The value-based care (VBC) framework was first introduced in the United States in 2006 to combat fast-rising healthcare expenditures. The VBC framework is a healthcare delivery model that aims to achieve maximum health outcomes relative to the cost of delivering care. At its core, VBC focuses on outcomes that matter to patients, such as symptom control, faster recovery and patient experience. The framework includes measuring outcomes and costs of providing and delivering care across the care pathway, aligning payment models that incentivise quality and efficiency, via an integrated, patient-centric operating model, supported by robust data and an effective governance framework. The most advanced VBC adoption has been in the United States, the Netherlands, and parts of Scandinavia, with emerging programmes in the United Kingdom, Brazil, and elsewhere in Europe. In this paper, we have identified the top three lessons learned from our work with organisations worldwide, and propose solutions needed to make VBC more effective.
Discussion points:
- Focusing on meaningful outcomes and actionable data: Many organisations focus heavily on contract design and financial incentives, but underinvest in operational infrastructure such as data integration, workflows and analytics.
- Balancing administrative complexity with pragmatism: Many early VBC initiatives underperformed not because of a lack of ambition or goal, but due to the underestimation of the technical and operational demands that are required.
- Moving away from activity-based reimbursement to a value-based model: A VBC model’s aim to reduce utilisation is in direct conflict with organisations’ goal to improve financial performance when incentives and compensation continue to be based on activity or volume.
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