Value-Based Healthcare Initiatives in Practice: A Systematic Review

Abstract

EXECUTIVE SUMMARY Value-based initiatives are growing in importance as strategic models of healthcare management, prompting the need for an in-depth exploration of their outcome measures. This systematic review aimed to identify measures that are being used in the application of the value agenda. Multiple electronic databases (PubMed/MEDLINE, Embase, Scopus, Cochrane Central Register of Controlled Trials) were searched. Eligible studies reported various implementations of value-based healthcare initiatives. A qualitative approach was used to analyze their outcome measurements. Outcomes were classified according to a tier-level hierarchy. In a radar chart, we compared literature to cases from Harvard Business Publishing. The value agenda effect reported was described in terms of its impact on each domain of the value equation. A total of 7,195 records were retrieved; 47 studies were included. Forty studies used electronic health record systems for data origin. Only 16 used patient-reported outcome surveys to cover outcome tiers that are important to patients, and 3 reported outcomes to all 6 levels of our outcome measures hierarchy. A considerable proportion of the studies (36%) reported results that contributed to value-based financial outcomes focused on cost savings. However, a gap remains in measuring outcomes that matter to patients. A more complete application of the value agenda by health organizations requires advances in technology and culture change management.

Prediction of Long-Term Recovery From Disability Using Hemoglobin-Based Models: Results From a Cohort of 1,392 Patients Undergoing Spine Surgery

“…In view of the recent advancements in spine treatments, surgery is considered clinically effective from a medical perspective. However, healthcare systems are progressively moving toward value-based business models ( 2 ), with the definition of clinical success increasingly based on patient-reported outcome measures (PROMs) ( 3 ). The Oswestry disability index (ODI) is a widely-used, validated, and self-administered questionnaire to assess a patient's functional impairment related to the spinal condition, encompassing questions about personal care, movements, sleeping, and social life ( 4 ), and can be used to evaluate the outcomes from the patient's perspective ( 5 ).…”

Whose values are represented in value-based healthcare?

“…Although superficially attractive, much depends on how value-based healthcare is defined. Of concern is the possibility that PHI-payors will use a narrow interpretation of value-based healthcare as a way to reduce costs through inducements and financial penalties rather than one that encompasses healthcare outcomes that are important to patients and carers (Zanotto et al, 2021). We discuss the implications of a narrow PHI-payor-driven implementation of value-based healthcare, based primarily on cost reduction, for private psychiatric practice in Australia.…”

“…The evidence to date is not encouraging, with limited data on outcome measures that are relevant to mental health patients. More broadly, a systematic qualitative review of the outcome research on value-based healthcare in general found that of 47 included studies, only 16 used patient-reported outcome measures, and only 3 reported comprehensive outcomes (Zanotto et al, 2021). This was less than those specifically reporting cost-saving outcomes.…”

“…Importantly, these data are derived entirely from studies of primary care, medical and surgical specialities, and not mental health services. Zanotto et al (2021) concluded that a more comprehensive approach to assessment and implementation of value-based healthcare was needed, specifically focussing on the gap in outcome measures that are relevant to patients. Given that, formally defined value-based healthcare initiatives have not demonstrated effective outcome measurement – how then can the ‘value’ of healthcare be assessed?…”

“…In conclusion, the fiscally focused HH version of value-based healthcare is predicated on managed care incentive models that are ineffective in either cutting costs (Scott et al, 2018), or assessing and achieving patient-relevant outcomes (Zanotto et al, 2021). As Orwell observed, the meaning of a word, such as value-based healthcare, can be forcibly defined by the user of the term, and, for PHIs this could mean profit.…”