The European Training Network “HealthPros 2020” had its 5th bi-annual meeting on the week of the 22nd of March. OptiMedis, as one of the initiative’s partners, saw the participation of Dr. Oliver Gröne and our two early-stage researchers, Sophie Wang and Nicolas Larrain.The meeting was hosted on-line, due to the Coronavirus pandemic, by Corvinus University (Budapest) under the leadership of Prof. László Gulácsi. The meeting revolved around the topics of value-based care and economic evaluation of healthcare interventions, and seminars were held in a wide arrange of topics and technical levels. Participants had the opportunity to discuss technical aspects of economic evaluation techniques, the use and valuation of patient reported outcomes, to assess regular evaluation tools such as EQ-5D and exploring preferences-based valuation techniques such as discrete choice experiments, among others.
Three guest speakers contributed to the meeting with their experiences.
They explained the Hungarian health system, its structure, strength, and weaknesses and highlighted several issues that can be related to other health systems worldwide. The presentation by Prof. Imre Boncz, Vice Rector of the University of Pécs was particularly relatable to OptiMedis, as it explored the use of insurance data to improve quality of care and support financial decision making. The presenter stated that unclear responsibilities regarding the health of the population, lack of incentives for integrating care, and data silos and inefficient capacities for sharing were the active restrictions to implementing efficient monitoring systems. Other concerns, such as creating appropriate frameworks and indicators were also deemed crucial, but in a second stage.
The meeting culminated with an assessment of possible interventions to guide health systems towards value-based care.
Within this work, several key statements were raised from the main stakeholders’ perspective for this purpose. For patients, value in healthcare is related primarily to the goal of maximizing health, but also care experience and, within a sensible range, decision making at both the care level and public health funding and management. For care providers, a comprehensible and measurable definition of value is crucial to refocus their business models towards this objective. In this sense, the partnership with higher structures such as payers and government are essential to define incentives and the support needed to integrate and align business models of multiple providers and the system objectives. From a business perspective, this means making value the unit of competition between, and the ultimate output of, care providers. From the payer perspective, value relates to maximize health within the budget restriction. Cost effectiveness and waste reduction in treatments are key for this purpose. Responsibility towards patients will push for patient outcomes and experiences to be part of the system evaluation. From a business perspective, sharing financial risks is essential to align objectives between stakeholders. Long term contracts are essential to see results from a payer’s perspective. Finally, from a government perspective, value in healthcare relates to the overall health of the population, the correct functioning of the system, the efficient and accountable use of public resource and the adequate support for different stakeholders to secure care provision, quality, and innovation.
Following this exercise, from my point of view, a health management institution such as OptiMedis, will determine its added value to the system by the ability to implement four main capacities; 1. To safeguard the safety and quality of care that reduces wastes and optimizes patient outcomes; 2. To ensure access to timely, complete, and quality patient information and performance data to monitor structures, processes and outcomes; 3. To optimize the use of a well-organized, high-performing, competent human resources force; and 4. To efficiently invest in interventions and intelligence to achieve these capacities.
The OptiMedis model complies in general terms with all the key principles stated above.
And consequently, the proposal for introducing value-based care in the German health system that resulted from this work is very much like the one proposed by OptiMedis. Nevertheless, there were two new ideas that are worth mention. First, the HealthPros group deemed sensible to consider the possibility to determine the unit of care in care cycles, to the detriment of patients’ freedom of provider choice. Following M. Porter ideas for achieving value-based healthcare, the provision of care in cycles facilitates the competition in value as the responsibility for the health outcome stays within the cycle and is not shared between different actors. Second, the inclusion of the users of the health system, through patient and community associations, in the management and financing structure of the system. This way, a direct lever is put in place in the relation between providers and users, creating the space for priority setting and allocation of funds to people-centred innovative solutions. At the same time, patient and community associations can take part in the application for extra government funding directed to innovation, and this way secure an effective funding of initiatives directed to attend patient experience and quality in care.
By Nicolas Larrain, Analyst at OptiMedis