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Diane Bell looks at how Value Based Care can happen at a greater scale and what steps healthcare leaders should follow to transform lives and create a positive human future
Value-based care (VBC) – the ability to improve outcomes using the resources available – is recognised worldwide as a laudable ambition for healthcare services. Having seen VBC used to great effect with clients to improve people’s lives, we believe patients would benefit from its widespread adoption in the NHS. And yet, even though VBC has been discussed and promoted for over a decade, only pockets of providers have embraced it. So, how can VBC happen where you are?
We recently spoke with global healthcare leaders to understand their perceptions of VBC, and how they differed across global regions. Results revealed that value in healthcare was perceived to be increasing, regardless of geographic location. This was due to improving patient satisfaction and quality of life, and not necessarily from reducing healthcare costs. While this was celebrated by participants in regions such as the US and Middle East, it seemed to be less appreciated by UK participants working in a system where the emphasis is on cost-control and population-based approaches are taken as standard.
According to the research, the UK was more likely to focus on the operational issues relating to VBC – integrating care and streamlining processes – and less likely to focus on improving population health, compared with other global regions. This may be because we take for granted that the NHS is a population-based service because it is funded and arranged in that way, unlike in the US and Nordics.
However, it also suggests a relative disinterest in the NHS in prevention and early intervention – key tenants of the population health approach – compared with other global healthcare systems.
Finally, we found that, while respondents are aware of the existence of VBC case studies and approaches, there continues to be appetite for learning to be shared. So, as the early adopters mature in their use of VBC, information about their experiences needs to continue to be made available, demonstrating not just how to establish VBC but how to make it flourish.
Making VBC relevant
We all need to be smarter about making VBC relevant to NHS professionals and managers. And this doesn’t have to be complicated or difficult. For example, in a West Midlands NHS trust, patients referred to their outpatients physio clinic are asked to complete and return a short questionnaire that is then used to categorise their risk of a poor outcome. Based on which category a patient falls into, the clinic staff decide which type of practitioner is best suited to meet their needs. The result? Patients get to see the right professional for their needs from the outset, junior staff aren’t overwhelmed with complicated cases, and senior staff feel their skills are being put to best use. A win-win for patients and staff alike, and a simple example of taking a VBC approach.
Alongside this, we need to do more to celebrate our successes and, with that, promote better value healthcare as being just as important (if not more) as cost savings. For example, since 2014, all musculoskeletal (MSK) care in Bedfordshire has been delivered by a single integrated service called Circle MSK, which is free to NHS patients. Over the last five years, it’s improved patient outcomes, reduced waiting times, improved satisfaction, invested in technological innovation and biomechanical treatments as alternatives to surgery, as well as delivering an estimated £19 million in cost savings.
Such experiences are not unique to Bedfordshire either – the first two years of a similar model in Greenwich are producing similar results. And this is without falling into the traps of cream-skimming or reducing quality of care. In Bedfordshire, the integrated MSK system managed 14 per cent referral growth on a fixed budget, and received a highly positive report from the Care Quality Commission after its inspection in September 2018.
It can be done. To get started, there are six simple steps:
1. Just do it. There will always be plenty of reasons not to start such as “it’s not the right time” or “I need permission to do this” but, as the examples illustrate, the benefits you stand to achieve will outweigh any potential reasons not to start.
2. Build trust by being realistic. Start small with a few passionate people and grow. Be sensitive to the burden of change on already stretched clinicians. Describe the benefits to them from their perspective and from their patients’ viewpoints.
3. Organise the change around patients. Find out more about who your patients are and what matters to them, so you know how to design care that makes a positive difference in their lives. This can be as simple as talking to them and asking them, making patient engagement activities meaningful.
4. Get a grip on data. Work out what’s important to know about and what isn’t, when you need to know it and when you don’t, and how you can simply and easily capture it.
5. Learn from those a step ahead. The networks and case studies are out there, through LinkedIn or through organisations such as the International Consortium for Health Outcomes Measurement (IHCOM). Tap into them and don’t be afraid to ask.
6. Remember why you’re doing this. Don’t get lost in the details of actions and plans. Keep aiming to improve the outcomes of those you serve.
With the benefits of VBC recognised globally, there is clear appetite to make it happen at a greater scale. By taking the steps above, healthcare leaders can make VBC happen across the NHS – transforming lives and creating a positive human future.
Diane Bell is a healthcare expert at PA Consulting.