Single-Payer Advantages for VBHC Implementation. The Case of Bulgaria.

Operating within a single-payer system often results in reduced competition and hierarchical decision-making. For nearly a quarter of a century, the Bulgarian health insurance system has operated under a single payer, and I am not optimistic about any short or mid-term changes. However, I want to explore the potential for significant advantages in implementing Value-Based Health Care (VBHC) within such a system by aligning long-term benefits with the single payer’s objectives.

In contrast to a competitive insurance market, a single-payer model allows the payer to reap the full rewards of improved health outcomes and cost efficiencies from mid- and long-term investments in driving value for patients.

In a single-payer model, data on outcomes and costs is theoretically centralized, enabling more comprehensive analysis, particularly for key medical conditions. This allows all stakeholders to access innovative pilot programs, fostering collaboration and improvement.

In Bulgaria, this approach can facilitate the co-development of risk-adjusted clinical pathways for inpatient care, introducing pay-for-performance models tailored to various medical conditions.

The current capitation model for primary care can be expanded to subgroups of patients and linked to quality measures and specific patient metrics, tailored health plans, and rewards. This incentivizes providers to focus on preventive care and manage chronic conditions more efficiently.

Tying payments to outcomes incentivizes providers to achieve better health results. Extending payment episodes across the entire care cycle ensures continuity, integration, and comprehensive health management.

Cultural changes through continuous improvement are essential. Planting seeds before harvesting involves introducing pilot programs, analyzing data, and scaling successful elements. It is important to avoid overly complex or narrow conditions and instead focus on broad applications to ensure success.

By adopting these strategies, a single-payer system can drive significant advancements in VBHC, promoting better health outcomes and cost efficiencies across the healthcare system.

This also means that the current division of responsibilities—where payers handle payments and providers deliver care—should evolve into a cooperative approach for managing costs and outcomes. Additionally, the payer's role should transition from merely being a financial institution and reimbursement tool to becoming a supporter of enhanced value for patients.