Gaining a Global Perspective on Value-Based Healthcare: ICHOM Conference 2024
Value-based health care is NOW.
Value-based health care is GLOBAL.
Just START.
I just returned from a week in Amsterdam, The Netherlands, after attending the International Consortium for Health Outcome Measures Conference of 2024 and feel incredibly encouraged by the energy, attention, and effort placed on value-based care (VBC) across the globe. With representation from over 40 countries, including low and middle-income nations, I heard this clear message: value-based care is NOW and is the FUTURE of healthcare. We have so much to learn from each other, regardless of country, government, organization, or vocation. In addition to great plenary and small-group sessions, it was fantastic to meet individuals during the networking time and ‘compare notes’ with people from India, South Africa, Thailand, the US, Switzerland, to name a few.
In America, the term “value-based care” has, in the words of ICHOM CEO Jennifer Bright, been co-opted. It has come to mean make-more-money-by-checking-boxes and cost-cutting, a term indicating an endpoint to “sanitize mediocrity.” VBC means value for whom? Value in the US is measured primarily by the governing body or payer, not the individual patient, reflecting an impersonal, algorithmic approach to medicine. At the ICHOM conference, we saw instead the promotion of the principles of standardization, personalization and digitizing care which transcends payers, governments and borders. Whether you are from UK, Mexico, Thailand, Ghana or the United States, we all want to have our care personalized within a trusting relationship and informed by reliable data. We recognize “value” as an equation - a change in the health outcome of an individual patient over the cost of producing that change; it is defined by the user (i.e. patient).This conference gave hundreds of examples within numerous patient segments of the components of a well-functioning VBC system: tailored strategy, measuring outcomes that matter to patients, and developing a learning culture that catalyzes and reinforces a virtuous cycle of improvement.
It's difficult to capture it all, but here are some of my key takeaways:
From Susanna Fox, author of Rebel Health
Listen for the unexpected voice (of patients). The solution may exist, we may just not know about it yet.
Empower problem solvers.
Their body, their data.
Transition from being patient-centered to being patient-led (something most of us in healthcare are afraid of – more on that in a future post)
Burnout and increased administrative burden for physicians is not unique to the US healthcare system, so neither should be the solutions. The Netherlands is facing a physician shortage. Flexdokters in The Netherlands is a cooperative of general practitioners formed to improve the attractiveness of owning an independent practice, give patients their ‘own’ GP (rather than just ‘a’ GP) and providing ‘ever-better’ care. In this model, insurers paid for innovations such as allowing patients to schedule their own call-back time with their physician in set scheduling blocks. They measured costs, patient self-reported “number of healthy days,” and secondary outcomes such as disease-specific metrics.
Create platforms and incentivize data sharing on outcomes with patients. A German Rehab Clinic platform was tasked with helping patients needing inpatient rehabilitation services differentiate between various facilities. They developed a platform to coalesce patient outcomes, patient satisfaction, safety and process management to create a simple, valid, and comparable tool that allows patients to input their condition and find the best place for their recovery.
Incorporate outcomes with shared-decision making tools to use with patients in clinical care. As part of their digitization strategy, the Dutch have developed a decision aid called “Patients Like Me” for cancer care. It translates oncology trial data into a real-world model for outcomes in lung and breast cancer, allowing patients to use data to decide between treatment pathways (chemo, radiation, surgery) based on what is important to them.
From Dr. Elizabeth Teisberg, winner of the Michael Porter Lectureship, “use technology to tighten relationships, not replace them.” The use of digital tools in health is exploding, but it comes with important principles:
Make solutions intuitive– think from the outside to inside
Be aware of the increased disease burden you may place on patients by asking them to interact more with their disease through an app (as stated by a patient panelist).
Data collection from patients can create a burden on the patient. Transparency with data can help motivate patients to stay engaged, showing how it is being used to make improvements in their health and the health of others.
Learn from non-health industries about how they address challenges with digital solutions
Digital literacy is a new social determinant of health
Age and income is not a proxy for digital literacy.
You don’t need to be complicated to do VBC, just start. From the Christian Health Association of Ghana (CHAG) we learned about how poor control of chronic, non-infectious diseases are decimating the health and lifespan of their citizens, calling for new approaches to disease management. For example, only 6% of Ghanaians have their blood pressure controlled. CHAG is deploying VBC principles across their country’s clinics, seeing enrolled patients lower their blood pressure on average by 10 points through personalized and high-touch care models. They’ve started with measuring clinical outcomes and are moving into PROMs and PREMs
Research on VBC is increasing. I realized I need to read primary research on how VBC is evolving and innovating, not just the latest chatter on LinkedIn or informal articles. I really enjoyed reading the abstracts and posters of those working to improve VBC across the world.
From Dr. Thomas Lee, CMO of Press Ganey Associates:
Constraints in human and financial capital will ALWAYS exist for healthcare
Social capital is a resource that keeps on giving through the concepts of “brokering” (bringing people together) and “closure” (creating agreement and standardization).
There’s so much more, and it inspired me to keep learning and pushing forward to bring VBC to rural communities in America particularly. If you’re not familiar with ICHOM, I’d encourage you to visit their webpage. For more in-depth learning, they have collaborated with renowned experts in VBC (and former faculty of the MS in Health Care Transformation program) to deliver a new certificate program in High-Value Health Care. Their conference in 2025 will be in Dublin, Ireland and will be another fantastic opportunity to join minds and mutually encourage one-another in the journey to deliver ‘ever-better’ care! Onward!
