Value-based care progress: Country by country analysis

Value-based healthcare is in its early stages around the world, according to a new analysis from the Economist Intelligence Unit (EIU).

Medtronic, the global medical technology company, commissioned the EIU for an independent study to develop a framework that assesses the global adoption of value-based healthcare (VBHC) across 25 countries. The EIU, in consultation with an international roster of healthcare experts, took an in-depth look at what is required to adopt VBHC and built a new framework to evaluate health systems. The framework consists of 17 key indicators organized into four domains: Enabling context, policies and institutions for value in healthcare; measuring outcomes and costs; integrated and patient-focused care; and outcome-based payment approach.

Pannelay

“Many elements must be in place along with broad stakeholder buy-in,” says Annie Pannelay, principal, EIU Healthcare. “For those willing to adopt VBHC, the study puts forth a transparent framework for organizations interested in the building blocks of a value-based system. We understand that it is too early to evaluate health systems values vs. costs. For this reason, this study was conducted to develop a framework for evaluating the enabling environment of policy, institutions, and infrastructure needed for health systems to align with value-based healthcare.”

Key findings of the analysis include:

• Sweden and the U.K. are in the lead with very high and high levels of alignment with VBHC, respectively.

• The US aligned with VBHC at a “moderate” level overall. Within the four domains, the EIU rated the U.S. alignment at the following levels:

1.    Enabling context, policy and institutions for value in healthcare: Moderate

2.    Measuring outcomes and costs: High

3.    Integrated and patient-focused care: Moderate

4.    Outcome-based payment approach: Moderate

• The advantage of bundled payments for coordinating care and focusing on the patient is increasingly being recognized. For example, in six of the 25 countries studied, bundled payments are being implemented by one or more payers.

• The impetus to measure outcomes and costs is strengthening through the presence of disease registries and efforts by many countries to implement electronic health records.

“However, in many instances, these sources of health data are not coordinated and the IT systems are not interoperable,” Pannelay says. “Moreover, outcomes data, which are a prerequisite for alignment with value-based care, are almost universally lacking.”

• Strong policy support, which helps countries align their health systems more closely with the tenets of VBHC, tends to be found in wealthier countries. Of the seven countries with a high-level policy or plan for VBHC, only two-Turkey and Colombia-are developing countries.

“Healthcare professionals and payers can use the framework and results to examine their health systems today,” Pannelay says. “And if they are interested in VBHC, the study helps identify what elements they should explore to move their organizations toward it.”

Next: Link between a country's health spending and VBHC

Link between a country’s health spending and VBHC

A country’s high health spending does not necessarily mean a presence of supporting factors for alignment with VBHC, according to Pannelay.

“For instance, neither Japan nor the U.S.-two nations that spend more than 10% of GDP on healthcare-has a recognized national health technology assessment organization,” she says.

The shift from siloed, single-provider-based care to a coordinated, team-based approach will remain challenging, Pannelay says, as roughly one quarter of the countries in the study have no national coordinated care pathways in any of the five therapy areas reviewed.

“In the U.S., coordinated care pathways exist but only within hospitals or provider groups, and they are not nationally standardized,” she says.

To help accelerate VBHC adoption, additional work for data on patient outcomes is important, according to Pannelay. “Secondly, it will be critically important to focus on buy-in from many different stakeholders,” she says. “Lastly, managed care executive must begin understanding what ‘value’ means from a patient perspective as this is a key foundation of VBHC and should be determined according to individual health system needs.”