One thing that all healthcare stakeholders agree on is that our global health systems are near breaking point. The aging population and increasing incidence of chronic disease has led to an unsustainable cost explosion, and it is unsurprising that the pressure is mounting. The statistics make difficult and conclusive reading. Global healthcare spending is projected to increase at an annual rate of 5.4% in 2017–2022, from USD $7.724 trillion to USD $10.059 trillion [1]. Next to rising demand for healthcare, this is exasperated by high levels of clinical waste and unexplained variance in treatment and outcomes. It is estimated that $3 trillion goes to waste every year in healthcare with the USA alone accounting for $1 trillion [2]. Adding to the challenge is worryingly high staff burnout rates, administrative complexity and excessive and widely varying prices.
If you have recently received medical treatment or supported a family member or friend to engage the healthcare system, you will probably have experienced this wastefulness first-hand. Repeat procedures, gaps in information and long waiting times tell the story of overburdened and under-resourced hospitals. You may also have noticed that our healthcare systems tend to place their focus on acute and emergency episodes. Advanced prevention and disease management strategies are struggling to make inroads. Add access constraints and increasingly unhealthy lifestyles to this mix, and you will understand that we are in the midst of a global crisis. As a priority, the global healthcare community is urgently seeking strategies and solutions to rebalance the status quo. And despite these challenges, we have many reasons to be optimistic. Day-by-day, the healthcare community is collaborating to transition away from siloed and wasteful care delivery to more patient-centric and productive healthcare. But we still need to act faster!
First originating as a framework by Harvard Economist Michael Porter, value-based care is a delivery framework to improve health outcomes at lower cost. It focuses on what patients value and allocates resources according to the health outcomes delivered by the system. Therefore, when put into practice, to drive efficiency and raise quality standards, value-based care attaches incentives and payments according to results, not system workload. As a result, it encourages elements like quality, safety, the patient experience and their participation in decisions to be prioritized by the care team. Most importantly, value-based care seeks to avoid unnecessary diagnostic and therapeutic interventions. With the right execution, it supports cost-effective care delivery while still being compliant with evidence-based guidelines. Compare this with the traditional fee-for-service model where every time you see a doctor or undergo a medical test or procedure, you (or your insurance provider) pay for every step in the process. This payment (or reward) happens regardless of whether a diagnosis or procedure is successful or not, and whether or not the steps taken are high-quality or even considered as best practice. In other words, traditional healthcare is not necessarily working in the best interests of the patient. Value-based care seeks to address this contradiction by reorganizing healthcare around patient values, not volumes. However, we should not overlook that access to care is also an important part of the equation. The Philips Future Health Index accounts for this in a “value measure” [3] that assesses care delivery against the Quadruple Aim: better patient outcomes, improved patient experience, improved staff satisfaction, and a lower cost of care.
To align processes and incentives, one of the initial steps towards value-based care is the standardized measurement of (patient-reported) outcomes related to costs per capita. You start by measuring outcomes that matter to a particular population segment, and then apply those insights to tailor and improve interventions across the care pathway. This forms the basis for promising care pathway innovation and lean process optimization that is really gaining momentum in healthcare. However, the all-important final piece of the puzzle comes in allocating an objective payment that is weighted according to how well the system performed for the patient. Historically, in health systems defined by silos, fragmented ways of working, and legacy IT systems, this approach has been difficult to implement. Another challenge: as health systems and medical processes first went digital with Electronic Health Records, clinicians soon found themselves overwhelmed by data and unable to understand and interpret large swaths of digital information. Leap forward a few years and I am pleased to say that, as digitalization of healthcare gathers momentum, the situation is quickly improving. Moreover, I am convinced that we have a golden opportunity to standardize and bring meaningful scale to value-based care. The reason I am so optimistic: the steady integration of sophisticated health informatics. Best characterized as powerful data analytics networks, health informatics connects clinical processes and workflows end-to-end. And importantly, with the right configuration and data visualization capabilities, informatics can enable clinicians to interpret information from multiple sources and inform decision-making in real time. The positive impact for a value-based approach is three-fold: It’s complex work that requires all stakeholders in the system (clinicians, administrators, technicians, technology partners and supply-chain partners) to commit to the “measure, optimize, repeat” lean methodology. And there are also platform and systems integration challenges to be overcome. For example, seamless connectivity requires a common architecture that integrates hardware (databases and devices), software (analytics tools) and services around interoperable and secure data formats. While not insurmountable, these factors are slowing adoption and scale. The healthcare industry must confront and overcome these issues, especially as the medical Internet of Things (IoT) reaches maturity along with next-generation 5G connectivity.
