"The patient should be put first". - is a phrase that almost every medical student or doctor hears during their preparation for the profession. However, in the current health care system, where patient care is fragmented and specialists are billed based on the number of visits made and services provided, this is not the easiest task.

With the increased need to humanize treatment and take a holistic approach to the patient, a new concept has materialized. "Value-based healthcare" (VBHC), or value-based medicine, is a model for organizing a healthcare system that aims to achieve results that have a significant impact on a patient's quality of life and are consistent with the patient ' s needs. Doctors, in turn, are to be rewarded based on the realization of this goal.

In this article, you will learn how value in medicine is defined according to the VBHC model and how to take the first steps toward implementing such a model in your medical practice.

‍Whatis "value" in the health care system?

When describing the value-based healthcare model, it is important to consider the definition of the word "value" provided by the creators of the concept, Michael Porter and Elisabeth Teisberg, in their publication Redefining Health Care:

Value in health care equals results that matter to patients, relative to the cost of delivering them.

The authors of the European VBHC guidelines have expanded this definition with pillars that provide guidance for its implementation in practice:

Personal value - care directed at meeting the patient's personal goals, in which the patient's opinion is taken into account in the treatment planning process;
Practical value - achieving the best possible results with available resources, including current medical knowledge (Evidence-Based Medicine is an important element of VBHC);
Social value - the participation of the health system in building and developing communities, as well as effective and valuable relationships between doctors and patients;
Allocative value - the fair and rational distribution of resources - both material and human - among groups of patients, in order to increase the efficiency of the treatment process.

The pursuit of the aforementioned goals is expected to lead to the development of a health care system in which financial and time losses are minimized, and room is created for building a fruitful doctor-patient relationship in the therapeutic process. From this article you will learn what value-driven care is and how you can implement it in your medical practice.

‍Howdoes it work in practice? - An example of VBHC implementation in the treatment of type 1 diabetes.

Diabeter is a group of Dutch clinics dedicated to the care of patients with type 1 diabetes. By focusing resources on the treatment of one specific condition, the experts have created the conditions for multidisciplinary collaboration between specialists and holistic patient care. Moreover, in keeping with the spirit of VBHC, Diabeter meticulously collects PROMs (Patient-Reported Outcomes) and monitors objective treatment outcomes (HbA1c%). To do this, it uses a special online platform to contact patients and record measurements from glucometers and insulin pumps. The information it receives allows it to assess which staff actions bring the most benefit to patients, and which only generate unnecessary costs.

Important to the implementation of the project was the data collection methodology. Diabeter adhered to ICHOM's international standards, which facilitate the evaluation of treatment outcomes for patients with diabetes. This systematization of the data collected enabled a more reliable evaluation of the results achieved and the possibility of comparing them on a larger scale, including internationally.

O sukcesie projektu świadczą rezultaty pacjentów kliniki - utrzymują oni zdrowszy poziom glikemii niż ogólna populacja mieszkańców Holandii chorych na cukrzycę typu 1. (55% vs 28% z HbAc1<7.5%), a także rzadziej wymagają hospitalizacji (3% vs 8%). Jak podsumował dr Henk Veeze, jeden z założycieli: “obecnie 10% holenderskich szpitali przekazało swoich pacjentów z cukrzycą grupie Diabeter, w tym dwa z siedmiu szpitali uniwersyteckich.²”

Importantly, the Diabeter Group has managed to achieve these results without raising the costs incurred in benefits.

‍Whatcan you do to implement elements of VBHC in your medical practice?

The medical literature describes numerous examples of implementing the value-based healthcare model in medical care around the world. Some of the first steps you can take to also adhere to the tenets of VBHC include:

collecting and analyzing the results achieved in therapy, for example, by collecting PROMs and feedback from patients, and monitoring the costs incurred in the therapeutic process - a good practice is to use the Time-Driven Activity-Based-Costing model - in this article you will learn more;
Incorporating an online platform into its practice to keep in touch with patients and collect data from them about their health;
A change in the patient billing model - instead of one-time fees for visits, the VBHC concept involves remuneration in a subscription or bundle model - in this article you will learn more about subscription-based patient billing;

EIT Health has also released a VBHC implementation chart that can help you plan for implementing changes in your medical practice.

‍Summary.

Value-based healthcare is the model of healthcare system the WHO says the world is aiming for in the 21st century. It is based on putting the patient at the center of the therapeutic process, but it also brings numerous benefits to doctors and other health care professionals. In addition, it reduces the cost of treatment relative to the health results received. EIT Health has created a guide from which you can learn more about implementing VBHC into your practice and how it is already being implemented in Europe.