Gemma Badger, Senior Associate, and Rob McGough, Partner, Hill Dickinson LLP, examine how digital health solutions and medtech can align with VBHC to create mutually beneficial outcomes
Value-based approaches to healthcare align stakeholders to focus on delivering outcomes which matter to patients. There is no single agreed definition of ‘value’; however, outcomes are commonly measured on both an individual and broader population basis. VBHC targets better patient-centric outcomes at most affordable cost, but best value does not mean ‘cheapest’. Affordability goes beyond the lowest financial cost of individual inputs. Instead, the measurement sought can be of holistic value achieved through a combination of inputs over time, and, optimally, throughout a patient journey.
Briefly, challenges encountered in healthcare systems globally where VBHC may offer solutions include:
• Financial – the OECD has estimated that growth in healthcare costs is outpacing growth in GDP. Even if money were no object, spending does not automatically improve outcomes – many countries spending the most on healthcare are not achieving commensurately better health results for their population.
• Growth in cost is also exacerbating health inequalities.
• Research produces more treatment options, but those treatments are expensive, and availability increases demand beyond what is achievable within most systems.
• Healthcare workers risk burning out – there is insufficient funding for professionals required, and those remaining can experience decreased job satisfaction through feeling unable to deliver the best outcomes owing to factors beyond their control.
Aligning VBHC and digital/medtech solutions
Digital and medtech adoption can be part of the solution to the challenges above. As such, it is not difficult to see how those solutions and VBHC are mutually beneficial, for example:
VBHC is patient-centric – medtech and digital solutions offer many options for improving patient outcomes and experience:
Patient focus is a key component of digital innovation. Some of the patient-centric benefits include:
• Waiting list management – options for patients to be seen for appointments more quickly.
• Speed of diagnosis – innovations enabling quicker diagnoses due to better list management, through new technologies enabling clinicians in different locations to collaborate to accelerate results or supported through AI.
• Remote / continuous monitoring – monitoring patients without travel for tests, enabling them to manage their conditions more independently by reacting to self administered testing – thereby feeling more in control, providing more information on condition fluctuations over time to enable clinicians to spot changes and adjust medications accordingly.
• Collaboration – joining up digital records between stakeholders in patient care can improve patient experience in many ways, including avoiding them needing to ‘retell’ their story at every appointment and enabling caregivers to stay informed and react proactively to new information. An example that we are aware of is an app supporting the parents of neurodiverse children who may be managing input from a variety of sources including healthcare, but also social care and education provision.
VBHC prioritises efficiency – digital solutions can deliver this:
While VBHC is about more than the financials, stripping out wasted costs from systems and pathways (if not always reducing the cost of individual inputs) is key. This solution can release funds to spend elsewhere and produce more efficient, effective systems. Digital solutions which redesign systems and processes, rather than simply digitising existing ones, can increase efficiency and decrease cost, and are therefore key to VBHC. They can deliver benefits across systems, from funders to providers, to suppliers and the broader population.
VBHC is underpinned by powerful data insights:
Simply measuring and recording information will not create value. However, providing healthcare systems and individual clinicians with access to a range of data points to assess how interventions are working and the success of outcomes achieved from a broad range of perspectives (e.g. clinical, financial, patient experience) is a key enabler to producing and demonstrating value. Digital medtech solutions produce, record, monitor and store a wide range of data across full cycles of care. Harnessed and effectively analysed, this data underpins VBHC approaches enabling healthcare systems and individuals to understand what is working and develop interventions / pathways to improve outcomes.
There are undoubtedly tricky ‘spin-off’ issues to resolve relating to data in healthcare systems including agreement on standardised collection and coding for transparency and a ‘single version of the truth’, together with legal questions around recording, access and sharing. However, when these issues are managed collaboratively, data that digital solutions offer is immensely powerful in making VBHC work.
Planetary health is an important stakeholder in VBHC – digital and medtech solutions support this:
For example, travel to healthcare settings for appointments is a major source of emissions. Using digital healthcare practices to reduce travel, or localising diagnosis / treatment so that patients / their visitors do not travel far will have a significant impact.
Likewise, any approach that removes waste from the system, including eliminating unnecessary procedures and the physical resource accompanying these, also has the potential to have a positive environmental impact.
Both VBHC and digital solutions offer potential to improve workforce experience:
Caregivers are key stakeholders in VBHC, such that solutions which improve their experience tackling issues including poor working environments, excessive workload and inefficient practices built into systems are a core component. Digital innovation supports this, for example through:
• Telehealth reducing workload / freeing up time to see more patients or spend more time with them.
• Digitally enabled collaborative approaches allowing caregivers to share workload and collaborate on care delivery.
• Instantly available data enabling clinicians to assess outcomes in real time
Using value-based procurement and contracting to implement these shifts
Common between VBHC and digital adoption is the need for stakeholders to work collaboratively and transparently together often over a long period of time. Both approaches require a clear shared view about what is working and what is not, as well as a joint appetite for innovation, taking risks and shared learning from doing so.
While much about the relationships needed to implement these approaches can only be built through individual interactions and a more nebulous ‘will to succeed’, there are commercial and legal approaches which would underpin these to ensure a better chance of success. We have seen numerous projects flounder without a core binding legal structure to allow them to navigate disputes and changes in policy.
In VBHC, the procurement process is designed on value, ensuring that all parties involved understand the aims in terms of outcomes from the outset (including during pre-tender engagement), with these having been formulated by a multidisciplinary team of stakeholders. The award process defines value to go beyond financial value, and there is continual development within the relevant marketplace with feedback provided to unsuccessful suppliers, and a contract management focus post-award. Procurement approaches can also be designed around frameworks linking together healthcare products and services, healthcare providers and data providers to produce the kinds of measures needed to drive and demonstrate value.
Value-based contracting prioritises discussion of the ultimate agreement from the outset of negotiations and, importantly, reward based on outcomes not just inputs. It looks to build in terms to enable an incremental approach to achieving outcomes, and transparent risk share, which is also important for digital and medtech innovation and the collaborative approach to developing products to meet needs over time.
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