the ValueCare approach, which includes: Consultation between the patient and care provider to discuss the results of the self-reported ICHOM questionnaires; a personalised care plan co-created by the patient and care provider; a digital solution to support the patient's personalised care plan; and monitoring of the personalised care plan by caregivers. ValueCare's digital solution enhances the assessment and monitoring of the personalised care plan through: a mobile application for older people, a wearable, and a web application for caregivers. The mobile application uses a motivation and goal-setting approach, including a Virtual coach who acts as a conversation partner to help participants achieve their personal goals. The impact of the intervention will be evaluated using a self-reported ICHOM Standard Set for Older Persons at three time points: Baseline T0, Follow-up T1 (after 12 months) and T2 (after 18 months). Our results will shed light on the potential of digital technologies to transform the prevention and treatment of MI and ultimately improve patient outcomes and reduce healthcare costs. Key messages • Digital health has emerged as a promising approach to transforming healthcare and improving patient's outcomes. • Value-based healthcare improves outcomes and reduces costs for myocardial infarction treatment, putting patients at the center of care.

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.

Using Publicly Reported Global Hospital Rankings to Improve Dissemination of Patient-Reported Outcome Measures (PROMs)

Summary Patient-reported outcome measures (PROMs) represent an essential element of value-based care in health care sectors worldwide by transferring the quality definition from process- to outcome-based indicators that focus on the patients’ needs. However, the adoption rate of PROMs in hospitals is still low. To address this challenge and to account for the growing importance of value-based health care, Newsweek and Statista developed a PROMs implementation survey along with a global board of medical experts to determine the current state of PROMs implementation in hospitals. The results of this survey were incorporated into the 2023 editions of Newsweek’s World’s Best Specialized Hospitals and World’s Best Hospitals rankings. The inclusion of PROMs adds a patient outcome–focused dimension that overcomes methodologic limitations and improves the comprehensiveness of these rankings. Furthermore, the public reporting of clinical outcomes such as PROMs serves as a catalyst to improve the quality of care. In this article, the authors describe what they believe is the increasing relevance of value-based health care and PROMs, the process of developing and launching the PROMs implementation survey, and its incorporation into hospital rankings to improve the value of care for patients on a global level.

Safety and Feasibility of an Emergency Department-to-Outpatient Pathway for Patients With TIA and Nondisabling Stroke.

Evaluation of transient ischemic attack/nondisabling ischemic strokes (TIA/NDS) in the emergency department (ED) contributes to capacity issues and increasing health care expenditures, especially high-cost duplicative imaging. As an institutional quality improvement project, we developed a novel pathway to evaluate patients with TIA/NDS in the ED using a core set of laboratory tests and CT-based neuroimaging. Patients identified as 'low risk' through a safety checklist were discharged and scheduled for prompt outpatient tests and stroke clinic follow-up. In this prespecified analysis designed to assess feasibility and safety, we abstracted data from patients consecutively enrolled in the first 6 months. We compared data from 106 patients with TIA/NDS enrolled in the new pathway from April through September 2020 (age 67.9 years, 45% female), against 55 unmatched historical controls with TIA encountered from April 2016 through March 2017 (age 68.3 years, 47% female). Both groups had similar median NIHSS scores (pathway and control 0) and ABCD2 scores (pathway and control 3). Pathway-enrolled patients had a 44% decrease in mean ED length of stay (pathway 13.7 hours, control 24.4 hours, p < 0.001) and decreased utilization of ED MRI-based imaging (pathway 63%, control 91%, p < 0.001) and duplicative ED CT plus MRI-based brain and/or vascular imaging (pathway 35%, control 53%, p = 0.04). Among pathway-enrolled patients, 89% were evaluated in our stroke clinic within a median of 5 business days; only 5.5% were lost to follow-up. Both groups had similar 90-day rates of ED revisits (pathway 21%, control 18%, p = 0.84) and recurrent TIA/ischemic stroke (pathway 1%, control 2%, p = 1.0). Recurrent ischemic events among pathway-enrolled patients were attributed to errors in following the safety checklist before discharge. Our TIA/NDS pathway, implemented during the initial outbreak of COVID-19, seems feasible and safe, with significant positive impact on ED throughput and ED-based high-cost duplicative imaging. The safety checklist and option of virtual telehealth follow-up are novel features. Broader adoption of such pathways has important implications for value-based health care.

