VALUE-BASED HEALTH CARE CONFERENCE 2021

The Value-Based Health Care Conference, held in Perth on 27 – 28 May 2021, was the inaugural national conference focused on value-based health care, and was developed by AHHA in partnership with the Continuous Improvement in Care Cancer Project from the University of Western Australia. This is a 5-year research-led program aimed at improving cancer care through a value-based health care approach, and is unique in that it is a partnership of public and private providers with researchers and patients.

Pre-conference workshop

The conference was themed Patients first, and to support that theme, a pre-conference workshop led by the Value Institute at the University of Texas focused on the measurement of outcomes and costs. There were a couple of key lessons which were appreciated by all the participants:

– firstly, it is possible to get started on a value-based health care program without having all the enablers (for example a perfect set of PROMs or a fit-for-purpose funding environment) in place. The VBHC program at Dental Health Services Victoria was cited as an example of ‘just doing it’, even if data are not perfect and funding is complicated. Participants noted that key to success was executive leadership including strong support from the Board, and close engagement with clinicians and consumers as the program was designed and implemented.

– secondly,PROMs do not need to be hugely complicated and onerous. An excellent case study from the Cincinnati Children’s Hospital showed how shifting from a complex 45-minute questionnaire which consumed valuable time with patients to a 4-question infographic-based survey provided effective measurement of patient outcomes for children with Obsessive-Compulsive Disorder.

– thirdly, it can be possible to work within existing funding envelopes, if there is a good understanding of how funding is being used and how it can be more effectively applied. The Value Institute’s approach is based on Time-driven Activity based costing, to understand where funds are applied across clinical team members and other resource inputs, and to assist in reallocating these to make better use of existing funds (for example, looking at routine data collection work which can be done by admission staff rather than by clinical staff; using allied health teams to support patients to achieve outcomes rather than moving directly to more costly surgical interventions).

Keynotes: Patients first

These themes continued into the conference, which started with a very lively discussion from Prof Elizabeth Teisberg from the Value Institute and Julie McCrossin, a patient advocate.

Prof Teisberg’s discussion of patient outcomes used the Capability, Comfort and Calm framework, describing this approach as consistent with both patients’ reasons for seeking care and their experience of it, as well as clinicians’ professional identities.

• Capability measures a patient’s functional status.
• Comfort measure relief from physical and emotional pain.
• Calm measures the extent to which patients can continue to live their life in the way they want.

Julie McCrossin noted that while her cancer care experience helped restore capability and in the longer term, calm, she had had an adverse experience in relation to comfort and emotional pain, particularly during radiation therapy for a head and neck cancer.

She talked about strategies to ensure patients were heard, and were included in decision-making about their care. This was very similar to the feedback from a consumer workshop which had been held the day before the conference.

Trust and relationships, choice and empowerment to participate in decision-making were strong themes throughout these discussions.

There was some discussion about changing the language used from patient-centred care to relationship-centred care as a more effective way to describe the goals of a value-based care program which considers the perspectives of patients, carers and family, clinical team members within and across services more effectively.

Keynotes: Implementing VBHC in different jurisdictions

Elizabeth Koff, Secretary of NSW Health, and Dr Daphne Khoo, who leads VBHC work for the Singapore Ministry of Health, presented on jurisdictional approaches to implementing VBHC programs.

It was evident from both these presentations that every jurisdiction will approach the implementation of VBHC differently – based on the capabilities and enablers they have in place in their jurisdiction, the health outcomes they are seeking to optimise, and the priorities for their respective governments.

There is not a one-size-fits-all approach to VBHC, and there’s much that can be learned from jurisdictions like NSW and Singapore, both in what they have been able to achieve in a relatively short period of transformation and from the frameworks they have established through which to progress and evaluate their work.

Both these jurisdictions were authorising transformative programs from the very top of their health departments. In the case of NSW Health – and indeed other Australian states and territories – this authorisation is also formalised in the Addendum to the National Health Reform Agreement which all jurisdictions finalised in July 2020; although it was notable that in the opening ministerial speeches to the conference, while Minister Hunt spoke in glowing terms of the Agreement, WA Minister for Health Roger Cook was less positive both about the funding envelope in the addendum and the relevance to the transformation agenda which will be needed post-COVID.

Keynotes: Social determinants, funding and variation

Joe Conte, CEO of the Staten Island Performing Provider System (PPS) in New York, spoke about the dramatic improvement in health outcomes across a range of programs supporting very vulnerable patients including homeless people, refugees and migrants. The Staten Island PPS is an accountable care organisation, purchasing social care as well as health care, and working in very close partnership with (and funding) both community services like the justice system, public housing, schools, and employment agencies, as well as with health providers in the primary and acute care sectors.

Dr Ross Crawford, an orthopaedic surgeon from Brisbane, was compelling in his arguments that we must address variation in health care, that to do this we needed to leverage big data and AI to best understand where efforts should be directed, and that we need to be more agile in testing, adopting and evaluating new technologies like robotics if we are to provide the best available health care, achieve the best outcomes and pay the best prices.

Richard Spencer from the Productivity Commission talked about a recent publication which included case studies on innovation in health care – many occurring within the Primary Health Networks. There was much discussion about how these programs might be evaluated, diffused and developed at scale in the system.

National awards

The conference closed with an awards ceremony, honouring three programs – two from NSW Health and one from Dental Health Services Victoria – that represented the best of innovation, effective implementation, and collaboration.

• Qld Health Innovation Award: Smile Squad School Dental team (Dental Health Services Victoria)
• NSW Health Inspiration Award: Leading Better Value Care Bronchiolitis (Sydney Local Health District)
• St John of God Subiaco Hospital Collaboration Award: Osteoarthritis Chronic Care Program (Concord General Repat Hospital)