Ultimately, the widespread adoption of value-based care requires openness, trust and strong collaboration and partnerships between all healthcare stakeholder groups.
Jan Kimpen
Chief Medical Officer, Royal Philips
Meantime, aside from accelerating value-based care, health informatics and digital innovation is enabling vital data aggregation and analytics that is literally changing the ways in which healthcare is accessed and experienced by patient and staff. Artificial Intelligence (AI) is an undeniably exciting trend. Whilst I believe we are still a number of years away from unstructured or ‘’true” AI in healthcare, AI applications are already helping clinicians and health systems to quantify and make sense of more data than ever before. In this respect, I am convinced that – in tandem with health informatics platforms – AI will continue to make healthcare more personal, predictive and precise. Here is a brief summary of the informatics and AI-enabled health technology solutions that I am so optimistic about:
Given this potential, I firmly believe that we can innovate ourselves out of the current crisis and towards a more promising global outlook for healthcare. But we should not lose sight of the fact that there is still a huge amount of work to be done to bring seamless digital solutions and value-based care to reality. In spite of a growing pool of pilots and visible pockets of excellence, health systems are proceeding with caution. A recent survey of 364 healthcare executives in the United States reported that just one third are experimenting with some form of value-based reimbursements [6]. If we are to really accelerate and bring scale to value-based care, there are clear priorities to tackle: Ultimately, the widespread adoption of value-based care requires openness, trust and strong collaboration and partnerships between all healthcare stakeholder groups. Technology and IT deployments, legal and regulatory frameworks, clinical skills, training and payment reform must each be managed in a comprehensive and progressive approach to healthcare reform. It is a demanding and long road ahead, but it is vital that we seize the opportunity before us. I am convinced that we have what it takes! [2] Sahni, N R, et al. How the U.S. Can Reduce Waste in Health Care Spending by $1 Trillion. Harvard Business Review. October 13, 2015. https://hbr.org/2015/10/how-the-u-s-can-reduce-waste-in-health-care-spending-by-1-trillion [3] https://www.philips.com/a-w/about/news/future-health-index/value-measure.html [4] Based on snapshot data from Philips Encore Anywhere database. Total nights of sleep therapy data stored within Encore Anywhere for US companies = 2,791,991,652 as of January 2018 [5] Subbe et al. Effect of an automated notification system for deteriorating ward patients on clinical outcomes. Critical Care (2017) [6] https://www.washingtonpost.com/sf/brand-connect/philips/transforming-healthcare/
Chief Medical Officer, Royal Philips Before joining Philips in 2016, Jan Kimpen, Professor of Pediatrics, was CEO of the University Medical Center in Utrecht. He leads the global clinical team of Philips, focusing on advocacy, customer partnerships, clinical research and medical consulting, and is responsible for the annual publication of the Philips Future Health Index. He is a strategic advisor for commercial and clinical strategy, market reimbursement, R&D roadmaps and partnerships and M&A, and provides thought leadership on relevant clinical and medical topics. Jan participates in the WEF Global Future Council on Healthcare, the American Heart Association alliance and the Board of Sanara Ventures in Israel. Jan is president of COCIR, the European trade union for imaging, healthcare informatics and radiotherapy.
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