The first report in this year’s Future Health Index assesses the value delivered by the health systems in 16 countries. But how will that definition of value evolve as technology becomes more deeply integrated in healthcare? We put together a panel of healthcare experts from around the world to discuss this and shed some light on where our healthcare systems are heading.
- Bret Schroeder, healthcare expert at PA Consulting in Denver, USA
- Dan Spors, founder and Chief Technology Officer at HealthFactors, Inc. in Minneapolis, USA
- Dave deBronkart, patient engagement activist based in Nashua, USA
- Diane Bell, healthcare expert at PA Consulting in London, UK
- Jean-Manassé Theagene, CEO and President of 360Medlink in Montreal, Canada
- Johan Larsen, president of Catapult4D in Knoxville, USA
- John Halamka, Chief Information Officer at Beth Israel Deaconess Hospital in Boston, USA
- Kim Hodge, director of Clinical Performance for West Coast BPCI at naviHealth in Brentwood, USA
- Patricia Mechael, co-founder and policy lead at HealthEnabled in Cape Town, South Africa
- Rex Mahnensmith, practicing internist at Docs of CT in Connecticut, USA
- Stephen Canon, practicing urologist and cofounder of Phyzit TCM® in Arkansas, USA
Q: How should we define value in healthcare?
Dan Spors: We need to shift from traditional metrics such as mortality rates and move towards tracking patient-focused outcomes, such as how long a patient was out of work. Value-based healthcare should be able to empower patients to be better stewards of their own health. Technology should create efficiencies, provide data to care teams and facilitate easy access for patients.
John Halamka: Instead of measuring quality and cost, we should measure outcomes and experiences. What is the patient’s view of their healthcare experience? How does the patient feel? Is the patient able to lead a healthy and productive life?
Patricia Mechael: Value cannot simply be measured in dollars and cents – it must be measured in terms of one’s overall quality of life. New technologies and innovations worldwide enable greater insights into human health that will allow us to measure outcomes in real or near-real time for enhanced engagement and decision-making.
Diane Bell: To date, healthcare value in the UK has been based on clinical outcomes (improving blood test parameters) and system-level outcomes (reducing the level of non-attendance at outpatient clinics). We must shift the focus to patient outcomes (improving an individual’s quality of life) or population outcomes (reducing health inequalities). That requires us to embrace AI-based clinical decision support tools and deliver more consultations via app and web portal.
Bret Schroeder: Value is relative to the person or entity paying for or receiving care. What’s important to measure is efficiency and waste. There is too much inefficiency and waste in our current global healthcare system. Technology can improve efficiency, but it must be applied to a specific business problem.
Jean-Manassé Theagene: In Canada, the first challenge in defining value is to understand how value differs for each stakeholder and learning to capture measures of value that align with each definition. For healthcare organizations, value can be defined by resource utilization. For healthcare providers, value can be found in workflow management and clinical outcome improvements. For patients, however, value is tied to the experience and outcome of care. To develop and correctly evaluate technological innovations, we must capture data that accounts for each of these value propositions.
Q: What’s the greatest barrier in the way of changing how we define healthcare value?
Stephen Canon: Physicians in the US, especially those who operate in both fee-for-service and value-based payment models, may lose revenue in the short-term because it’s difficult to navigate both effectively.
Rex Mahnensmith: The US healthcare industry must overcome the tendency to overemphasize the importance of cost reduction. The industry must focus more on clinical best practices that automatically enable efficiency.
Johan Larsen: Healthcare professionals and administrators in the US are slow to adapt to change. Few have the agility, capability and resources necessary to stay current in this arena.
John Halamka: We don’t have the right data. My father died five years ago after living with multiple sclerosis for 23 years. We should have measured his pain, his gait and his muscle flexibility instead of his compliance with medications. Innovative devices and apps will enable us to gather patient-generated data and patient reports of outcomes much more easily.
Patricia Mechael: Healthcare reimbursement models don’t pay for all types of connected care. The good news is that this is changing. Recent reimbursement opportunities for remote patient monitoring in the US and other countries is a promising first step. Various countries are also implementing telemedicine strategies and policies. However, we need more rigorous studies (such as randomized control trials) that demonstrate the health impact of connected care approaches.
Dave Debronkart: Commercial players object when rules and regulations that ultimately enable value-based and patient-centric care change.
Kim Hodge: We need to be able to hold patients accountable for risky health behaviors and non-adherence. We also need a governing body to define value and enforce it.
Diane Bell: We need to change the culture of ‘professional knows best’ to focus more on what matters to individuals. The health system in Wales has started to adopt this mentality, but there are challenges related to collecting and using patient outcome data systematically throughout a patient’s course of treatment.
Bret Schroeder: One challenge is access to accurate and consistent data across multiple stakeholders to track, calculate, and report on the metrics that define value. Traditional measures of value compare outcomes versus cost, but they fail to incorporate causal factors, and they don’t consider patient satisfaction, access and/or consumer preferences – all of which are essential components of value-based healthcare. For example, in the US, patients value choice and access – neither of which is a consideration in traditional value measures.
Q: What’s the future of value-based healthcare?
Dan Spors: Analytics – including data acquisition, algorithms, reporting and distribution to stakeholders – will be paramount. We’ll see a shift from siloed information hubs to a patient-centric ecosystem of integrated partners.
Johan Larsen: If done correctly, connected care will improve public health and quality of life, which is the real value. We shouldn’t forget that healthcare is about people and not just technology, dollars and cents.
John Halamka: The future includes cloud-hosted services backed by machine learning, which are connected to mobile applications via application programming interfaces. Come 2019, there will be a perfect storm of innovation with alignment of technology, industry, academia, government and patient demand. However, we also need to overcome certain barriers to more connected care, such as heterogeneous privacy laws in the US. No clear nationwide patient identification strategy and a lack of a nationwide provider directory are also challenges.
Patricia Mechael: AI and wearable technologies will provide insights that help individuals engage with their own health. The shift to personalized health is also on the horizon, enabling healthcare professionals and patients to co-design the most appropriate approaches.
Dave deBronkart: Data mobility enabled by smartphone-based health apps will allow consumers to subscribe to their own health data feed and pursue value as they define it.
Diane Bell: In the UK, we’ll see more use of machine learning to interpret medical imaging. Aspects of care that require the human touch (such as breaking bad news, explaining the options available for care and providing empathy) will become more defined and valued as the UK’s health services shift from paying for encounters to paying for improving outcomes that matter.
Jean-Manassé Theagene: With the acceleration of connected health worldwide – the use of artificial intelligence, virtual assistants and virtual coaches – we will see the healthcare horizon becoming more personalized, widely accessible and far less expensive for patients than ever before.