Shift to digital during the pandemic could enable universal health coverage

The coronavirus disease (COVID-19) pandemic which started as an outbreak in one country, and very quickly travelled around the world, makes a strong case for investment in global public health and has resurrected the debate of universal health coverage (UHC).

An estimated 400 million people around the world lack access to basic health services. Each year, close to 100 million people are pushed into extreme poverty because they have to cover their own health costs. These numbers have increased with COVID-19 and will continue to increase as people lose jobs, health insurance and health expenditures rise due to COVID-19 related spending on testing, treatment and vaccines.

The shift to value-based healthcare (VBHC) is fundamental to achieving UHC objectives of quality healthcare, financial protection and equitable access to healthcare. These systems are already stretched, riddled with chronic diseases and complex morbidities that have been further exacerbated by COVID-19.

It is crucial to optimize the efficiency of health systems and deliver patient-centric care where the focus is on health outcomes that truly matter to the patient and society. To achieve this, here are the three ways VBHC can enable UHC in a post-pandemic recovery world.

Throughout the global effort to mitigate the spread of COVID-19, many traditional services have rapidly pivoted towards innovative remote access care. The inherent inertia in legacy healthcare systems was swiftly superseded by an urgent need to facilitate remote healthcare delivery, which has created a digital health boom.

The value of digital health in advancing the UHC agenda has increasingly been validated by support from the World Health Organization who agreed on a mandate for digital health as a tool for advancing UHC.

In particular, Telemedicine has allowed for greater levels of doctor-patient engagement regardless of location, thereby significantly increasing the geographical reach of healthcare personnel. Other capabilities of digital health include e-learning and mobile-learning tools that can drive greater preventative and health-seeking behaviours consistent with UHC.

The value of data captured by these elements gives greater clarity to the ‘digital divide’, highlighting how underserved populations lack the tools to engage in appropriate health-seeking behaviours. This allows for targeted approaches to care delivery for patients living in digital deserts – enabling them to access care through alternative models such as mobile clinics.

This data-driven approach to optimising care delivery is consistent with VBHC as it focuses on improving outcomes. WHO Director-General Dr. Tedros Adhanom Ghebreyesus states that: “harnessing the power of digital technologies is essential for achieving universal health coverage.”

COVID-19 has accelerated this digital transition and we must harness the power of data to identify key pain points and blind spots in our healthcare delivery models, and expand coverage to more of the world’s population.

Despite many countries nominally providing UHC and improving access, there are still many problems related to quality of care and missed opportunities for improving outcomes. To maximise the efforts that improve health coverage, we must move beyond access and benefits packages to an emphasis on quality of care and health outcomes – a defining pillar of VBHC.

Digital health and data-driven care are increasingly recognised as drivers of UHC and we must ensure that these tools involve systematic collection and analysis of comprehensive health-outcome data. By meticulously tracking health outcomes for appropriately segmented groups we can measure the impact of health interventions independent of access.

These models have been embraced by several countries, and it’s expected that the seismic shift to digital health in the aftermath of COVID-19 will increase take-up of value-based decision-making. Rwanda is often touted as a developing country with a noteworthy healthcare system, which includes significant use of computerized medical records and comparatively high healthcare outcomes.

In India, Aravind Eye Care System (a network of ophthalmology hospitals) has been responsible for a substantial reduction in the incidence of blindness. This was achieved through innovative care delivery models, involving VBHC tracking of health outcomes for cataract surgery and providing high-quality, low-cost cataract surgery en masse. The high outcome rates have increased consumption of their services, allowing some cross-subsidized healthcare, enabling them to spread costs and offer healthcare to a wider patient base.

Another defining pillar of UHC involves ensuring that populations can receive the health services they need without suffering financial hardship. It is essential that new healthcare models seek to reduce financial barriers faced by patients. Value-based models of care typically involve accurate measurement of costs across the entire cycle of care, with compensation dependent on the quality of care as measured by outcomes.

This system differs from the traditional “fee for service” system, where medical providers use a "pay per use" type of compensation structure. Embracing alternative compensation models encourages healthcare providers to deliver more efficient care and also reduces the overall costs of healthcare for patients – solving management inefficiencies and broadening patient accessibility.

Increased commitment to health outcomes leads to long-term cost savings for patients as they are incentivised to optimise their health. In a fragmented “fee for service” system, physicians often lack access to the information necessary to deliver care and can end up delivering a piecemeal approach to patient management – treating the symptom instead of the patient.

In VBHC, providers are reimbursed based on the effectiveness of their care, encouraging greater coordination on patient care and producing cost-savings for the patient. These models have been shown to yield between 8% and 3% increases in adherence to important care management factors such as medication adherence and blood pressure control management.

Such interventions ultimately reduce avoidable healthcare spending and ensure that patients are able to utilise their saved resources in more prudent health-seeking behaviours.

The combination of superior health outcomes, lower costs and accessible care, represents measurable clinical and social impact that make VBHC a highly compelling model for moving the global healthcare needle towards UHC.

As we rethink our world post-pandemic, we must harness the tools within VBHC to advance the welfare of collective humanity in line with Goal 3 of the UN Sustainable Development Goals: “Ensure healthy lives and promote well-being for all at all ages”. In so doing, we can reconcile the illusionary gap between VBHC and UHC and produce health systems that are defined by high-value, low-cost and extensive reach.