Examining Value Based Health System

Introduction

Healthcare provision is accompanied by costs and expenditures that accompany the implementation of measures to improve healthcare in the country. Healthcare is largely a responsibility of the government with regulating bodies like NHS England committing their efforts to provision of healthcare within their respective jurisdictions. However, Healthcare system has been grappling with problems occasioning from persistence in medical conditions, widespread chronic diseases such as heart cancer and obesity (Lakdawalla et al 2018). These problems create pressure on the healthcare system.

One of the aspects of the healthcare system that is severely affected by these problems is funding. The costs to meet the health care needs have increasingly gone up making governments adjust their budgets to meet healthcare needs (NHS 2013). Occasionally, however, government has failed to meet the runaway costs of healthcare ad in some instances have had the budgetary allocations to healthcare cut to meet other needs. All these problems have led to deterioration in the quality of healthcare provided to patients. The value-based health system is suggested to be the solution to these problems and boost the quality of healthcare (EFPIA 2019).

A value-based healthcare system seeks to restructure the healthcare system and healthcare delivery with a shift in the orientation and approach toward health service delivery (Porter 2014). In this case, healthcare should be tailored to the value it will create for the patients. With reports of wasteful spending of the budgetary allocations to healthcare of up to 10% or 30% of the expenditures (OECD 2017), the value-based healthcare system has been proposed to be the ideal alternative and the needed change in healthcare.

In value-based health system, value is measured through the level of care of the patient through the treatment cycle and is understood by prioritizing health outcomes that matter to the patient over the cost of delivering the outcomes (Lakdawalla 2013). This places the patient’s experience at the core focus of a value-based health system. This results in reallocation of resources to meet the patient’s outcomes and thus creating cost-effectiveness.

Value-based healthcare is a model where providers such as hospitals and physicians are paid according to patient outcomes. The reward comes after helping the patient improve their health, reduce the incidences and effects of chronic medical conditions and enabling patients to live healthier (Porter 2014). All these aspects are measured using solid evidence-based approach. This places value-based health system as a promising approach in enhancing health of the patients and managing their conditions. This promise warrants examination of whether evidence-based healthcare system is indeed effective and the experience of the patients in value-based healthcare. Additionally, understanding how value-based healthcare can tackle the pressures associated with technological advancements and increasingly complex and multiple health complications of patients (Porter 2014).

Study objectives

This study seeks to achieve the following objectives

Examining the benefits of value-based healthcare

Examining value-based healthcare models

Exploring patient experience in the value-based health system

Hypothesis

This study is based on the following hypothesis

A value-based health system is an effective approach to improving health care.

Introduction

The literature review chapter entails examination of scholarly works relevant to the objectives of the study. This helps to present diverse views on the topic of discussion and paints a clear picture of the available information in relation to the topic of study. This chapter thus presents an examination of the study objectives by utilizing literature from other scholarly works.

Benefits of value-based healthcare

Value-based health care is mainly focused on improving the quality of health service delivery and the capacity of the healthcare system to manage and address key health problems (European Union 2019). Advocators for value-based healthcare have pointed out some benefits of this approach.

Effective approach

Different scholars have supported the idea that a value-based health system is more effective compared to conventional health care (Larsson et al 2010). However, the measures of effectiveness vary from one author to another. EFPIA (2019) points that value-based care health system ensures that the patient-relevant outcomes in are achieved in a conceited way across providers. On the other hand, SAS (2016) presents that a Value-based health system is more effective by allowing for provision of integrated care and optimal utilization of the available resources.

However, critiques point out that value-based healthcare systems are contradictory in terms of some of the measures proposes to increase integrated care (Lakdawalla et al 2018). For instance, first responders may opt to provide care to the patients closer to their homes, while for specialized care, it may be noble for patients to be confined at the health facility to access specialized services and encounter specialized doctors.

