Value-based healthcare: what comes next?

Alexandre Lourenço

More than 15 years have passed since the publication of Michael Porter and Elizabeth Teisberg's iconic book Redefining Health Care.

As a seasoned consultant, Porter delivered a simple message: Value-Based Healthcare (VBHC), an attractive concept to healthcare professionals, providers and payers. Presented as a solution to the health care crisis in the United States, the concept of value – the relationship between results and the cost to achieve them – quickly spread throughout Europe, South America and Australia. Like a magic potion, it provided a solution for almost all health-system problems: addressed fragmentation, variation, over-provision of care, financial lack of sustainability, medical errors, clinical compromise, lack of trust, patient disengagement, etc.

"Our" patient experience

Paco Miralles

In a recent friends meeting, we discussed the issue of health and the quality of health care services. My friends, as users of the health care system, both public and private, related their real patient experiences, experiences that on many occasions were far from the parameters that we strive for. Once again I thought that we do many things for patients, but without counting them in (the patient in focus?).

Narrative, expectations and relevant outcomes for patients

Gustavo Tolchinsky

At the beginning of my medical residency, I used to experience some frustration with some patients whom, despite having gone through a correct assessment and having been diagnosed with a treatable and straightforward pathology, when they were discharged, they were still not satisfied. After some time, I began identifying that at least one of my mistakes was in my approach to patients. Excessively focused on diagnosing a pathology as if I were to “nail it” in an exam, I wasn’t paying attention to what led the patient to visit me, their concern; this couldn’t be solved by giving a mere diagnosis and treatment. When we go through these situations, we find it traumatic, frustrating and disconcerting. On top of that, this may lead to over-acting that only leads to over-treatment due to repeated patient demand at different points of the system. This could be because the clinical solution we offer does not solve those concerns that went unidentified in the clinical interview, or that the patient's expectations are ill-adjusted to realistic results and these, therefore, are unattainable.

Measuring the effectiveness and value of clinical practice

In the "XIV Conference of the Sign Foundation", Jens Deerberg-Wittram, Director of the Boston Consulting Group, gave the inaugural lecture entitled "From volume to value". It was a very timely speech, at a time when the obsessive control of budgets and waiting lists prevents clinicians and managers from reflecting on what contributes so much care activity to society. The concept of value expressed by the German speaker is very new for healthcare managers, who tend to understand clinical effectiveness as a rhetorical concept more typical of epidemiological studies.

Value-based healthcare: the patient's perspective

Glòria Galvez

More and more organizations are adopting the new model of value-based healthcare (VBHC) where, according to the formula developed by Michael Porter:

                                                         Results that matter to the patient

                                        Value = ______________________________

                                                                           Costs

In order for the results to be measured correctly and standardized, the International Consortium for Health Outcomes Measurement (ICHOM) -a non-profit organization recently joined by Vall d'Hebron Hospital- is defining sets of indicators standardized by clinical conditions. In this line, the Vall d'Hebron Hospital, which is implementing this new model of care, has set up working groups to define the indicators that they provide value to patients for the clinical conditions of stroke and localized prostate cancer.