Enhancing Healthcare for Sarcoma Patients: Lessons from a Diagnostic Pathway Efficiency Analysis.

Sarcomas, rare and with lower survival rates than common tumors, offer insights into healthcare efficiency via the analysis of the total interval of the diagnostic pathway, combining the patient interval (time between the first symptom and visit with a physician) and diagnostic interval (time between first physician visit and histological diagnosis). Switzerland's healthcare system, Europe's costliest, lacks research on treating rare conditions, like mesenchymal tumors. This study examines the total interval of the diagnostic pathway for optimization strategies. Analyzing a dataset of 1028 patients presented from 2018 to 2021 to the Swiss Sarcoma Board (MDT/SB-SSN), this retrospective analysis delves into bone sarcoma (BS), soft-tissue sarcoma (STS), and their benign counterparts. Demographic and treatment data were extracted from medical records. The patient interval accounted for the largest proportion of the total interval and secondary care interval for the largest proportion of the diagnostic interval. Age, grade, and localization could be elicited as influencing factors of the length of different components of the total interval. An increasing age and tumor size, as well as the axial localization, could be elicited as factors increasing the probability of sarcoma. The patient and secondary care interval (SCI) offer the greatest potential for optimization, with SCI being the bottleneck of the diagnostic interval. New organizational structures for care work-ups are needed, such as integrated practice units (IPU) as integral part of value-based healthcare (VBHC).

Designing Clinical MRI for Enhanced Workflow and Value.

MRI is an expensive and traditionally time-intensive modality in imaging. With the paradigm shift toward value-based healthcare, radiology departments must examine the entire MRI process cycle to identify opportunities to optimize efficiency and enhance value for patients. Digital tools such as "frictionless scheduling" prioritize patient preference and convenience, thereby delivering patient-centered care. Recent advances in conventional and deep learning-based accelerated image reconstruction methods have reduced image acquisition time to such a degree that so-called nongradient time now constitutes a major percentage of total room time. For this reason, architectural design strategies that reconfigure patient preparation processes and decrease the turnaround time between scans can substantially impact overall throughput while also improving patient comfort and privacy. Real-time informatics tools that provide an enterprise-wide overview of MRI workflow and Picture Archiving and Communication System (PACS)-integrated instant messaging can complement these efforts by offering transparent, situational data and facilitating communication between radiology team members. Finally, long-term investment in training, recruiting, and retaining a highly skilled technologist workforce is essential for building a pipeline and team of technologists committed to excellence. Here, we highlight various opportunities for optimizing MRI workflow and enhancing value by offering many of our own on-the-ground experiences and conclude by anticipating some of the future directions for process improvement and innovation in clinical MR imaging. EVIDENCE LEVEL: N/A TECHNICAL EFFICACY: Stage 1.

The impact of changes in a physician fee schedule on medical expenditures, fees, and volume of services. Evidence from a national fee schedule reform in Australia

We examine the impact of changes to a national physician fee schedule on total medical expenditures, the volume of services, and fees charged. In our context, changes to the fee schedule were designed to promote value-based health care, and so included different types of changes to subsidised medical services, including changes to fees. Using claims data from a sample of doctors linked to a physician survey, we use difference-in-difference methods with a staggered adoption design to compare medical services which were affected with those which were not. We show that medical expenditures and the volume of affected services fell, though there is uncertainty about the magnitude of the fall. For GPs, we find evidence of increases in expenditures and fees and an increase in fees for some services provided by specialists.

From volume to value: a watershed moment for the clinical laboratory.

The clinical laboratory is often evaluated for the volume of testing. However, it is undeniable that laboratory tests affect clinical decision-making and are included in many clinical guidelines, meaning their contribution to determining clinical outcomes. Therefore, the clinical laboratory professional has the task of enhancing laboratory tests by optimizing the request and reporting phase and addressing patient outcomes. This opinion paper, presenting practical examples of managing value-based health care in the clinical laboratory context, underlines the need to shift towards value-based management to optimize outcome-based health care.

