Global healthcare thought-leaders are increasingly focused on the shift from ‘volume’ to ‘value’, thanks to the work of Harvard’s Michael Porter. Many have assumed Australia is well positioned to take a leading role in the ‘value-based healthcare’ (VBHC) movement – but is this really the case?
It’s important to first look at some of the key foundation stones of VBHC:
- Awareness and Intent: VBHC requires a shared commitment among stakeholders – experts, payers, clinicians, administrators, and consumers – to move away from healthcare payments focused on volume of services delivered or products utilised, and towards a system where payments are focused on the value of outcomes delivered;
- Data and Metrics: Connected and shared data systems are used to track and assess the outcomes achieved, and costs incurred for services delivered. While varying in size and complexity, the ability to track outcomes, agreed by stakeholders, through diagnosis and the care pathway is critical;
- Integrated Care Pathways: VBHC requires optimal treatment pathways be adopted and followed by care-providers to improve the efficiencies and outcomes of healthcare;
- Bundled Care: Bundling brings together related activities and processes over time, providing more holistic care for an illness event or condition. Bundles define the care requirements and timeframes expected to achieve the desired patient outcome. They can also improve the tracking of healthcare costs; and
- Aligned Provider Units or Networks: Ensuring healthcare delivery settings are aligned is the best way to achieve the most efficient and effective care.
So, using the key foundation stones as a yardstick, how does Australia stack up?
On ‘awareness and intent’ there is a growing mindfulness in Australia of the general concepts of ‘value-based healthcare’. This is evidenced by State and Territory health departments stating their desire to move in this direction.
For example, the 2018 Heads of Agreements between the Commonwealth and the States and Territories on public hospital funding and health reform references payments based on outcomes and quality of life. However, a deep understanding of the principles of VBHC remain patchy, which too often leads discussions away from achieving value through outcomes to achieving value by driving down the price of products and services. Until we move to paying for real outcomes, valued by consumers, we will continue to miss the mark.
When it comes to ‘data and metrics’ it is a mixed story, again. The only comprehensive datasets across the care continuum that currently exist are in the Veterans Affairs area. Segments of the Commonwealth and States, as well as private stakeholders, hold significant datasets of varying applicability. Despite recent positive moves by the respective Commonwealth and State health departments to free up data access and transfers, they remain largely fragmented and poorly shared amongst stakeholders.
The real golden opportunity for Australia is to leverage the MyHealth record which will move to an opt-out model soon. If properly utilised, this could become a very powerful tool for gauging outcome measures at a population level. Whether existing systems could be used very much depends, at this point, on the scale and breadth of the ambition.
With regard to the remaining foundation stones: the available clinical guidelines currently fall short of a comprehensive set of care pathways measured for compliance and outcomes. There are some pockets, public and private, of provider units and networks that aim to provide better managed care, but their results are rarely tracked and published.
The Federal Government’s Healthcare Homes initiative, which is rolling out some bundled payments in primary care for some chronic conditions in select communities, is an important first step to better coordinate care. However, by being restricted to primary care, being fully administrated within General Practice and not yet paid on a true outcomes basis, limits the initiative in its full VBHC effectiveness.
Ensuring procurement systems are aligned is critical for identifying non-traditional solutions to health problems. This might include flexible methodologies aimed at procuring value rather than a set of predetermined attributes at the lowest price.
Having spent time considering the question of Australia as a leader in VBHC, there are some promising signs. Health systems within Australia are increasingly aware of VBHC principles, and are developing VBHC ambitions, however, it remains the case that we still have a long way to go. To fully realise these ambitions, we will need considerable progress in data linkages. We will also need to develop methods of pooling funds across the many fragmented Commonwealth and State primary, secondary and tertiary healthcare, rehabilitation and aged care, and public and private healthcare systems to commission care based on outcomes.
So, until there is a deliberate set of policy reforms aimed at facilitating VBHC in Australia, it is likely to remain limited to small scale pilot programs and/or in simpler disease states.
ABOUT THE AUTHOR
ANDREW WILTSHIRE is Senior Director, Government Affairs, Asia Pacific. He is responsible for managing Government Relations, coordinating and driving Government Affairs strategies and best practices within APAC – supporting the execution of regional and business strategic objectives.