Value Based Care and Patient-Centered Care: Divergent or Complementary?

Abstract

Two distinct but overlapping care philosophies have emerged in cancer care: patient-centered care (PCC) and value-based care (VBC). Value in healthcare has been defined as the quality of care (measured typically by healthcare outcomes) modified by cost. In this conception of value, patient-centeredness is one important but not necessarily dominant quality measure. In contrast, PCC includes multiple domains of patient-centeredness and places the patient and family central to all decisions and evaluations of quality. The alignment of PCC and VBC is complicated by several tensions, including a relative lack of patient experience and preference measures, and conceptions of cost that are payer-focused instead of patient-focused. Several strategies may help to align these two philosophies, including the use of patient-reported outcomes in clinical trials and value determinations, and the purposeful integration of patient preference in clinical decisions and guidelines. Innovative models of care, including accountable care organizations and oncology patient-centered medical homes, may also facilitate alignment through improved care coordination and quality-based payment incentives. Ultimately, VBC and PCC will only be aligned if patient-centered outcomes, perspectives, and preferences are explicitly incorporated into the definitions and metrics of quality, cost, and value that will increasingly influence the delivery of cancer care.

Opportunities and Risks of Terminological Ambiguity: The Perception of Value in Value-Based Healthcare – A Multi-Method Study

“…This argument is in line with other scholars arguing that the patient perceives value as the interaction and relational aspect between the provider and the patient [12,35] rather than only the outcome of a treatment. Patient value may not be solely dependent on outcome and cost for all patients [36,37] . It is highly unlikely that all patients would value the same measure of outcome of a care episode.…”

Patient Participation in Cancer Network Governance: A Six-year Case Study

“…The lack of PLC participation here raises a contradiction that is likely to increase tension in the network over time. Notions of value in PCC may differ from those arising from government concerns such as health economics (44), and some describe value-based care and PCC in opposition to one another (45). In this sense, indicators of patient experience could, if they moved in opposite directions to cost control or e ciency indicators, pose problems to national network leaders.…”

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

“…First, to deliver care that is meaningful to patients and caregivers, we need to understand how patients and caregivers define "good" outcomes and overall well-being, even if beyond traditional conceptualizations of health (e.g., beyond disease, symptoms). Tseng and Hicks (2016) noted that it is important to align person-centred care and value-based care by incorporating patient data (including preferences and perspectives) into quality metrics to influence the delivery of care. We push further and argue that this can be facilitated by a learning health system approach -collecting these data, feeding the information back to clinical teams and tailoring care and future research in an ongoing quality improvement cycle.…”