Data – its collection, flow, and use – is vital to achieving Value-based Healthcare. You’d expect me to say that; I work for Salesforce after all. But the need for optimal flows of data is becoming more urgent as the entire sector – publicly funded or privately provided – is moving toward a model that prioritises patient outcomes. And not just for the sake of the patient, though that’s the priority, but for the sake of economic rigour and efficiency.
Understanding what value means in all healthcare settings, from clinics to GP practices and hospitals right through to the labs of pharma companies, demands a rational and comprehensive approach to the creation, distribution, and use of data in all those settings. You can only judge the value by critical data: patient outcomes, costs, and the availability of funds for ongoing investment.
Back in a report by the Centre of Evidence-Based Medicine identified the barriers that needed to be overcome to achieve value across the Continuum of Care. They cited ‘overdiagnosis, too much medicine, poor allocation of resources and the introduction of inadequately evidenced technologies.’ The key to removing those barriers was not just extra money, but the training of staff in the ‘necessary skills in value-based healthcare…in how to measure outcomes, patient experience and resource use.” 
The ticking time bomb
In the four years since that was written, the world has changed dramatically. And not just because of the pandemic. Global healthcare systems are under pressure from rising energy costs and seemingly endemic inflation, as well as shrinking government budgets. Some argue that the real crisis is a shortage of healthcare workers. It’s been called ‘A Ticking Time Bomb’ in the press.
The World Health Organization revealed that across Europe many countries were experiencing a ‘severe shortage of nurses.’ Even places like Finland, often cited as a place where healthcare works highly efficiently, were suffering. Falling numbers of GPs, clinicians in all disciplines, support staff, and even cleaners, were described by Hans Kluge, the WHO’s regional director for Europe, as “a ticking tomb bomb… likely to lead to poor health outcomes, long waiting times, many preventable deaths and potentially even health system collapse.”
It might seem odd, then, to start introducing concepts like Value-Based Healthcare and talking about the ‘continuum of care’ at a time of crisis. Surely we need to sort out the fundamentals before bandying about buzzwords and phrases in PowerPoint presentations at conferences or sales meetings! Well, I believe that those so-called buzzwords and phrases are a key element in solving the problems we face both in the short and long term.
Why? Because when a system is close to being on its knees (as the global healthcare system is), you either take radical action or you just try and patch things up in the hope that the tide will turn. I don’t believe the tide will turn without a radical re-evaluation of how healthcare works across both the private and public sectors. I’m not pessimistic. I’m optimistic. That’s because the value-based healthcare approach has been growing in importance over the years. It’s not a new concept. In fact, you can go back to the early 2000s and Geisinger’s Model for Care Transformation. That introduced the idea of basing reimbursements in healthcare on patient outcomes. It was a new paradigm which has been growing in popularity ever since.
Paying for what works takes data
Reimbursing pharmaceutical companies based on the efficacy of their drugs in delivering improved patient outcomes is set to become the norm. As a Social Market Foundation report argued in 2017, there were definite “benefits of introducing an outcomes-based model for drug purchasing as a mechanism to address the affordability challenge, to reduce risks within the NHS and to improve outcomes for patients.” Simply, the NHS should only pay for ‘what works’.
And that principle should extend to all aspects of healthcare provision – public and private. It puts the patient at the heart of the process and, in theory, should join every element of the patient journey together, from prevention to diagnosis, to treatment and after-care. But what really joins everything together is the data. The data is the measure of the outcome as well as the problem. It’s also what joins everything together to achieve the transparency needed to assess the efficacy of each element of the continuum of care.
Data is what optimises and enables. The Social Market Foundation report stressed that any outcome-based model needs access to “excellent data on health outcomes.” Where there is a lack of confidence in the availability of data, or the necessary workforce or training to make the most of it, then that undermines any healthcare organisation’s ‘readiness and ability to engage on innovative reimbursement structures.’
What’s needed is an urgent change in culture
If the timebomb is ticking then we all need to show a sense of urgency. We’re at an important inflection point. One that could become a breaking point if we don’t act with alacrity. The Guardian pointed out that in many countries medical staff are ageing, and there’s a shortage of younger entrants into all aspects of the medical profession. It’s also important to acknowledge that there are four generations now working in healthcare, from Boomers to Gen X through Millennials and Gen Z. All could be described as digitally savvy, some are digital natives, so they should all be confident in the use of technology. But do they have the right tech to do their job?
Probably not. That’s why the culture of healthcare organisations needs to change. It’s not that the practitioners aren’t capable of leveraging the power of digital to unlock and use valuable data, it’s that the organisations they work for must take positive steps to up their game. In an interview with the New England Journal of Medicine, the Director of the Value-Based healthcare program at Luz Saude Hospital in Lisbon, Portugal, Filipe Costa, said, ‘We have a culture that is patient-centric, but it’s important to align the ecosystem between payer, providers, and suppliers.’ To do that it’s ‘important to build a value chain in our organisation that can attract, develop, and retain exceptional people.’
It takes the right culture and leadership
It’s a cultural thing. All the digital aspects of the healthcare organisation need to be joined up. Not just in technical terms, but culturally. Joined-up data must be in the DNA of a healthcare organisation. Achieving that means training people to use the data they generate and/or receive and ensuring that it’s totally joined up, end-to-end. That takes leadership. It has to be a culture, as Filipe Costa stressed. It means adopting the principles of approaches like Geisinger’s Model (ProvenCare is a good example to look at), and it means establishing a long-term vision that underpins the right culture.
At Salesforce we’re able to help you do that. We’re focused on improving the ability of healthcare professionals as well as pharmaceutical companies, researchers, and other stakeholders, to put in place the right processes in the right places to achieve a fully end-to-end flow of data to deliver tangible value across the entire Continuum of Care.
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 Hurst L, Mahtani K, Pluddemann A, Lewis S, Harvey K, Briggs A, Boylan A-M, Bajwa R, Haire K, Entwistle A, Handa A and Heneghan C. Defining Value-based Healthcare in the NHS: CEBM report May 2019.