Value Based Healthcare as the key to sustainable healthcare in Poland

In a few days the ‘Priorities in Healthcare 2023’ conference, will take place where many passionate health care professionals will share their views on what a sustainable healthcare system in Poland looks like.

Ahead of the conference, I want to share my thoughts on what I believe is the cornerstone of sustainable healthcare, a topic very close to my heart: Value Based Health Care (VBHC).

I will share why I think VBHC is important, the potential impact for all stakeholders especially the patient and my thoughts on the three main enablers for Poland. That will be a lot, yet I will refer back to it in later blogs in which I will share more examples and insights from other stakeholders in healthcare, so stay tuned.

So why do we need Value Based Health Care?

We cannot open a newspaper or website without being confronted with seemingly universal challenges:?shortage of health care staff, aging populations, increase in chronic disease, problems setting up true coordinated care, need to digitalize many parts of the health care ecosystem, health care costs rising faster than GDP etc. etc. It is a true burning platform and when we continue health care delivery of these challenges with Fee for Service or Diagnosis Treatment Combination models, then the health care system becomes ?truly unsustainable. The challenge is so large that cost reduction measures that are being deployed now will not work since these do not increase the level of value delivered for patients.

How do we ensure we can leverage the full potential of scientific and digital innovations and increase the value delivered to each patient, and do that for a lower cost per patient across the patient journey?

Value-based Healthcare (VBHC) is the answer for that, since it enables healthcare systems to become sustainable, connected, cohesive, and resilient. It brings different healthcare stakeholders together around a common goal of shared values.

That sounds nice, but what does VBHC really mean?

Let’s start with a definition, the founder of VBHC is Michael Porter who kickstarted the VBHC movement by publishing his book “Redefining Healthcare”, defines VBHC and patient value in the following way.

“Patient value is defined as patient-relevant outcomes, divided by the costs per patient across the full cycle of care in order to achieve these outcomes. Value-Based Healthcare focuses on maximizing the value of care for patients and reducing the cost of healthcare”.

The focus on the full cycle of care means that VBHC is by definition a multi-stakeholder collaboration to provide patient value.?This value needs to be relevant for society and include health services & technologies in a sustainable and equitable way.

·??????For patients the focus of quality over volume means getting the fastest possible diagnosis, optimal full recovery and treatment with better life conditions and improved quality of life wherever they are – e.g., telemonitoring, home care.

·??????For health care professionals better care coordination, optimized workload with better streamlined access to optimal tools for effective treatment.

·??????For payer (NFZ) lower cost per patient with better treatment outcome; so more sustainable health care.

·??????For policymakers (incl. Ministry of Health) comprehensive and optimal disease management aligned with medical guidelines.

·??????For pharma and med tech – encourages and supports innovation beyond therapeutic innovation. ?

As stated in the World Economic Forum report, the move to value-based payments is not an incremental one but rather disruptive in the ways healthcare delivery must be organized, measured, rewarded, and paid. As described by value-based experts, in the old marketplace, the product was “treatment” and the measure was “volume”. In the new marketplace the product is “health”, and the measure is “value”.?

That sounds nice, but what does that mean for Poland?

Whilst some healthcare challenges mentioned before are shared across countries – aging population, new technologies, budget challenges - one thing stands out for Poland specifically; we have the lowest number of doctors and nurses per capita compared to all other OECD countries.

In implementing VBHC in Poland, special focus can be given to comprehensive solutions that help address that challenge. For example, set a cost for all that is necessary for diagnosis, treatment and follow-up in a given disease, where the follow-up will be supported by e-health solutions that enable more care with lower health care professional time investment. These e-health solutions already exist and many more are in development.

Such solutions allow patients to identify symptoms while at home, HCPs will see these real time and can act upon them quickly. Especially in oncology every day counts, so the possibility of earlier intervention has already proven to increase outcomes for patients. Doing that through an e-health solution avoids calling and visiting the hospital, reducing the time investment needed of HCPs, who can take care of more patients. Several HCPs can be connected in the same digital environment, enabling coordinated care. Last but certainly not least, patients feel taken care off in between visits, positively impacting their mental health.

Why not start the VBHC path in Poland by including these services in the payment schemes? That provides a valuable incentive for all partners in healthcare to provide these, and increases patient value with more efficient healthcare professional usage; so crucial for Poland.

This example immediately underlines which three enablers are key to make this a reality: data, partnership and outcomes based payment schemes. How can we start the VBHC journey for each of these enablers?

