Shifting to triple value healthcare: Reflections from England

Abstract

Increasing need and demand because of growing and aging populations combined with stagnant or decreasing resources being invested into healthcare globally mean that a radical shift is needed to ensure that healthcare systems can meet current and future challenges. Quality-, safety- and efficiency-improvement approaches have been used as means to address many problems in healthcare and while they are essential and necessary, they are not sufficient to meet our current challenges. To build resilient and sustainable healthcare systems, we need a shift to focus on triple value healthcare, which will help healthcare professionals improve outcomes at the process, patient and population levels while also optimising resource utilisation. Here we present a brief history of the Quality and Evidence-based Healthcare model and then describe how value emerged as a predominant theme in England. We then highlight the four solutions that we, as part of the RightCare programme, designed and refined in the English NHS to turn theory into practice: We end with a description of how triple value is being introduced into Germany and steps that can be taken to facilitate its adoption.

Value in Healthcare and the Role of the Patient Voice

“…Such data can also be used to support professional decision making, relationship management and improvement actions, enabling value to accrue to providers. In these ways, it is possible to measure, incentivize and support delivery of triple-value healthcare at personal, technical and allocative levels ( Jani et al 2018).…”

Value-based genomic screening: exploring genomic screening for chronic diseases using triple value principles

“…This question gained even more importance after the 2008 financial crisis which resulted in austerities within healthcare systems internationally [24, 25]. Among many responses, the Triple Value Healthcare principles were introduced in 2010 and are currently used within the English National Health Service (NHS) RightCare Programme, the Prudent Healthcare Programme in Wales, the Realistic Medicine Programme in Scotland, the Model of Care in Saudi Arabia and have also been adopted by an EU Commission Working Group on value based healthcare [26–28]. They adapt Avedis Donabedian’s work and apply them to universal healthcare systems which have the two constraints of needing to deliver care to an entire population and doing so within a finite budget, neither of which are constraints in the US where Donabedian did most of his work [29].…”

The use of PROMs and shared decision‐making in medical encounters with patients: An opportunity to deliver value‐based health care to patients

“…In the Netherlands, the recent emphasis on value‐based health care (VBHC) in health policy is thought to provide new opportunities for SDM, especially by using information based on patient‐reported outcome measures (PROMs) in routine medical encounters. VBHC is a health care delivery model organized around patients' needs, aimed at improving outcomes that matter to patients/populations while optimizing resource utilization . PROMs are standardized questionnaires for patients to measure how they experience their health or quality of life, such as the SF‐36 and EQ‐5D .…”

“…In mental health care, this same type of questionnaires is used in a process called ROM (routine outcome monitoring), typically throughout the treatment process to monitor patients’ condition in line with the symptoms being treated . Three types of value have been distinguished in VBHC: (a) personal value—the delivery of services informed by what matters to the individual patient via SDM; (b) technical value—determined by how well resources are used within services for each purpose, favouring the right intervention for the right patient at the right moment; and (c) allocative value—determined by how assets are allocated to services for different purposes, thus maximizing health benefits at a population level. For a patient with knee arthrosis, the choice between being able to kneel in the garden vs having a knee prosthesis and less pain may be a matter of personal value; performing a technically optimal surgery and discharging the patient as soon as he can take care of himself at home may be a matter of technical value; identifying the patients that gain most quality‐adjusted life years out of the many with arthrosis, if only a limited number of surgeries can be performed, may be a matter of allocative value.…”

“…VBHC is a health care delivery model organized around patients' needs, 19 aimed at improving outcomes that matter to patients/populations while optimizing resource utilization. [20][21][22] PROMs are standardized questionnaires for patients to measure how they experience their health or quality of life, such as the SF-36 and EQ-5D. 23,24 In mental health care, this same type of questionnaires is used in a process called ROM (routine outcome monitoring), typically throughout the treatment process to monitor patients' condition in line with the symptoms being treated.…”