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How to build value-based healthcare

By Dr. Mark Khayat, Jan Schmitz-Hubsch, and Dr. Walid Tohme

Article

The COVID-19 pandemic is creating significant changes to healthcare systems. Under considerable pressure, GCC healthcare systems organized care differently while protecting their populations. In doing so, these systems moved toward value-based healthcare, which is centered around patients and driven by data. Value-based healthcare aims to deliver the best patient outcomes, while being cost-efficient. Healthcare system stakeholders can absorb the lessons from how they reacted and move deliberately to build on the foundations of value-based healthcare that were laid during the pandemic. All stakeholders need to contribute actively to enable this transformation.

The pandemic enabled unprecedented collaboration that brought together key elements of value-based healthcare in a way that had not happened before. Healthcare systems rapidly set aligned goals centered on patient outcomes. The focus on these common goals allowed for previously unseen cooperation among policymakers, providers, payors, and life science companies. Many elements of value-based healthcare that required collaboration, that was deemed too difficult before the pandemic, became urgent and achievable. Consequently, GCC healthcare systems managed to cut hospitalization and death rates from COVID-19 substantially.

Stakeholders took five critical steps during the pandemic:

First, they segmented populations, allowing them to tailor healthcare interventions for target groups. Second, they defined a unified set of outcomes and standardized ways of measuring them, in line with global standards. Third, they exploited innovation to collect the outcomes, including exploiting automation such as through test-and-trace technology. Fourth, they disseminated the data and created benchmarks that provided insights that in turn enabled continuous improvement. Fifth, they were nimble in centering care around their citizens’ priorities to improve outcomes.

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All of these steps yield lessons for the future. First, stakeholders must segment the population to identify priority groups, create the necessary healthcare interventions and services, and that are centered around the specific needs of the prioritized segments.

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Second, stakeholders need to define concrete objectives for each population they are targeting. These objectives should be centered around the outcomes that matter most to patients, such as by using patient-reported outcome measures, or PROMs. Policymakers can define and introduce standard outcomes that enable stakeholders in the healthcare system to cooperate and pave the way to compare the results of interventions.

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Third, providers need to measure and collect the information. Regulators and the public sector need to support the development of tools that can do this at scale.

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Fourth, the data need to be made available and shared among stakeholders. The point is to pool, and use, this information to improve services. For example, the data can be used to benchmark outcomes across providers. This enables use cases that enhance outcomes and reduce costs, such as allowing payors to direct patients to providers that achieve the best outcomes.

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Fifth, value-based healthcare is a continuous cycle of improvement. This involves identifying variations, deriving leading practices, and deploying them. Stakeholders must learn about leading practices to introduce service improvements that create better value for patients and the healthcare system overall.

Stakeholders across GCC health systems can now build on the foundations of value based healthcare laid during the pandemic.

Policymakers can define standards, provide the incentives to measure and report, support data transparency, and invest to supply the enabling infrastructure.

Providers can segment their populations, focus on specific groups by reorganizing care around their needs and to deliver best outcomes. They can measure those outcomes, and set up a cycle of continuous improvement.

Payors can encourage patients to use providers that deliver high value care to priority segments of the population. They can help providers innovate services for costly patients through information sharing. They can introduce value-based payments based on agreed outcome measurements to reinforce further the delivery of outcomes.

Life science companies can leverage outcomes to offer more personalized treatments and to help providers understand what outcomes can be achieved for specific patient segments. They should cooperate with regulators to introduce pricing changes according to the results for different kinds of patients.

By aligning objectives around patient outcomes, healthcare stakeholders can continue the momentum toward value-based healthcare. The result will help healthcare systems to achieve improved health outcomes for their populations and better use of scare resources.

This article originally appeared in Omnia Insights, January 2022.

About the authors

Dr. Mark Khayat, Jan Schmitz-Hubsch, and Dr. Walid Tohme are partners with Strategy& Middle East, part of the PwC network.

Contact us

Jan Schmitz-Hubsch

Jan Schmitz-Hubsch

Partner, Strategy& Middle East

Dr. Walid Tohme

Dr. Walid Tohme

Partner, Strategy& Middle East

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