No return to the status quo: Why now is the time for value-based change

Value-based, person-centred healthcare is the key to system resilience – and now is the time to make it happen.

COVID-19 offers a “unique opportunity” to build healthcare systems that are both agile enough to deal with future crises and strong enough to overcome existing challenges.

That’s according to a new policy paper from the European Alliance for Value in Health. Health Systems after COVID-19: Building Resilience Through a Value-Based Approach argues that instead of trying to reinstate the pre-pandemic status quo, the sector should “strive to reimagine” how health systems are organised and operated.

“The onset of (the pandemic) presents rare momentum to realise ambitious reforms and establish a new paradigm for defining and building health system resilience that will also answer the long-term health challenges Europe faces.”

The policy paper calls for a broad assessment of health system resilience and using the findings as a basis for the building of a value-based system that will improve care across the board. This outcomes-focused, holistic approach would reorganise the allocation of resources towards “high-value care and prevention that tackles unmet meet”, and create healthier, more resilient populations and societies, it says.

“A key take-home message from the ongoing pandemic is that health systems produce and spill over well-being to the entire society, while, predictably, their lack of resilience can have detrimental spill over effects to economic, social and government activity.”

This new model could be possible thanks to the utilisation of high quality, comparable data and insights, and enabled by financing models and payments that reward value and outcomes, they said.

“This process builds off continuous learning processes, utilising high-quality, comparable data and insights. Special emphasis is placed on reaching high levels of health literacy and increasing the use of patient-reported outcome measures and experience measures (PROMs and PREMs).

“Innovations in care delivery and integrated health and social care networks can be enabled by financing models and payments that reward value and outcomes. Importantly, investment in healthcare is recognized as an investment in societal well-being.”

Making it happen, they went on, will rely on the kind of cross-sector, cross-border collaboration we have witnessed during the pandemic.

What is resilience anyway?

Healthcare system resilience isn’t a new concept. In 2014, the European Commission, which defined it as a system’s ability to adapt to changing environments and tackle significant challenges with limited resources, named it as one of its key healthcare priorities.

It listed stable funding mechanisms, sound risk adjustment methods, good governance, information flows, adequate costing of services, and an adequate, skilled health workforce, as key resilience drivers.

The 2020 Strategic Foresight Report, published in the midst of the pandemic, laid out further commitments to resilience, but progress has been slow.

Part of the challenge, says the alliance, is the difficulty associated with measuring resilience in a way that can guide meaningful change. Existing proposed metrics, such as medicine stockpiles or wait times, are input- or process-based, while the policy paper calls for a broader, outcomes-based approach.

“None of the assessment frameworks proposed (by bodies including the EU’s Expert Group on Health System Performance Assessment and the Expert Panel on effective ways of investing in health) include the health status of the population or at-risk patient groups, including the outcomes of chronic disease management.

“This would be important, as many chronic disease patients have been extra vulnerable to COVID-19, and poor chronic disease management, therefore, would be a threat to resilience,” said the paper.

Value-based healthcare reforms

A value-based system “creates incentives and investment capacity for high-value interventions and innovations that improve patient and population health outcomes in the long term”, says the alliance.

That includes strategies to encourage disease prevention and tackle health inequalities, both of which can help create a healthy, resilient population and help overcome existing challenges such as increasing comorbidity.

“Taking an outcomes-based approach, comparing health outcomes between different communities and population segments and guiding health interventions through risk stratification, could decrease health inequalities and improve the prospects of vulnerable population groups, both before and during a pandemic,” said the paper.

Flexible, integrated health funding frameworks are also needed, as they would ensure limited resources are directed to where they can make the most impact.

“A more cohesive financing approach reinforces system resilience through gains in efficiency that free up previously under-used resources, while simultaneously allowing for faster, more responsive realignment of financing streams during an emergency,” says the alliance.

The paper makes a number of recommendations to policy makers and stakeholders on a national, regional and EU level. They include:

• The incentivisation of health promotion and prevention
• A reformed framework for health funding, both at the macro and meso level, to facilitate a more holistic approach to expenditure and financing
• A new reimbursement system that includes value-based contracts and risk-sharing models, to support the adoption of high-value, unmet need-tackling innovation
• National strategies for the collection and use of PROMs

Alliances and coalitions

The COVID-19 response demonstrated what was possible when the medical community worked together towards a common aim – and the same principle can be applied to resilience.

“Critically, stakeholders should build coalitions at national and/or regional level to support the transformation to value-based and person-centred healthcare. These new partnerships will also strengthen the resilience of health systems during a crisis,” says the alliance.

In essence, they argue, there should be no return to business as usual – now is the time to build Europe’s future healthcare systems.

• Read the European Alliance for Value in Health’s Health systems after COVID-19 – Building resilience through a value-based approach report

About the author

Amanda Barrell is a freelance health and medical education journalist, editor and copywriter. She has worked on projects for pharma, charities and agencies, and has written extensively for patients, HCPs and the public.