Value Based Healthcare Experts

One of the most popular games of chance in the world is the lottery, we have the Euro Millions, Mega Millions in the US and a whole range of national lotteries and Lottos…there are vast numbers of people who play this in the hope that they will win the big prize and it will change their life forever. Healthcare can also be a lottery, but instead of needing to pick the right six numbers in sequence, you need to have the right letters and numbers in your postal code to become a winner in the game of healthcare provision. As the CEO of Luach Consulting Group and Board Member for the European Association of Value Based Healthcare (EAVBHC), I have view that quality and affordable healthcare shouldn’t be a game of chance, but that it’s the right of all citizens. The belief is that the adoption of value based healthcare is key to addressing these inequalities and was a question posed to a group of multidisciplinary stakeholders from around the world at the EAVBHC session I led at the ICHOM Conference in Barcelona in 2023. In this short article consideration is given to how to increase the chances of winning on the VBHC lottery, by focusing on the ‘what’, the ‘how’ and the ‘when’ to implement a value based approach to healthcare. The What Value is a homonym. A word that can and does mean different things to different people. In the context of value based healthcare there is an agreed definition that value means improved patient outcomes at lower cost. However there remain a number of challenges with this i.e. How do we define and outcome, what tangible benefits are being delivered? Who is responsible for defining the outcome – the healthcare professional or the patient? How to we know the outcome has been achieved, what measures do we need to use? Opinions from the assembled delegates at the EAVBHC session, particularly clinical colleagues, was focused very much on the fact that the patient should be at the centre of determining what an outcome should look like. However, within the group and the wider ICHOM conference the view was generally that this was easier said than done. Patients are people and we are all diverse in our views as to what we want, and therefore health systems need to create mechanisms that can accurately reflect the overall consensus of what is desired and required. That said we are living in world of limited financial resources, whether we like it or not delivering value based healthcare at scale requires that the stated outcomes are affordable. This balance between clinical and commercial is traditionally fraught with tensions, largely down to traditional behaviours and tug of war between front line care staff (resources) and hospital administrators (finance). In determining the “what”, patient groups, healthcare registries, ICHOM and the use of organisations such as the EAVBHC could all be a rich source of information for systems looking to specify the desired outcomes as a starting point for a value based approach. The How Despite the fact that VBHC has been around for many years, there is still much debate as to how it can be introduced, to increase the chances of success, I’ve recommended these three steps to help you: 1. Establish a coalition to support the change - The drivers for system change towards value are predominantly through the efforts of clinical leaders, with one colleague from Brazil in the group clearly passionate about the need for a value approach, yet frustrated at the speed and process of adoption. in South Africa they are fortunate to have system leaders, such as the COO at Healthforce, who are enlightened and can set the strategy to facilitate a more value based approach. A third level of creating momentum is through the leadership of Healthcare Commercial, (both finance and procurement), with examples being shared by both Canada and the UK. The authors experience and assertion is that for a value based strategy to have any chance of being implemented, there needs to be a blended approach and commitment from both clinical, senior leadership and commercial stakeholders to commit resources and energy to delivering the programmes. If you can garner support from political leaders, then this will allow you to move at pace and scale. 2. Create system learning - by a developing and delivering a comprehensive education package available for both internal stakeholders (Clinical. Operations, Finance and Commercial) groups and external (Industry partners) focusing on the principles, practices and system interconnections relating to value based practices. 3. Be incremental - In the same way you wouldn’t go out and run a marathon after being on the couch for a lifetime, its about taking small steps. In this case by creating pilot studies that can be used to help test how best value can be adopted in your health system, allowing you to highlight any challenges in a controlled environment and create solutions to address them. The When I’m sure we’ve all experienced the challenge of the “should” when it comes to going on a diet, exercising or going back to study, the hardest part is actually starting. We plan, we strategize and put things off until finally something happens that forces us to take action. Health systems need to recognise the burning platform for change that exists in terms of increasing demand set against a backdrop of limited financial resources; and that by failing to address health inequalities now we will only make the situation worse. Like many of the delegates and health systems attending the session and the ICHOM conference, it is clear to me that the time to take action is now. Brian Mangan FCIPS CEO Luach Consulting Group www.luachcg.com Board member European Association of Value Based Healthcare EUROPEAN ASSOCIATION OF VALUE-BASED HEALTH CARE -Your health, your choice- (eavbhc.org)