Reduction on the healthcare costs by minimizing wastages

According to a report from OECD (2017) at least 10% of the monetary allocations o healthcare do not get return on investment. Value-based healthcare is therefore expected to reduce the healthcare costs by minimizing wastages through identifying waste by minimizing the costs, shifting resources from lower to higher-value activity and ensuring that the right persons are treated at the right time (European Union 2019).

Enhancing the quality of healthcare

Quality and performance go hand in hand and a performing healthcare system should have tailored healthcare to fit its purpose. According to EFPIA (2019), value-based healthcare can facilitate timely provision of health services by directing efforts such as prevention and interventions that bring most value to the patients. Accessibility of health care enhances the quality of service delivery since the patient will have a crucial role to play in evaluating the services provided (OECD 2017). Furthermore, value-based health system creates an environment for championing preventive interventions and integrating innovative solutions in provision of healthcare. However, OECD (2017) points out moving from free-for- service of payment models to outcome-based could reduce access to access to interventions that are low value to the patients. These interventions include caesarean section and percutaneous coronary intervention in stable patients.

Value-based healthcare model

Considering the paradigm shift of value-based care from the conventional healthcare approach, there is an accompanied healthcare model for value-based healthcare. According to the independent (2017), value-based healthcare proposes a change in the payment model from the current free-to-service to value-based reimbursement.

Value-based reimbursement, however, is premised on key models such as accountable care organizations,

patient-centered medical homes, pay for performance, bundled or episodic payment, capitation and shared savings (Lakdawalla et al 2018). However, one of the major challenges I transitioning to value-based models is the huge investments in information technology required to acquire, aggregate and analyse data.

In value-based healthcare, patient centred medical homes are coordinated approach to patient care often focused on primary care and led by the patient’s primary physician tasked with directing all the patient’s clinical care teams (Independent Health 2017). Electronic medical records are shared among the practitioners forming part of the care team with the aim of reducing redundant care and associated costs.

Accountable care organizations, on the other hand, are designed to provide high-quality care to Medicare patients (EFPIA 2019). This involves collective and teamwork from the doctors, hospitals and other health providers who commit to deliver the best possible care at lowest possible cost. On the other hand, under hospital value-based purchasing, acute care hospitals receive adjusted payments based on care they offer (European Union 2019). In this regard, the hospitals are encouraged to offer quality and improve the safety of patients through reducing adverse events, adopting evidence-based care standards, creating better patient experiences and increasing care transparency (NHS 2013).

Patient experience in a value-based health system

NHS (2013) explains that patient experience is the perception of how care is by the patient and their family. The patient’s perspectives and feelings about the care that is accorded to them are what constitutes their experience in healthcare. This experience can be both positive and negative. Thus patient experience is largely determined by the approach of the health practitioners to the patients and examination and explanation of the entire process of healthcare to the patients (Larsson et al 2010). In conventional healthcare, which is often faced by myriad of challenges, patient experience is largely negative. However, Value-based healthcare seeks to change the narrative by adopting patient-centred approach and quality service delivery aimed at improving the patient experience (European Union 2019).

A value-based health system appears to offer a commitment to improving the patient experience with the system (EFPIA 2019). This is due to the fact that value-based healthcare advocates for patient engagement, staff engagement and measurement and reporting of the health care provider and the patient’s perspective or feedback. These are pointed out by NHS (2013) as key measures of improving patient’s experience.

The patient-centered approach in healthcare is one of the ways of enhancing positive patient experience (NHS 2013). This is achieved through effective communication, engaging the patient in all aspects of healthcare and collecting patient’s feedback through surveys and other methods. This feedbacks enable the health practitioners to evaluate if the healthcare provided satisfied the patient (Lakdawalla et al 2018). It is worth noting that patient experience is personal and thus the health facility will not possibly satisfy all the patients, however, value-based healthcare seeks to satisfy the greatest percentage possible of the patients (EFPIA 2019).

