Value-based Transformation Research Articles

Accelerating the pace of value-based transformation for more resilient and sustainable healthcare

Value-based healthcare (VBHC; delivering the best possible health outcomes for patients in a cost-efficient manner) has been a strategic priority among healthcare stakeholders for years. Pioneering providers embrace VBHC principles (such as organising care delivery around medical conditions, monitoring health outcomes and costs per patient group along the clinical pathway, and using those metrics to drive organisational improvements). Still, widespread adoption has been slow due to multiple factors, one of which is the sheer complexity of such a transformation. However, because of the urgent need for infection control during the COVID-19 pandemic, providers made unprecedented strides towards VBHC and achieved VBHC goals that were unattainable before. This article considers the barriers to adopting VBHC and shares best practices from an extensive knowledge base to advise providers on capitalising on the pandemic's momentum to implement value improvement quickly and efficiently.

Mass General Brigham’s Patient-Reported Outcomes Measurement System: A Decade of Learnings

This article describes the strategies that leaders at the Mass General Brigham (MGB) health system have used in launching a standardized patient-reported outcome measure (PROM) collection program in 2012, a major step in the value-based transformation of health care. This article documents many benefits to patients, clinicians, and payers from the effective design, collection, and use of PROMs. These benefits include shared decision-making aligned to patients’ goals; improving patient expectations about their likely experiences and outcomes from treatment; empowering patients to self-monitor during recovery; facilitating communication between physicians and patients about what matters most to patients; enhancing treatment by having PROMs embedded in the patients’ electronic health record; and reducing disparities in access, treatment, and outcomes for previously underserved racial and ethnic groups. For payers, PROMs allow payments to be based on patient outcomes. By continuously answering each stakeholder’s “what’s in it for me” question, MGB has taken an important step toward building a learning health system to equitably achieve health outcomes that align with patients’ goals for their health. Working together, the MGB PROMs Program and the Brigham and Women’s Hospital’s Patient-Reported Outcomes, Value, and Experience Center, a transdisciplinary PROMs research hub, plan to continue their efforts to improve and expand the use of PROMs to accelerate the shift toward accountable, patient-centered care.

Бунт жінки в маскулінному просторі війни в романі «Доця» Тамари Горіха Зерня

The article is based on the example of the debut novel «Daughter» by the volunteer and translator Tamara Horikha Zernya, who won the Shevchenko Prize-2022 (the highest literary award in Ukraine). It analyzes the peculiarities of the formation of military discourse in modern Ukrainian prose through the perception of a female writer. The article describes the place of a woman in the hegemonic masculine space, characterized by militarism, aggression, and violence. The paper has been traced the process of internal transformation and, as a result, a woman's rebellion against the established gender models of behavior in war conditions by asserting an active civic position and participation in the country's social and political life (volunteering). The writer not only joined the isolated female voices to highlight the topic of the Russian- Ukrainian war in all its manifestations, but she also became almost the only author who brought to the public the irritating topic of gender role polarization in wartime. She raised her voice against the forced removal (taboo) of women from the military discourse. The writer touches on the problem of gender stereotypes in tragic wartime, when men and women, faced with the threat of losing the nation, the motherland, and their own lives, are induced to try on different gender roles, actualizing the manyfolded tragedy of a person at war. Women's voices in understanding war topics play an important role inasmuch they record local, mental, socio-political and other changes in society. Women, being involved in the state of war, analyze the reasons that led to the inevitability of armed conflict, but first of all, they raise the issue of gender polarization roles in the conditions of martial law, in particular the forced removal of women as the weaker sex from the military discourse. The novel «Daughter» by Tamara Horikha Zernya allows you to trace the path of the internal transformation of the heroine under the influence of external circumstances, genetic, mental and psychophysical characteristics. The spiritual and value-based transformation naturally leads to a woman's rebellion against the stereotyped gender models and results in active volunteer activities. The artistic text is the first-person narrative, the real name of the heroine is not mentioned in it, instead the generic designation «Dotsia» is used to highlight the fact that the fate of the protagonist is not unique in our society. The writer is involved in her volunteer experience as the documentary evidences. Thus, the protagonist strives to integrate into the masculine militarized world to realize the desire to be involved in the process of nation-building and restoration of state sovereignty. Keywords: war, masculine space, women, military prose, women's prose, military discourse.

Facilitating transformative science education through futures thinking

PurposeThe aims and pedagogies in the field of science education are evolving because of global sustainability crises. School science is increasingly concerned with responsible agency and value-based transformation. The purpose of this conceptual paper is to argue that perspectives and methods from the field of futures studies are needed to meet the new transformative aims of science education for sustainable development.Design/methodology/approachThis paper analyses some contemporary challenges in science education and gives reasons for introducing a futures perspective into science classrooms. The suggestion is illustrated by reviewing some results, published elsewhere, on future-oriented activities trialled within the European Union project “I SEE” and students’ experiences on them.FindingsRecent research has shown that future-oriented science learning activities, involving systems thinking, scenario development and backcasting, can let students broaden their futures perceptions, imagine alternatives and navigate uncertainty. Practising futures thinking in the context of contemporary science offers synergies through shared perspectives on uncertainty, probabilities and creative thinking.Originality/valueThis paper highlights the relevance of the futures field for science education. Future-oriented activities appear as promising tools in science education for fostering sustainability, agency and change. Yet, further work is needed to integrate futures aspects into science curricula. To that end, the paper calls for collaboration between the fields of futures studies and science education.

