Four lessons for a successful switch to value-based healthcare 

Let’s start with the good news; we know that value-based healthcare (VBHC) works. Measuring and reporting health outcomes improves clinical performance. Value-based payments, such as bundled payments for surgical conditions, can save costs and improve outcomes. Improved care coordination has significant benefits for patients.

And now for the bad news. Achieving a value-based health system is hard. Transforming a health system so that it truly puts patients at its centre, improves the outcomes that matter to patients, and optimises the costs to achieve those outcomes requires a lot of work. In particular, a value-based health system transformation requires:

- Sufficient technical expertise about VBHC to design and implement its core features.

- Leaders committed to trying ideas and willing to accept the risks involved.

- Cooperation among different organizations working together to improve outcomes for patients.

Moving to a value-based health system requires fundamentally different ways of working, and collaboration among organizations who normally operate in their own silos. That’s why we are helping to build national-level platforms which will work with the Global Coalition for Value in Healthcare to facilitate this change and accelerate the pace of health system transformation.

For example, Canada faces significant challenges with regards to the value of healthcare delivery. Across the nation’s 13 provinces there is a 2.5-fold difference in the per capita spend on healthcare, but this variation does not account for variation in health outcomes.

Indeed, even in provinces with similar levels of health spend, the data indicates that there is massive variation in health outcomes for everything from 30-day mortality following heart surgery to hospital re-admissions for mood disorders.

There are numerous ongoing initiatives to address these challenges using value-based healthcare approaches, including pilots for bundled payments in Ontario, telehomecare and digital health solutions, and better care coordination. One of the most important ways to drive change across the nation is to ensure learnings, experiences, and best (and worst) practices are shared among the groups venturing into this space. That’s why last March, the inaugural Value-Based Healthcare Canada Summit brought together senior health system leaders from across the country to explore key concepts and the leadership and collaboration necessary to expand and support VBHC on a pan-Canadian basis. Building on this momentum, Canada is working to establish a permanent network to provide resources and support for VBHC, establish executive education opportunities for current and future health system leaders, and contribute expertise and perspective to World Economic Forum initiatives such as the Coalition’s User Guide for Health System Transformation.

In France, despite strong performance overall on health outcomes, major disparities remain in health outcomes among different groups across the country, and measuring these outcomes presents a significant challenge. As noted by Agnès Buzyn, French Minister of Health, “the evaluation of healthcare outcomes remains one of the major weakness of the national health system”.

How can France address this challenge? The Consortium VBHC France is a non-profit organization whose core mission is to launch a VBHC community of leaders to support the implementation of condition-specific outcome registries using standardized instruments. Following its inaugural conference in May at the Conseil Economique, Social & Environnemental, the Consortium announced its transformation roadmap last December during a VBHC conference under the patronage of the French Minister of Health. The Consortium will facilitate multi-stakeholder alignment among patient representatives, healthcare practitioners, hospitals, payers and industrial manufacturers. Its initial focus will be on how to contribute to the development of outcome registries, provide guidance and training on how to measure outcomes, and promote health outcome transparency.

These new public-private initiatives are still in their early stages, and there will inevitably be challenges and learnings as they progress. However, we have identified several key lessons that are critical for getting started:

· Focus on outcomes that matter to patients. One of the key differentiators of a value-based system is that it focuses on improving health outcomes, rather than merely focusing on processes or costs.

· Engage partners from across the whole health system. In order to achieve meaningful system-wide change, transformation efforts have to include organizations from across the entire system, including the private sector. Patients and patient advocates should also stay core to the mission of the work, and should contribute at every step of the process.

· Acknowledge upfront that systems change is hard. If stakeholders embark on this work looking only for “quick wins” or easy answers, they will be sorely disappointed, and will likely disengage when major obstacles to change arise. Achieving success with public-private partnerships requires engaging individuals and organizations in meaningful ways that allow them to address and confront the system-wide barriers to change.

· Take a problem-driven approach. Rather than just copying and pasting solutions from other health systems, focus on the problems in your own health system, and then determine what solutions, either from others, or homegrown, are most likely to succeed in your context.

These national initiatives, and other partnerships around the world, are only one step for turning the evidence-based practices of VBHC into real change at scale. We hope they will help bring together leaders from the public and private sectors to move the needle on healthcare transformation, and they will ensure that healthcare practitioners have the right knowledge about VBHC to implement change. We look forward to continuing the conversation, sharing what we learn, and learning from others about how to take this critical next step forward for health systems.

For more information about other initiatives focused on stakeholder collaboration to drive value-based health systems around the world, see the report Value in Healthcare: Accelerating the Pace of Health System Transformation.