Conclusion

This chapter has reviewed literature on the key objectives of this study regarding value-based healthcare. It goes without saying that value-based healthcare presents hope for revolutionizing healthcare since compared to the conventional methods, most literature view this approach as more effective and promising in delivering the desired change in healthcare

Study design

A research study is guided by the study design of the data collection and analysis. According to Cresswell (2011), quantitative and qualitative approaches are the main components of the study design. This study is based on qualitative analysis. Cropley (2019) explains that qualitative research is useful in examining the differences between variables and cause and effect relationships among them. In examining the value-based healthcare system, qualitative approach will result in gaining insights on the key elements of human behaviour including patient experience which can’t be quantified.

Procedure for the study

This study will source data from both primary and secondary sources. In primary data collection, questionnaires will be distributed to a random sample of 20 patients in a health facility to capture their experience in healthcare provided at the health facility. Additionally, secondary research will be conducted where scholarly works relevant to the study objective will serve as sources of data. The researcher will source these works over the internet through a search strategy guided by exclusion and inclusion criteria for analysis. Cresswell (2011) explains that one of the advantages of using secondary sources is vested on the abundance or relevant literature from associated studies that have been conducted by other scholars allowing the researcher ability to analyse these sources.

A literature search will be conducted using the available online search engines and websites presenting scholarly peer-reviewed journals will be considered. Keywords such as value-based care, health system, health care, and patient experience will be used in guiding the search for literature. With regard to the exclusion criteria, all sources dating 10 years and above from the year of their publication to date will not be used in the study regardless of how relevant they may be. The researcher will focus on recent publications as sources of data.

Data analysis and management

This study will adopt a qualitative data analysis approach. According to Kumar (2011), qualitative data analysis adopts a particular approach to enable the researcher to conclusively draw inferences, descriptions, and narratives from the data. In this case, qualitative data analysis entails documenting the collected data, categorization of data into concepts, connection of data to show how one aspect may influence the other, and corroboration by evaluating alternative explanations to the data or disconfirming the evidence. Following the data analysis, the information is presented in form of descriptive or narratives as the researcher compares the key variables of the study.

In order to uphold and conform to the ethical standard of conducting research, the researcher will acknowledge the scholarly works cited in the study. These in-text citations and references comply with the academic regulations for using other scholarly works in the study. During primary data collection, consent or approval will be obtained from the respondents before distributing questionnaires. The researcher will adhere to ethics in primary research by, for instance, ensuring confidentiality of data collected from respondents.

References

Creswell, J.W. (2017) Qualitative Inquiry and Research Design: Choosing Among Five Approaches. London. Sage

Cropley, A. J. (2019, 2nd updated, revised, and enlarged edition). Qualitative research methods: A practice-oriented introduction for students of psychology and education. Riga, Latvia: Zinātne. (open-access – doi: 10.13140/RG.2.1.3095.6888)

European Federation of Pharmaceutical Industries and Associations (EFPIA): Value-Based healthcare - an industry perspective. 2019; Available from

European Union (2019): defining value in “value-based healthcare”; Report of the Expert Panel on effective ways of investing in Health (EXPH). Luxemburg. European Union.

Independent Health (2017) A Catalyst for Change in Moving to a Value-based Model of Health Care Delivery; a special report from independent health, Independent Health Association, Inc

Kumar, R. (2011): Research methodology, a step by step guide for the beginners, 3rd edition, Padstow, Cornwall; TJ international Ltd/p>

Lakdawalla D, Doshi J, Garrison L, Phelps C, Basu A, and Danzon P (2018): Defining Elements of Value in Health Care, A Health Economics Approach: An ISPOR Special Task Force Report. Elsevier Inc.

Larrson S, Lawyer P and Silverstein M (2010): From concept to reality; putting value-based care into practice in Sweden. The Bolton Consulting group.

NHS (2013) The Patient Experience Book A collection of the NHS Institute for Innovation and Improvement’s guidance and support. NHS Institute for Innovation and Improvement

Organization Organisation for Economic Co-operation and Development (OECD). Tackling Wasteful Spending on Health. 2017; Available from

Porter M (2014) Value-Based Health Care Delivery, Harvard Business School.

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