VALUE-BASED HEALTHCARE GLOBAL EVOLUTION PERSPECTIVES

An article from the Insights Series

 

Dr. Jason Arora, BMBCh, MPH, MA

USING DATA AND PARTNERSHIPS TO QUASH ‘VALUE VACUUMS’

Dr. Jason Arora, BMBCh, MPH, MA,
director of Value-Based Healthcare, Latin America, Medtronic

No matter where you fit as a healthcare stakeholder, the successful execution of value-based healthcare (VBHC) ultimately requires a focus on two fundamental principles: data and collaboration. This may seem obvious, but it is surprising how many healthcare institutions forget this as they begin to venture down the VBHC ‘rabbit hole’. Payers, providers, and suppliers who want to build a VBHC strategy can simplify their approach — and speak a common language — by bringing everything back to these two core elements. The two are closely interrelated. Data is the key currency, or engine, on which value partnerships need to be designed and executed.

Outcomes are defined as the results that matter most to the patient — the one true 'consumer' in healthcare. Cost is defined as the total costs of developing and delivering healthcare, rather than charges or prices.

WHICH DATA?

Healthcare data exists everywhere. However, not all of it is useful in telling us how well we are doing. We’ve repeatedly heard that we need to generate granular data on patient-centred outcomes and costs, but this doesn’t just apply to payers and providers.

Medical technology companies, such as Medtronic, are now collaborating with providers to pair expertise in technology and care delivery to help achieve better outcomes, and — in the process — to develop value propositions for payers. Without granular value data across all stakeholders, this type of work simply isn’t possible.

Importantly, it becomes difficult to identify ‘value vacuums’ — gaps in care or spaces where outcomes are poor and costs high — where collaborations can provide solutions. Such efforts may be internal — addressing organisational misalignment — or external, addressing stakeholder misalignment. Again, this may seem obvious, but the narrative is often lost, and the line between ‘VBHC’ and ‘not VBHC’ quickly begins to blur.

Should this matter? It should, because we hope to articulate better outcomes, lower costs, and a win for all stakeholders involved. If something is labelled as ‘VBHC’, it needs to tick all these boxes.

Payers, providers, and suppliers need to begin to see outcomes data in this way — as a tool for identifying value vacuums, and to guide the development of collaborative initiatives to address these directly.

So, ask yourself, what is your data strategy? 

  • Are you generating the right data? Does it reflect what matters most to the patient? Is it high quality? Do you have enough data? Is it going to help you identify value vacuums?
  • Is it transferable? Can it be shared across all stakeholders? Is it relevant to all stakeholders?
  • What does it tell you? Where are outcomes poor and cost high? Where are the value vacuums?

COLLABORATION IS NECESSARY TO QUASH 'VALUE VACUUMS'

A very simple example from Chile involves a heart failure care provider who discovered — through simple outcomes data collection — that patients who live furthest away from primary care support were experiencing poor outcomes (e.g., worsening symptoms and multiple readmissions) and high costs (e.g., lengthy transport, longer hospital stay, and re-interventions). The provider has worked with Medtronic and its payers to pilot a program that incorporates remote monitoring for these patients. Whilst the identification of the potential contributors to these outcomes isn’t rocket science, without the right data, it is difficult to articulate the value to all stakeholders involved, and the scale opportunity for the health system — in this case:

  1. Cost savings for a public payer that can free up vital resources, which can then be used to expand access to remote monitoring for thousands of other isolated patients suffering from heart failure. 
  2. A reduction in congestion for the hospital — a key priority as they look to reduce wait times for patients.

The lack of a data-driven narrative that speaks to all stakeholders and provides the scale potential is ultimately what slows down the development of VBHC collaborations. This also applies within institutions — such as a hospital, or within a supplier like Medtronic. Such deep-rooted transformation is tricky, and it requires us to form internal teams that are guided by real-world data on patient outcomes – our ultimate collective goal, and truth.

So, once you figure out your data strategy and have some informative data to begin with, ask yourself: what is our partnership strategy, internally and externally?

  • Internally, what can you do to address misalignments that are leading to poor value?
  • How are you going to use data to guide this?
    • In a hospital, this might be between different clinical or non-clinical departments. In a technology company like Medtronic, this may be between strategic and commercial teams.
  • Externally, who can you collaborate with to drive value? What combined capabilities are required? Do we need something new, or something that already exists?

THE WAY FORWARD

We need to deliver healthcare:

  1. To everyone at some point in their lives.
  2. At high quality — because health is a key enabler for everything else we do.
  3. With limited resources.

That is the industry we are in. The proactive management of quality and resources —outcomes and costs, or value — is therefore an essential component of healthcare. We just haven’t realised it until relatively recently. Unfortunately, healthcare stakeholders have always had very transactional relationships. Stakeholders work largely in their own silos, and then come together to negotiate. Each stakeholder has a different agenda, and supporting data, and that creates misalignment. High-quality value data on patient outcomes, therefore, needs to be the common ‘truth’ on which collaborations are formed, and the currency in which healthcare transactions are undertaken. At scale, this will naturally infuse value into health systems as they evolve to meet changing needs.

Value-based healthcare is widely acknowledged as one of the only comprehensive solutions to the resource, quality, and access issues that we are facing in global healthcare. As we continue to see global initiatives take shape and provide overarching guidance, it is critical that individual healthcare institutions also begin to shape their own destinies, whilst maintaining a common language between themselves. That is, to build independent VBHC strategies around data and collaborations, and when things become complicated, to bring everything back to these two fundamental tenets. If done correctly, this — in combination with global umbrella initiatives — should see us get to the critical mass of movement required to truly revolutionise global health systems at scale.


Jason Arora

Dr. Jason Arora, BMBCh, MPH, MA

Director of Value-Based Healthcare, Latin America, Medtronic

Jason Arora

Jason leads Medtronic’s VBHC work across Latin America. He also serves as a Global Health Expert at the World Economic Forum and a Global Leader at the Center for Health Care Innovation. Prior to this, Jason was a director at the International Consortium for Health Outcomes Measurement (ICHOM) and a practicing physician in the UK. He is the recipient of Harvard’s 2018 Public Health Innovator Award, and was named on Forbes’ "30 under 30 Health Care and Science" list in 2017 and on KPMG’s "Top 100 Asians in Tech" list in 2018. Jason holds degrees in medicine and medical sciences from Oxford, and public health from Harvard, and is a former Fulbright Scholar.


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