Applying robust management approaches to transit to value-based healthcare

Applying robust management approaches to transit to value-based healthcare

Innovation and strategy in clinical research with the SCIOSM method

Innovation in clinical research is a long-term need due to several factors, including the high failure rate and skyrocketing costs. Healthcare has been changing rapidly for many years. The COVID-19 pandemic has accelerated by helping drive the shift to value-based healthcare. Instead, the productivity of pharmaceutical development has been declining due to high failure rates in clinical research. The SCIO method is an innovative and strategic method implementing a tailored approach to drug development. The SCIO method customizes strategy and roadmap for pharmaceutical and biological candidates allowing robust clinical data generation and informed decision-making during the early clinical development stages. The complexity of diseases contributes to the high failure rate and increases the cost of research. Clinical research in developing new drugs and treatments is associated with a high late failure rate. Late-stage trial failures can delay patients' access to potentially lifesaving or disease-modifying treatments. Strategy is valuable in reducing late clinical trial failure. A well-developed and carefully executed strategy helps mitigate risks, optimize trial design and execution, and increase the chances of successful outcomes. A failed trial can harm the credibility by raising concerns about the research methods, the quality of the data, or the reliability of the therapy under investigation. The SCIO is an innovative drug development method, including a strategic approach before initiating clinical trials that ensure a solid scientific basis and a reasonable likelihood of success in human trials.

High value healthcare analysis of “triggers” in deteriorating patients

Objective: To review “triggers” for deteriorating patients who required intervention by a medical emergency response team (MET). In addition, to assess whether these “triggers” differed by medical or surgical governance of these patients. A secondary objective was to report laboratory investigations performed via the MET, with particular interest in tests duplicating haemoglobin (Hb) values and their degree of concordance within the context of low-cost, high value inpatient care.Methods: This quality improvement initiative involved a prospective observational cohort of inpatients, who were attended to by the MET at Royal Perth Hospital in Perth, Western Australia over a 2-year period between 2020 and 2022.Results: The mean number of MET calls for inpatients under surgical governance was slightly higher than for those patients under medical governance (1.34 vs. 1.25 calls respectively p = .03). Hypotension triggered a MET call in 184 (40.9%) surgical patients compared to 154 (28%) under medical governance (p &lt; .001). Comparing haemoglobin values obtained from FBP and VBG, Lin’s concordance correlation coefficient (CCC) was found to be 0.986, 95%CI: 0.983, 0.989. The Bland-Altman limits of agreement suggest that the haemoglobin value on a VBG ranges from 9.55 g/L higher than the FBP to 4.7 g/L lower than the FBP.Conclusions: Significant differences in the frequency of triggers for patients under medical vs surgical governance highlight the need for proactive planning around hypotension management of patients under surgical governance. In addition, understanding the nuances between haemoglobin values obtained from FBP and VBG can help with value-based health care and efficiencies in patient care, since measuring haemoglobin values is one of the key components in hypotension management.

Generative pretrained transformer 4: an innovative approach to facilitate value-based healthcare

ObjectiveAppropriate medical imaging is important for value-based care. We aim to evaluate the performance of generative pretrained transformer 4 (GPT-4), an innovative natural language processing model, providing appropriate medical imaging automatically in different clinical scenarios. MethodsInstitutional Review Boards (IRB) approval was not required due to the use of nonidentifiable data. Instead, we used 112 questions from the American College of Radiology (ACR) Radiology-TEACHES Program as prompts, which is an open-sourced question and answer program to guide appropriate medical imaging. We included 69 free-text case vignettes and 43 simplified cases. For the performance evaluation of GPT-4 and GPT-3.5, we considered the recommendations of ACR guidelines as the gold standard, and then three radiologists analyzed the consistency of the responses from the GPT models with those of the ACR. We set a five-score criterion for the evaluation of the consistency. A paired t-test was applied to assess the statistical significance of the findings. ResultsFor the performance of the GPT models in free-text case vignettes, the accuracy of GPT-4 was 92.9%, whereas the accuracy of GPT-3.5 was just 78.3%. GPT-4 can provide more appropriate suggestions to reduce the overutilization of medical imaging than GPT-3.5 (t = 3.429, P = 0.001). For the performance of the GPT models in simplified scenarios, the accuracy of GPT-4 and GPT-3.5 was 66.5% and 60.0%, respectively. The differences were not statistically significant (t = 1.858, P = 0.070). GPT-4 was characterized by longer reaction times (27.1 s in average) and extensive responses (137.1 words on average) than GPT-3.5. ConclusionAs an advanced tool for improving value-based healthcare in clinics, GPT-4 may guide appropriate medical imaging accurately and efficiently.

