RESOURCES

The Australian Centre for Value-Based Health Care has identified a number of resources that may support your work in value-based health care. They have been grouped into the following categories to help you navigate through the selections;

Defining value
Creating value in partnership with patients
Measuring outcomes and costs
Integrated and patient focused care
Outcome-based payment approaches
Enabling context, policy and institutions
Practical approaches to value-based healthcare

Defining value

Definitions of value in health care draw on the seminal work of Porter and Teisberg, as the health outcomes that matter to patients relative to the resources or costs required, over a full cycle of care. Around the world, definitions have been expanded to recognise, for example, technical, allocative and societal value as well.

Porter, M & Teisberg, E 2006, Redefining health care: Creating value-bsed competition on results (presentation), Boston, Mass: Harvard Business School, https://www.hbs.edu/faculty/Publication%20Files/20060502%20NACDS%20-%20Final%2005012006%20for%20On%20Point_db5ede1d-3d06-41f0-85e3-c11658534a63.pdf

Redding, D 2016, New approaches to value in health and care, The Health Foundation, https://www.health.org.uk/publications/new-approaches-to-value-in-health-and-care

NHS England 2017, NHS Board Paper PN 09.02 2017/06, NHS RightCare and the shift to value-based healthcare, https://www.england.nhs.uk/wp-content/uploads/2017/02/board-papers-090217-item-6-nhs-rightcare.pdf

European Commission 2019, Defining value in ‘value based healthcare’: Report of the Expert Panel on effective ways of investing in health, https://ec.europa.eu/health/expert_panel/sites/expertpanel/files/docsdir/024_defining-value-vbhc_en.pdf

 NSW Health 2019, Value based healthcare, https://www.health.nsw.gov.au/Value/Pages/default.aspx

Creating value in partnership with patients

Value for patients is created at the local level, by the combined efforts of providers in partnership with patients. Clinician and organisational leadership have been identified as critical factors in successfully shifting to value-based approaches to care. Defining patient groups or population segments, and mapping their healthcare journey is an important first step to get a shared understanding of the patient experience by everyone involved in the care cycle. Experience-based co-design is important for services considering the patient’s healthcare journey, and shared decision-making important for clinicians working with individual patients in clinical practice.

Dimopoulos-Bick, T, Osten, R, Shipway, C, Trevena, L & Hoffmann, T 2019, Shared decision making implementation: a case study analysis to increase uptake in New South Wales, Australian Health Review, vol. 43, pp. 492-499, https://www.publish.csiro.au/AH/pdf/AH18138

The Experience Based Co-Design Toolkit provides a convenient reference to equip those working in the health sector with the tools and approaches to bring consumers and health workers together in an authentic and equal partnership to co-design care to deliver an improved experience.

https://ahha.asn.au/experience-based-co-design-toolkit

If your organisation requires additional assistance to undertake co-design, AHHA has an experienced team who can support you. For more information contact Lisa Robey by email or on 02 6162 0780.

EBCD toolkit

Improving the Patient Experience – How to develop a Strategy by using Data and Digital Solutions to Advance Person-Centred Care (webinar), https://youtu.be/Ad3iZlcN8b0

Cochran, J & Saini, J 2019, Healer, Leader, Partner – the role of the physician leader in leading change in health care (webinar), https://youtu.be/6695S6yUP2c

Kelly, J, Dwyer, J, Mackean, T, O’Donnell, K & Willis, E 2017, Coproducing Aboriginal patient journey mapping tools for improved quality and coordination of care, Australian Journey of Primary Health, vol. 23, pp. 536-542, https://www.publish.csiro.au/py/pdf/PY16069

Measuring outcomes and costs

The concept of value should not be thought of as a simple equation. The health outcomes that matter to patients are multidimensional, including factors much broader than traditional clinical indicators. The resources or costs must reflect the actual costs of the care delivered to a patient over a full cycle of care.

The routine collection, sharing and analysis of outcomes and cost data and other relevant information will be enabled by an integrated health information infrastructure, enabling both patient and population-level health information. This includes not only the hardware and software of health informatics systems, but also the standards governing such systems and organisational capabilities to use them effectively.

