The case of value-based healthcare for people living with complex long-term conditions

Abstract

BackgroundThere is a trend towards value-based health service, striving to cut costs while generating value for the patient. The overall objective comprises higher-quality health services and improved patient safety and cost efficiency. The approach could align with patient-centred care, as it entails a focus on the patient’s experience of her or his entire cycle of care, including the use of well-defined outcome measurements. Challenges arise when the approach is applied to health services for people living with long-term complex conditions that require support from various healthcare services. The aim of this work is to critically discuss the value-based approach and its implications for patients with long-term complex conditions. Two cases from clinical practice and research form the foundation for our reasoning, illustrating several challenges regarding value-based health services for people living with long-term complex conditions.DiscussionAchieving value-based health services that provide the health outcomes that matter to patients and providing greater patient-centredness will place increased demands on the healthcare system. Patients and their informal caregivers must be included in the development and establishment of outcome measures. The outcome measures must be standardized to allow evaluation of specific conditions at an aggregated level, but they must also be sensitive enough to capture each patient’s individual needs and goals. Healthcare systems that strive to establish value-based services must collaborate beyond the organizational boundaries to create clear patient trajectories in order to avoid fragmentation.SummaryThe shift towards value-based health services has the potential to align healthcare-service delivery with patient-centred care if serious efforts to take the patient’s perspective into account are made. This is especially challenging in fragmented healthcare systems and for patients with long-term- and multi-setting-care needs.

“We are all there for the same purpose”: Support for an integrated community exercise program for older adults with HF and COPD

“…The results of this study suggest that community maintenance programs based on functional status and symptoms instead of primary diagnosis can be delivered consecutively to older adults with HF and COPD, which aligns with previous pilot work (Adsett et al, 2013;Woo et al, 2009). Amidst ongoing conversations around a valuebased approach to healthcare (Elf et al, 2017;Weeks & Weinstein, 2015), integrated community-based programs offer the potential to maintain the gains that currently diminish following the completion of rehabilitation (Brooks, Krip, Mangovski-Alzamora, & Goldstein, 2002), shifting the focus beyond the program cycle itself to include the patient's experience of their entire cycle of care. This practical strategy also extends the availability of exercise to older adults with HF and COPD, who reported a dearth of available and appropriate community-based programs following discharge from rehabilitation.…”

Fighting healthcare rocketing costs with value-based medicine: the case of stroke management

“…These calculate health and wellbeing gains using pre-and post-intervention surveys [5], encompassing caregiver-defined (PROMs) or patientdefined (PREMs) questions/issues. In this way, patients and their informal caregivers are included in the development of the outcome review, measuring the procedure efficiency based on the patients' priorities [12].…”

“…This comes together with a situation of chronic lack of rehabilitation places in many OECD countries, such as Italy, where, according to recent estimations, only 20% of the necessary high-specialization rehab beds are available [87]. Logistic aspects (increased number of patients needing rehabilitation and chronic lack of beds), economical considerations (reduction in reimbursements, leading to shorter hospitalizations [88]) and recent data, supporting the early discharge of subacute stroke patients [89], are moving the prize for value toward smart solutions for home monitoring and tele-rehabilitation [12,90]. Notwithstanding such techniques are still in their infancy, encouraging feasibility and costbenefit studies are showing how, despite still inferior to standard in-person procedures [91], tele-rehabilitation is largely cheaper than standard approaches, and it expands the service to individuals who would not otherwise have received any [92].…”

Toward a Person-Centred Learning Health System: Understanding Value from the Perspectives of Patients and Caregivers

“…The focus on outcomes moves away from a traditional focus on volumes of service or cost reductions alone (Porter 2009(Porter , 2010. The challenge is that health systems often operate in silos; thus, any focus on value tends to be sector specific (such as in hospital), which is only one component of the patient's care journey (Elf et al 2017). Work to date on value-based healthcare has primarily considered disease-specific and symptom-oriented outcomes, with little focus on understanding how patients and caregivers define valuebased outcomes (Anderson et al 2017;Ersek et al 2017).…”