Integration is opening the door to a new journey toward oral health value-based care.

Oral health is a key component of overall health and there is a cost to not including it in the value-based transformation conversation. Health care needs to break down the silos that exist between dentistry and medicine so we can leverage integration to achieve value-based care.

Seeking Consensus on the Terminology of Value-Based Transformation Through use of a Delphi Process.

Collaboration among diverse stakeholders involved in the value transformation of health care requires consistent use of terminology. The objective of this study was to reach consensus definitions for the terms value-based care, value-based payment, and population health. A modified Delphi process was conducted from February 2017 to July 2017. An in-person panel meeting was followed by 3 rounds of surveys. Panelists anonymously rated individual components of definitions and full definitions on a 9-point Likert scale. Definitions were modified in an iterative process based on results of each survey round. Participants were a panel of 18 national leaders representing population health, health care delivery, academic medicine, payers, patient advocacy, and health care foundations. Main measures were survey ratings of definition components and definitions. At the conclusion of round 3, consensus was reached on the following definition for value-based payment, with 13 of 18 panelists (72.2%) assigning a high rating (7– 9) and 1 of 18 (5.6%) assigning a low rating (1–3): “Value-based payment aligns reimbursement with achievement of value-based care (health outcomes/cost) in a defined population with providers held accountable for achieving financial goals and health outcomes. Value-based payment encourages optimal care delivery, including coordination across healthcare disciplines and between the health care system and community resources, to improve health outcomes, for both individuals and populations.” The iterative process elucidated specific areas of agreement and disagreement for value-based care and population health but did not reach consensus. Policy makers cannot assume uniform interpretation of other concepts underlying health care reform efforts.

Language matters: precision health as a cross-cutting care, research and policy agenda

The biomedical research and healthcare delivery communities have increasingly come to focus their attention on the role of data and computation in order to improve the quality, safety, costs, and outcomes of both wellness promotion and care delivery. Depending on the scale of such efforts, and the environments in which they are situated, they are referred to variably as personalized or precision medicine, population health, clinical transformation, value-driven care, or value-based transformation. Despite the original intent of many efforts and publications that have sought to define personalized, precision, or data-driven approaches to improving health and wellness, the use of such terminology in current practice often treats said activities as discrete areas of endeavor within minimal cross-linkage across or between scales of inquiry. We believe that this current state creates numerous barriers that are preventing the advancement of relevant science, practice, and policy. As such, we believe that it is necessary to amplify and reaffirm our collective understanding that these fields share common means of inquiry, differentiated only by the units of measure being utilized, their sources of data, and the manner in which they are executed. Therefore, in this perspective, we explore and focus attention on such commonalities and then present a conceptual framework that links constituent activities into an integrated model that we refer to as a precision healthcare system. The presentation of this framework is intended to provide the basis for the types of shared, broad-based, and descriptive language needed to reference and realize such a framework.

Digital Transformation and Disruption of the Health Care Sector: Internet-Based Observational Study.

BackgroundDigital innovation, introduced across many industries, is a strong force of transformation. Some industries have seen faster transformation, whereas the health care sector only recently came into focus. A context where digital corporations move into health care, payers strive to keep rising costs at bay, and longer-living patients desire continuously improved quality of care points to a digital and value-based transformation with drastic implications for the health care sector.ObjectiveWe tried to operationalize the discussion within the health care sector around digital and disruptive innovation to identify what type of technological enablers, business models, and value networks seem to be emerging from different groups of innovators with respect to their digital transformational efforts.MethodsFrom the Forbes 2000 and CBinsights databases, we identified 100 leading technology, life science, and start-up companies active in the health care sector. Further analysis identified projects from these companies within a digital context that were subsequently evaluated using the following criteria: delivery of patient value, presence of a comprehensive and distinctive underlying business model, solutions provided, and customer needs addressed.ResultsOur methodological approach recorded more than 400 projects and collaborations. We identified patterns that show established corporations rely more on incremental innovation that supports their current business models, while start-ups engage their flexibility to explore new market segments with notable transformations of established business models. Thereby, start-ups offer higher promises of disruptive innovation. Additionally, start-ups offer more diversified value propositions addressing broader areas of the health care sector.ConclusionsDigital transformation is an opportunity to accelerate health care performance by lowering cost and improving quality of care. At an economic scale, business models can be strengthened and disruptive innovation models enabled. Corporations should look for collaborations with start-up companies to keep investment costs at bay and off the balance sheet. At the same time, the regulatory knowledge of established corporations might help start-ups to kick off digital disruption in the health care sector.