Value Based Health Care Conference by Heather Warfield
30 June 2021
I was privileged to be sponsored by HCCA to attend, via Zoom, the Value-based Health Care Conference (VBHC) held in Perth held on 27 and 28 May 2021.
VBHC is a very different way of delivering health care.
The goal of VBHC is to improve patient health outcomes while reducing the overall cost of healthcare. Globally, VBHC is gaining momentum, transforming clinical practice, service delivery, payments, and policy to achieve the best outcomes for patients.
At present patients, the community and medical professionals are demanding more from the health system. Added to that equation, the population is ageing and, with increasing use of expensive technologies, funding a high-quality health system is becoming unsustainable.
The presenters at the conference were Australian and international champions of VBHC. The speakers were drawn from a diverse range of the medical and research fraternity, government, the allied health sector and patients.
Plenary 1: Patients First – what does this mean and what is needed to achieve it?
Speakers were Professor Elizabeth Teisberg, co-founder of the value-based healthcare concept and Julie McCrosin, broadcaster, journalist and stage four head and neck cancer survivor. Each spoke passionately about the necessity of keeping the patient at the centre of care and as equal decision maker about their care.
This requires medical professionals to ask at the beginning and throughout the patient journey what outcome the patient wants. By using real time data provided by the patient, their family and/or carers, the health service can meets the needs of the patient. This could involve the patient being cared for by a multi-disciplinary team. Elizabeth gave an example of a patient receiving cancer treatment is usually assumed to regard avoiding mortality as the best outcome. However, for the patient, receiving support and treatment for ‘chemo brain’ so they can function and carry on their lives as best as possible may well be their most pressing need.
Satisfaction surveys ask patients, ‘how were we?’. Value-based care providers ask, ‘how are you?’
Plenary 2: Transforming culture for value.
Daphne Koo, epidemiologist and Deputy Director, Medical Services Group, Singapore spoke of strategies to implement VBHC in a very different healthcare setting than Australia. Elizabeth Koff, appointed Secretary NSW Health in 2016 elaborated on what the word ‘value’ means in value-based healthcare and how to change the culture in the health system to achieve it.
The Australian Healthcare and Hospitals Association (AHHA) describe ‘value’ as ‘the health outcomes that matter to patients relative to the resources or costs required’. According to Elizabeth transforming culture ‘requires selling a compelling vision that captures people’s hearts and minds that has to be in the best interest of the patient always’.
Concurrent Session 1.2: Changing Culture
Michelle Maxwell, Director, Strategic Change, Strategic Reform and Planning Branch, NSW Ministry of Health spoke about the introduction of VBHC in NSW. The change management team went to local health districts holding forums to find out what ‘value’ means at an individual, service and system level. VBHC allows patients to feel empowered to work in collaboration with clinicians to meet the goals of the patient and it also allows the clinicians to work in a way that is entirely patient focused which increases job satisfaction and the feeling they are making a real difference.
Associate Professor Bruce Shadbolt’s current role is Research Director of the Centre for Health and Medical Research in the ACT. Epidemiologist: Nidhi Menon, is a biostatistician and epidemiologist within the Biological Data Science Institute, ANU and the Health Analytics. They spoke of using value-based research to measure what matters to patients and in collaboration with the health and wellbeing partnership board members, other contributors and ACT health to find the efficient use of resources to achieve the best outcomes.
Lea Kirkwood, Agency for Clinical Innovation, (ACI) and Margaret Kelly, Agency for Clinical Innovation also contributed. The ACI works with clinicians, consumers and managers to design and promote better healthcare for NSW.
All speakers gave practical examples of the challengers of changing the culture of NSW Health to VBHC. A revealing example of cultural change in the management of chronic disease is that in place of asking a patient to rate their pain on a scale of 0-10, the VBHC model is to ask the patient what effect their pain has on their quality of life.
Concurrent 2.1: Measuring What Matters To Patients.
