Even today there are many fragmented organizations whose healthcare services are not fully integrated (primary separate from specialized care, while social medicine is even more detached); healthcare systems are organized around rigid structures and process definitions that are highly conditioned by supply and administrative needs that were not defined with the patients at the core of the processes.
Therefore, we are not going to discuss whether our healthcare system as we know it today is sustainable; rather, we should put in place transformational levers that will truly lead us towards healthcare based on the value provided to patients at the lowest possible cost, while placing patients at the core of the system.
Value-Based Healthcare is one of these transformational levers, conceived as the new healthcare paradigm which leads us from evidence-based medicine (traditional medicine as we know it today that focuses on the activity performed) towards a paradigm based on the value we really provide to patients. Moreover, we must be able to measure this value objectively so we can compare results across organizations. It must also place patients at the core, reorganizing the processes around them and striving to satisfy them, while achieving the best results for their health at the lowest possible cost.
This transformation, which will be neither quick nor easy –but which I am absolutely sure will progress continually– will require a series of changes in healthcare organizations at several levels:
- Structural, organizational and methodological changes within healthcare organizations. These changes must reach valued-based organizations that should move from providing fragmented individual healthcare for acute diseases to a totally patient-centered holistic system. This value-based management must encompass multiple perspectives, including:
- Clinical perspective: Provide patients with top-quality medical care and improve their health from the outset with disease prevention. Moreover, the best medical care for certain pathologies may not necessarily be closest to a patient’s residence. In this area, services must be concentrated to provide the best care possible in combination with existing technology to provide the highest quality services to patients wherever they be performed.
- Process improvements: Improve the efficiency of processes ensuring that the improvements focus on value applied to the patients.
- Patient satisfaction: Incorporate the patients’ voice and vision, identifying their needs throughout the process so they become the focus of the action plans that must guarantee their satisfaction.
- Cost: Be capable of obtaining accurate costs for each process applied to patients to provide the best possible care at the lowest cost.
- Degree of health-organization employee satisfaction: Provide structures so healthcare professionals can attend patients using more effective, efficient and sustainable models.
- Degree of application of best practices: Foster a culture based on knowledge of best medical practices and standards to improve results throughout the entire organization.
- Implement new relationship models with healthcare providers (pharmacists and healthcare technology providers among others) based on payment for the value applied. We should move on from a healthcare system that pays for the activities performed by suppliers to one that pays for services that really provide value for the patients and that can be measured objectively using standardized indicators acknowledged by agents worldwide.
- Establish changes in how health results are quantified, which should be according to the medical condition and 3 established dimensions; these are: a patient’s state of health, the recovery process and the time it requires, and system sustainability. ICHOM’s work is of vital importance for establishing these indicators and ICHOLM must continue to support organizations as they implement them and progress in establishing indicators for a greater number of pathologies, including patients with multiple pathologies. Obviously, agreeing upon and acknowledging these indicators will accelerate their implementation.
- Implement Information Systems capable of collecting patients’ opinions throughout the healthcare processes, besides automatically obtaining health-result indicators and the costs associated with the processes. Furthermore, these new systems must be fully interoperational and based on Artificial Intelligence to aid clinicians in their decision-making.
In short, we must start implementing these changes in our healthcare organizations while constantly focusing on the value provided to patients and steadily prepare our organizations to embrace the new Healthcare paradigm: Value-Based Healthcare.