Value-based healthcare: Answering questions
Value based healthcare (VBHC) is increasingly viewed as the most likely way of delivering affordable and sustainable healthcare systems. Current delivery models, focusing on volume, are simply unable to cope with the demands of Europe’s ageing population. The need for change, to be able to extract greater value, is inevitable. Here at COCIR we have long believed that greater value will be found through patient-centric care and integrated care pathways, and that imaging technology, radiotherapy and Digital Health will play an increasingly important role.
However, establishing a widely accepted value-based approach poses its own challenges. Not the least of these are the competing ideologies - and competing interests - of what defines value. How much value should be apportioned to the various components of healthcare? How does timing of intervention impact value?
COCIR decided this year to focus its open session at its General Assembly to address such topic and examine ways to address some of the many challenges, in particular the rationale underpinning value-based healthcare (VBHC) models. As it stands, there is very little published data examining the financial impact of imaging technology, radiotherapy and Digital Health. We looked at some of the initiatives currently underway, as well as to stimulate wider discussion on identifying the value that COCIR’s sector delivers.
Dr Rishi Hazarika from the International Consortium for Health Outcomes Measurement (ICHOM) explained the work that his organisation was doing to increase the uptake of VBHC by defining global Standard Sets of outcome measures that really matter to patients. ICHOM has already published Standard Sets for nearly 50 percent of the global disease burden, including common conditions such as coronary artery disease, lower back pain and breast cancer. He used the example of ICHOM’s work on breast cancer, which examines the impacts of different treatment approaches.
However, despite ICHOM’s commendable efforts to date, a wide range of areas remain where these standard sets do not yet exist. For COCIR member companies, operating in an innovative, technology-driven and highly competitive sector, this presents a challenge. For companies seeking to maximise their contribution to VBHC, it’s important to know the direction health policymakers would be interested to pursue. This is why COCIR is taking a proactive role in promoting this debate.
Perhaps the most illuminating outcome was that those using the COCIR members’ technology are conscious that they have a critical role to play in ensuring value in healthcare, defining their own measures. Where Standard Sets did not yet exist, professional organisations are increasingly defining their own standard methodologies for ensuring that they make value-based decisions. Professor Lorenzo Derchi, Vice-President of the European Society of Radiology (ESR), explained his organisation’s work to develop a value-based approach for the imaging sector. The approach determines a measureable value of imaging, linking it to patient outcome. This should replace the current volume-based evaluation of imaging, which is largely unrelated to care quality or outcomes. As part of this, it has developed the ESR iGuide , an easy-to-use tool that lets physicians improve the relevance of their medical referrals. The iGuide helps them request the right examination, for the right indication at the patients’ first visit.
Meanwhile, Dr. Yolande Lievens, President of the European Society for Radiotherapy & Oncology (ESTRO), explained some of the projects that it is undertaking to quantify the value of radiotherapy. The ability of innovative radiotherapy to provide more accurate diagnoses and more effective treatment needs to be factored into value calculations.
She acknowledged the challenges – and the costs - that industry faces in generating evidence for comparative effectiveness without reimbursement. However, there was little alternative; without it, there would be limited likelihood of reimbursement in future. There needs to be a more innovative approach to evidence generation, costing and financing.
Victor Hugo once said; “There is nothing as powerful as an idea whose time has come.” This discussions at COCIR open session tells us that VBHC is just that - an idea whose time has come. The elements that will ensure the adoption of VBHC are being developed - not just through the work at ICHOM - but also by physician groups that see a genuine value-based approach as an increasing part of their responsibility.