Australian Healthcare and Hospitals Association
The twin challenges of last summer’s bushfires, swiftly followed by the COVID-19 pandemic, have exposed critical bottlenecks and vulnerabilities in the Australian health system, notwithstanding our relative success in meeting healthcare needs during this period compared with many other nations.
Our experiences addressing these challenges can provide a catalyst for reimagining healthcare, which will be required as we grapple with significant economic downturn, and its impacts both on available funding for healthcare and on the health and wellbeing of Australians.
The recently signed 2020-25 Addendum to the National Health Reform Agreement provides important opportunities for new thinking in the way health is delivered, including opening the door for system-wide attention to value-based health care (VBHC).
Much more than just a trendy catch phrase, value-based health care focuses in on the outcomes that matter to patients, delivered at a cost that is acceptable to patients and funders.
There is little argument that health providers want to provide care that improves the health and wellbeing of patients; that patients should be more engaged in deciding what they want to achieve out of their healthcare; and that we all should have an interest in doing this in the most affordable way possible.
However debate has arisen around issues such as:
• funding models (Is this just a cost-cutting measure? Can a system focused on paying for performance and activity shift to paying for value?)
• ability to measure health outcomes, including what matters to patients
• how clinical leadership and patient engagement can be structured effectively into models of care
• professional and provider resistance to alternative workforce and payment models.
The Addendum to the National Health Reform Agreement provides a base for system innovation across at least the first two of these issues.
The provision for the Independent Hospital Pricing Authority to approve trials of innovative funding models, including bundled payments, is a significant opportunity for state health departments and public hospitals to put forward proposals that focus on value rather than activity.
The commitment to develop national approaches to measuring health outcomes suggests new ways of thinking about performance and accountability in our health system, beyond the traditional approaches to reporting on inputs and outputs.
Importantly, better integration between the primary and acute care sectors is flagged, through specific provisions requiring Primary Health Networks and equivalent hospital networks to formalise agreements around their shared responsibilities for the health of the communities they serve.
Missing from the Addendum is greater recognition of the social determinants of health, a key gap in the work required to shift to value-based healthcare.
We should be factoring into our health policy decisions determinants, such as housing, income and employment. We should be breaking down the silos between departments of health, community and social services. We should be sharing data across these three areas and looking for smart ways to achieve better health outcomes and ensure nobody is left behind.
Whether the innovation anticipated in the Addendum can be translated to scalable long-term reforms that focus on value over volume, remains to be seen. Yet we must not shy away from the need for these reforms.
Now more than ever, we need to ensure Australia’s health system is sustainable and resilient, focused on the best possible health outcomes for all Australians, and capable of absorbing shocks, such as we are now experiencing and may well experience again.
For more information on value-based healthcare, see: https://valuebasedcareaustralia.com.au/
To access the Addendum to the National Health Reform Agreement, see: https://www.federalfinancialrelations.gov.au/content/npa/health/other/NHRA_2020-25_Addendum_consolidated.pdf
This article was publish by The International Foundation for Integrated Care here.
Value-based health care: how and why it can work in Australia
Alison Verhoeven, Chief Executive , Australian Healthcare & Hospitals Association
July 9th, 2019
The Australian Healthcare and Hospitals Association recently launched the Australian Centre for Value-Based Health Care.
Its purpose is to act as the nexus or hub of the value-based health care movement in Australia, bringing together educational and training opportunities, quality research, best-practice case studies and similar resources.
We all want value from public and private spending in health care—but defining value is not a clear-cut exercise, and adopting strategies from other countries without considering local context rarely works.
Health systems around the world have been exploring how to move the focus of their activities to delivering value rather than volume. They are trying to re-orient health service delivery towards evidence-based procedures and practices that maximise patient outcomes relative to resources and costs over the full cycle of care.
In aiming for outcomes that matter most to the patient, a value-based approach to health care must be patient-centric rather than provider-centric—and health systems and healthcare management have to be redesigned to fit.
The Centre’s first paper, by AHHA Policy Director Kylie Woolcock, is Value Based Health Care: Setting the scene for Australia.
The paper considers where Australia sits in terms of a value-based approach, as well as identifying important and essential enablers of value-based health care.
These enablers are already present in Australia, but a key hindrance is that the enablers and their components are being implemented individually and not as part of a coordinated national strategy involving all tiers of government in addition to healthcare providers and consumers.
The paper makes recommendations for effective development of value-based healthcare through public policy in Australia. These can be grouped under five main headings:
A national, cross-sector strategy for value-based health care in Australia—this will need sustained cultural change and unprecedented cooperation across sectors, as well as across regions, funding models, measures of performance, accountability and the sharing of research. Strong agreement at Council of Australian Governments (COAG) level is a key to progression.
Access to relevant and up-to-date data—including patient-reported outcomes and experience and costs, as well as robust and consistent cross-platform information at disease, sector, health service and whole system levels
Evidence for value-based health care in the Australian context—a strategic approach is needed to support value-based care trials, and developing and trialling value-based payment models.
A health workforce strategy supporting models of care that embrace a value-based approach—outcomes- and value-based changes in scope of practice and models of care will be needed, along with necessary changes to education and training.
Funding systems that incentivise the delivery of value-based health care—a mixed funding formula incorporating activity, block, and performance components will likely be required in addition to funds-pooling at regional level, bundled care mechanisms and commissioning of services.
Something for all of us to keep in mind is that value-based healthcare is not necessarily about saving money, although it may well do so in many situations—it is about achieving better outcomes that matter to patients and getting better value for every public dollar spent.
We invite innovative organisations from around Australia to partner with us to go on the value-based health care journey.
This article was published by openforum.com.au here.