·??????Data

o??In Poland the SMPT database contains a lot of information on patient outcomes that can be used today to move towards value based health care. Many clinical parameters necessary to qualify patents in drug programs are available. Some first steps in using these in outcomes based payment schemes have been done, let’s build on that by making that a systematic practice.

o??More data will become available each and every day. Many datapoints will come via telemonitoring tools that have taken off since the Covid pandemic, and that are especially necessary in Poland as described above. Also here we can use what is already available to integrate these into outcomes based payments. This will be ?possible when the outcomes of e-health solutions will be ?stored in a privacy protected aggregated way with an objective data board. This ?will also extend the possibilities to include wellbeing and other quality of life parameters that patients can enter from the comfort of their homes.

o??In the future the possibilities created by the planned European Health Data Space regulation will make these options exponentially bigger. All electronic data record will have to be compatible, whether a patient is seen in first line care or in a tertiary clinic. The full coordinated care team around a patient will thus be digitally connected and that will provide opportunities to truly embed all stakeholders around the patient in a value based health care way. Even stronger than described above in the e-health example this ?will increase visibility in the patient status, allows for improved outcomes, strengthens the patients voice, allowing them to take care of their own health better, and when combined with machine learning will enable earlier detection of flares, or relapses improving health outcomes at a lower cost.

·??????Partnership and thus trust.

o??When payment for outcomes is based on outcomes generated jointly, all partners in?health care need to be aware of, respect and fully trust all parties in delivering that outcome. That is easier said than done, and will likely result in starting smaller partnerships offering value, or in one party sub-contracting others to generate the overall patient value. Starting small while thinking big is key. No matter in which area a partnership will be started, it will be important to think of how that can be scaled to other areas. Whether that means adding other therapeutic areas or adding other health care partners. Without scalability projects will not succeed, since that would risk drowning people in an overwhelming number of systems, approaches and agreements. Being mindful of that at the start will be key.

o??It also means that care will likely have to organized around these partnerships. Porter calls that Integrated Practice Units, basically any form of coordinated care with clarity on which part of the value delivery is organized by who. In Poland this is being complicated by not having enough health care resources, setting up different care units instead of existing one will take resources at the start; yet experiences in cardiovascular care and oncology show us this is possible. Luckily there are plenty of examples from other countries that have worked well and can inspire us. More on these to come in later blogs.

o??When there is a lack of trust at the start, having an objective third party in the process can also help to start. Different health care parties will start working in more intense ways together while having different cultures, operating models, and definitions of what success and value look like. Having an independent party to ensure alignment and objectivity, can help start and continue these partnerships.

·??????Innovative contracting.

The way payers contract care needs to change to enable VBHC, and that often means legislation needs to change to enable payment based on outcomes, and payments over a longer term. Many countries do not have legislation that is fit for purpose for value based contracting and Poland is no exception. That is why having some level of clarity of what is expected from VBHC in Poland by Ministry of Health will be crucial, also when developing a new reimbursement law for example.

Ten years from now VHBC will be front and center, so any upcoming legislation needs to enable use of data, payment models based on outcomes, including the patients voice on the value delivered and provide the possibility to pay across all stakeholders involved in a given treatment. Having that all at once might be difficult, yet providing that possibility for pilots in areas where health care costs are increasing above average, or where the shortage of HCPs might be even bigger than elsewhere can be a good place to start.

How does VHBC reduce costs?

·??????Through its set-up, there is an incentive for all stakeholders in a given treatment to be efficient, and that incentive will lead to savings as has been shown in many pilots of this kind across the world.

·??????Some of the technologies will also reduce costs on itself Integrating artificial intelligence and machine learning will predict complications earlier, allowing cost-effective therapies to be started earlier. In addition, they can reduce the need for biopsies, telemonitoring can reduce cost of hospital admissions by keeping patients at home, and there are many more examples like this.

While it is clear these challenges will be intense, it is also clear that we do not have a choice. We cannot move forward with healthcare costs growing faster than GDP, with patients not benefitting from scientific and technological innovation that can positively impact their health.

Value Based Healthcare, with its premise to increase value delivered for patients at a lower cost per patient across the patient journey is, in my opinion, the answer we need. So all societies can be healthy societies where every individual can live their fullest life.

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@Ma?gorzataGa?azka-Sobotka;??@BartoszChmielowiec?@MarcinCzech @Micha?K?powicz @KrzysztofKope??@Roman Topór-M?dry??@MinisterstwoZdrowia @Takeda?@AdamNiedzielski @Manad?erZdrowia ?@AgencjaOcenyTechnologiiMedycznychiTaryfikacji @KrystianLurka@Infarma