Medicaid Value-Based Payments and Health Care Use for Patients With Mental Illness

Medicaid patients with mental illness comprise one of the most high-need and complex patient populations. Value-based reforms aim to improve care, but their efficacy in the Medicaid program is unclear. To investigate if New York state's Medicaid value-based payment reform was associated with improved utilization patterns for patients with mental illness. This retrospective cohort study used a difference-in-differences analysis to compare changes in utilization between Medicaid beneficiaries whose outpatient practices participated in value-based payment reform and beneficiaries whose practices did not participate from before (July 1, 2013-June 30, 2015) to after reform (July 1, 2015-June 30, 2019). Participants were Medicaid beneficiaries in New York state aged 18 to 64 years with major depression disorder, bipolar disorder, and/or schizophrenia. Data analysis was performed from April 2021 to July 2023. Beneficiaries were exposed to value-based payment reforms if their attributed outpatient practice participated in value-based payment reform at baseline (July 1, 2015). Primary outcomes were the number of outpatient primary care visits and the number of behavioral health visits per year. Secondary outcomes were the number of mental health emergency department visits and hospitalizations per year. The analytic population comprised 306 290 individuals with depression (67.4% female; mean [SD] age, 38.6 [11.9] years), 85 105 patients with bipolar disorder (59.6% female; mean [SD] age, 38.0 [11.6] years), and 71 299 patients with schizophrenia (45.1% female; mean [SD] age, 40.3 [12.2] years). After adjustment, analyses estimated a statistically significant, positive association between value-based payments and behavioral health visits for patients with depression (0.91 visits; 95% CI, 0.51-1.30) and bipolar disorder (1.01 visits; 95% CI, 0.22-1.79). There was no statistically significant changes to primary care visits for patients with depression and bipolar disorder, but value-based payments were associated with reductions in primary care visits for patients with schizophrenia (-1.31 visits; 95% CI, -2.51 to -0.12). In every diagnostic population, value-based payment was associated with significant reductions in mental health emergency department visits (population with depression: -0.01 visits [95% CI, -0.02 to -0.002]; population with bipolar disorder: -0.02 visits [95% CI, -0.05 to -0.001]; population with schizophrenia: -0.04 visits [95% CI, -0.07 to -0.01]). In this cohort study, Medicaid value-based payment reform was statistically significantly associated with an increase in behavioral health visits and a reduction in mental health emergency department visits for patients with mental illness. Medicaid value-based payment may be effective at altering health care utilization in patients with mental illness.

Patient-relevant health outcomes for von Willebrand disease, platelet function disorders, and rare bleeding disorders: a Delphi study

BackgroundTo assess patient value, it is essential to regularly measure health outcomes that matter to patients. It is currently unknown which health outcomes are important for patients with autosomal inherited bleeding disorders. ObjectivesThis study aimed to assess which health outcomes are important for patients with autosomal inherited bleeding disorders, consisting of von Willebrand disease, platelet function disorders, and rare bleeding disorders, as seen from the patients’, caregivers’, and healthcare professionals’ perspectives. MethodsTwo panels, one consisting of patients and caregivers, and one consisting of healthcare professionals participated in a Delphi process. A list of 146 health outcomes was identified from the literature. During 3 rounds, both panels rated the importance of health outcomes on a 5-point Likert scale. A health outcome was considered important by a panel if it received a median score of 5 with an IQR of ≤1. ResultsIn total, 13 patients, 10 caregivers, and 19 healthcare professionals participated in the Delphi study. Both panels reached consensus on the importance of health outcomes related to bleeding episodes, life-threatening complications, and the intensity and impact of menstruation. Patients and caregivers additionally reached consensus on the importance of health outcomes related to menstruation and the impact of the bleeding disorder on their daily lives. Healthcare professionals reached consensus on the importance of health outcomes related to treatment, joint health, and pain. ConclusionIn this study, health outcomes were identified that should be considered when implementing value-based health care in the care of patients with autosomal inherited bleeding disorders.

Value-based Healthcare: Can Generative Artificial Intelligence and Large Language Models be a Catalyst for Value-based Healthcare?