Australian Commission on Safety and Quality in Health Care 2019, Patient-reported outcome measures, https://www.safetyandquality.gov.au/our-work/indicators-measurement-and-reporting/patient-reported-outcome-measures

Australian Commission on Safety and Quality in Health Care 2019, National arrangements for clinical quality registries, https://www.safetyandquality.gov.au/our-work/national-arrangements-clinical-quality-registries

Australian Commission on Safety and Quality in Health Care 2019, Australian Atlas of Healthcare Variation Series, https://www.safetyandquality.gov.au/publications-and-resources/australian-atlas-healthcare-variation-series

Australian Medical Association 2016, Position statement: Measuring clinical outcomes in general practice, https://ama.com.au/position-statement/measuring-clinical-outcomes-general-practice-2016

Keel, G, et al 2017, Time-driven activity-based costing in health care: a systematic review of the literature, Health Policy, vol. 121, pp. 755-763, https://www.sciencedirect.com/science/article/pii/S0168851017301240?via%3Dihub

Integrated and patient focused care

The adoption of integrated care can be challenging due to diverse stakeholders with fragmented interests, the persistence of fee-for-service payment models and entrenched professional cultures.

Further, while traditional care delivery has focused on diagnosis, treatment, recovery and rehabilitation, a genuinely integrated, patient-focused and value-based approach will reach upstream to include preventive strategies and downstream to include long-term monitoring and management of chronic condition.

Productivity Commission 2017, 5 year productivity review: supporting paper no.5, integrated care, https://www.pc.gov.au/inquiries/completed/productivity-review/report/productivity-review-supporting5.pdf

Outcome-based payment approaches

Payment and financing can be an enabler or obstacle to value-based health care. 

Each payment system brings its own set of desired and perverse incentives; different approaches are likely to be required to fit the needs of different populations, different conditions and for different types of care. Particular consideration is needed when financial incentives between sectors are not aligned.

However, financing encompasses more than just the payment system, also reflecting the flows of capital to support service structures. Debate on payment systems must also give consideration to balancing financial risk, outcomes, performance and responsibility.

Hedge, S 2019, Issues Brief: Re-orienting funding from volume to value in public dental services, Deeble Institute for Health Policy Research, https://ahha.asn.au/publication/health-policy-issue-briefs/deeble-issues-brief-no-32-re-orienting-funding-volume-value

Fitzgerald, J 2015, Issues Brief: Options for finance in primary care in Australia, Deeble Institute for Health Policy Research, https://ahha.asn.au/system/files/docs/publications/deeble_institute_issues_brief_no._11_fitzgerald.pdf

Gough, R 2019, Implementing value-based healthcare procurement and contracts in the UK and Europe (webinar), https://youtu.be/_03_pELgNKg

Enabling context, policy and institutions

Due to the scale of reform required to realise a value-based approach to health care, leadership needs to transcend electoral and budgetary cycles, and jurisdictional and professional boundaries. Public policy has a critical role in enabling value-based health care.

Woolcock, K 2019, Value based health care: Setting the scene for Australia, Deeble Institute for Health Policy Research, https://ahha.asn.au/publication/health-policy-issue-briefs/deeble-issues-brief-no-31-value-based-health-care-setting 

Raymond, K 2019, Issues Brief: Reforming for Value: Opportunities for Outcome Focused National Health Policy, Deeble Institute for Health Policy Research, https://ahha.asn.au/publication/health-policy-issue-briefs/deeble-issues-brief-no-33-reforming-value-opportunities

The Economist Intelligence Unit 2016, Value-based Healthcare: a global assessment, http://vbhcglobalassessment.eiu.com/

Practical approaches to value-based healthcare

Actions taken to improve value will be determined not only by evidence and the needs of population, but also by the pattern of services and infrastructure that has evolved during decades of growth. The experiences of those who have embarked on implementing a value-based approach to healthcare are valuable to learn from.

Saunders, C, et al 2019, Perspectives brief: Towards value based healthcare: Lessons learnt from implementing outcomes measures, Deeble Institute for Health Policy Research, https://ahha.asn.au/sites/default/files/docs/policy-issue/perspectives_brief_no._5_toward_value_based_care_outcome_measures_2.pdf

Cole, D, McKee, S 2019, Case Study: Value-based health care – how Dental Health Services is transforming oral healthcare (webinar), https://www.youtube.com/watch?v=rbPI4GLQdkM&feature=youtu.be

Silva, C F 2019, Value-based Radiology – A Modern Practical Approach in the era of Value-based Healthcare (webinar), 

Okunade, O, Arora, J, Haverhals, A, Niessen, L 2017, Collaborating for value: the Santeon hospitals in the Netherlands, https://www.ichom.org/wp-content/uploads/2013/10/Santeon_Case_Study_Final.pdf

Beyer, B 2019, Martini-Klinik: patient-centred outcomes data collection to improve prostate cancer care, All.Can, https://www.all-can.org/efficiency-hub/martini-klinik-patient-centred-outcomes-data-collection-to-improve-prostate-cancer-care/

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If you have a resource that you believe would be of value to those exploring value-based health care and which you wish to share, please email value@ahha.asn.au with the details.

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