Melissa Tinsley, Clinical information and Decision Support, Agency Clinical Innovation (ACI), Grainne O’Loughlin, CEO Karitane, and Sue Murray, Zero Suicide Australia discussed the quantitative and qualitative elements underpinning VBHC. In their view VBHC is successful because the Patient Reported Outcome Measures Program (PROM’s) enable feedback in real time thus helping to make improvements in healthcare.
The questions capture patients’ perspectives about how their illness and/or care impacts on their health and well-being. Coverage includes mental, physical and social impacts and treatment and illness burden. PREM’s (Patient Reported Experience Measures) measures the patient’s experience of the healthcare system or service.
Questions are standardised, and to aid diversity and inclusion, patients whose first language is not English can answer in their own language. Indigenous patients are also catered for. Because the IT system is integrated the real time data can be accessed by the patient themselves and healthcare professionals.
Grainne discussed the changes and challengers of going ‘virtual’ with their residential unit. This occurred prior to the pandemic and has been successful because they are able to assist a far greater number of families with a multi-disciplinary team. Another advantage of this approach was being able to support fathers who were often missed being included in the standard residential unit. Parents filled in the ‘me as a parent and wellbeing score’. From this qualitative real time data adjustments could be made to the individual program.
Sue spoke of the ideal method of treating mental health and called on government at all levels to support it.
Breakfast Seminar: How Cancer Screening Programs Contribute To Value in Population Health.
The government funded screening program for bowel, cervical and breast cancer supported by the National Cancer Screening Register (NCSR) which is connected with MyGov and Medicare. The NCSR supports cancer screening program from the initial reminder letter, a safety net follow up to data collection of the screening results, blood tests etc to managing abnormal results. There is now a participant portal, which went live last month that people can access through MyGov and manage their participation, nominate a healthcare provider view previous correspondence and screening status. Now patients have more control over their data.
Plenary 3: Transforming Systems For Value.
Dr Joe Conti spoke of the project he and his team developed on Staten Island, USA to provide value-based care to a large uninsured population whose only access to medical care was presenting to the local hospital ED. Using a patient-centred approach they were able to analyse the patients’ unmet needs, which included insecure housing, food insecurity, inability to get to a pharmacy to fill their scripts or ability see an allied health professional – that is ‘the social determinants of health’. The team were able to connect patients with wrap around services which reduced ED presentations by 62% for this cohort.
Professor Ross Crawford, orthopaedic surgeon, looked at how clinicians can add value by looking at the role of registries and guidelines to inform evidence-based care, particularly in the field of orthopaedics.
Clinicians, hospitals and even Medicare have collected data on success and failure rates of joint prostheses and post-operative infections over a long period of time but the profession is not using this information to improve patient care. Making such data available to the general public so they can make informed choices regarding their care is another challenge. The UK have a Get It Right The First Time (GIRFT) program which undertakes clinically-led reviews of specialities to examine how things are currently being done and how they could be improved. Ross supports this program.
Last, he spoke of the introduction of new technologies, such as robotics and AI are changing the healthcare landscape now and in the future.
Concurrent 3.2: Patient Communication.
Six speakers focused on a different aspect of patient communication and patient choice. Jamal Hakim spoke of how the ANU were asked to research understanding patient expectations and experience which then morphed into looking at patient choices. Next Cassie McDonald discussed the availability and suitability of health information and what sources patients used to improve their health literacy. She asked what were the enablers and barriers to patients accessing health information? Patients are at a disadvantage when they visit a clinician. George Faithfull’s pointed out that orthopaedics patients have little to no knowledge of the various prostheses available and can only be guided by a surgeon’s preference. Having access to long term data on the soundness of the prosthesis and about the surgeon’s clinical history (such as with infection rates) would empower the patient to make informed choices.
And lastly, David White Geriatrics & Palliative Care Advanced Trainee discussed that to deliver high quality VBHC it is imperative to establish patient care goals (GoPC) but to do this requires good communication. David believes that it is vital for staff to receive specific GoPC training.
Conclusion: An excellent, informative and challenging conference. All presenters spoke with commitment and a deep knowledge of VBHC and its positive impacts for healthcare consumers, clinicians and healthcare providers.