Value-based Healthcare: Can Generative Artificial Intelligence and Large Language Models be a Catalyst for Value-based Healthcare?

Reported experienced stress during the COVID-19 pandemic and patient preferences for the consultation of periconception blended lifestyle care: a survey among (pre)pregnant women

Purpose To assess experienced stress on different aspects of life and evaluate patient preferences for the consultation of periconception blended lifestyle care, combining face-to-face counseling with eHealth, during the COVID-19 pandemic among (pre)pregnant women. Using this two-fold aim, we were able to analyze the levels of stress among (pre)pregnant women during the COVID-19 pandemic, and to study whether their preferences for the consultation modality of periconception blended lifestyle care was influenced by the levels of stress. Methods A quantitative survey among (pre)pregnant women who received blended periconception lifestyle care between March 2020 and December 2021, from the first until the fourth COVID-19 wave in the Netherlands. The questionnaire used a 5-point Likert scale and measured experienced stress and preferred periconception blended lifestyle care modality. Results 984 women (response rate: 55.2%) filled out the questionnaire. Experienced stress during the COVID-19 pandemic was relatively low and stable over time. The highest percentage of respondents (31.2%) reported to have experienced stress on fertility and pregnancy. 40.4% (309/764) of the respondents indicated that face-to-face consultations could be replaced by digital consultation. Additionally, the mean experienced stress did not differ between the patients who preferred a video consultation (2.60 ± 1.1), or a telephone consultation (2.57 ± 1.2), either a video or telephone consultation (2.54 ± 1.3), still preferred a face-to-face consultation (2.41 ± 1.4) (p = .83). Conclusions Our findings indicate willingness for wide implementation of telemedicine within health care delivery, and reorganizing of periconception blended lifestyle care toward personalized and value-based health care.

Educating patients on value-based health care to improve clinical outcomes

Patient education and health literacy are essential components of the effort to improve a patient’s health and assist them with meeting their medical goals of improved health and wellness. This paper provides actionable recommendations on educating patients on how value-based health care improves clinical outcomes. The qualitative exploratory case study outlined healthcare professionals’ experiences, perceptions and opinions regarding educating their patients about the value-based healthcare system. Fifteen healthcare professionals currently or previously providing patient care in the United States shared multiple perspectives on educating patients about value-based health care. Two recurring themes identified were (a) reimbursement is based on patient outcomes and (b) patient education and comprehension. Patient education allows healthcare professionals to collaborate with patients to improve their health. Gaps in the literature exist on whether or how healthcare professionals educate patients on value-based health care. The findings and recommendations from this study could raise consciousness about the clinical and business benefits of educating patients on value-based health care. Educating patients on this topic presents opportunities to engage patients as partners in promoting compliance and positive clinical outcomes.

The role of value-based healthcare in decision-making by executives in hospitals in the Netherlands: A nationwide evaluation

ABSTRACT Background This observational study investigates the role of value-based healthcare (VBHC) principles in executive decision-making in Dutch hospitals. Methods A total of 379 questionnaires were sent to executives in 69 Dutch hospitals. The survey included questions prioritizing VBHC and other elements in decision-making and the weight and frequency at which each VBHC element was considered. Results Responses were received from 82.6% of hospitals (57/69) and 26.9% of executives (102/379). ‘Clinical outcomes’ and ‘costs’ were most often considered in decision-making whereas ‘integration of care delivery across separate facilities’ and ‘bundled payments’ were considered the least. VBHC was reported as being considered in decision-making 8 out of 10 times and was given a median score of 8 out of 10. Members of the board of directors placed a higher priority on ‘clinical outcomes’, ‘internal politics’, ‘the ambition of healthcare professionals’ and ‘integrating care delivery across separate facilities’ and perceived that they include these elements more frequently than other direct colleagues. Conclusion This study reveals that, although VBHC is generally considered in managerial decision-making, ‘clinical outcomes’ and ‘costs’ predominantly have priority. Action must be taken to ensure executives implement all VBHC elements in decision-making to maximize the effects of VBHC.

Value-based healthcare in fertility care using relevant outcome measures for the full cycle of care leading towards shared decision-making: a retrospective cohort study

ObjectiveTo determine if the introduction of value-based healthcare (VBHC) in fertility care can help to create realistic expectations in patients resulting in increased patient value, by demonstrating the relevance of...