Dr BS Ajaikumar
Chairman and CEO,
HealthCare Global Enterprises Ltd.

Value-Based Medicine: New Patient-Centric Approach To Healthcare

Value-based healthcare (VBHC) has the potential to bring about a considerable change in the way healthcare systems operate. It is gaining attention with policymakers, payers, healthcare professionals, and care providers worldwide, who are furthering efforts to transition the concept into practical and actionable measures.

Measuring health outcomes against the cost of delivery

VBHC is a framework for restructuring healthcare systems with the overarching goal of creating value for patients. While healthcare systems around the globe are currently based on creating access, cost containment, convenience, or customer service, VBHC focuses on creating quality for patients. It seeks to define the cost of treatment based on the quality and outcome, thereby disrupting the traditional fee-for-service reimbursement model. Quality healthcare will directly be linked to patient outcomes, resulting in quicker recoveries, fewer re-admissions, lower infection rates, and fewer medical errors.

Determining payments based on the value of care delivered

The primary component of VBHC is the understanding and intent to move away from healthcare payments based on the volume of services delivered or products utilized. Healthcare payments, instead, would solely be based on the value of care delivered. Meeting the need for more holistic care, bundled care will also be integral to VBHC. On a deeper level, integrated care through optimal treatment pathways will help improve care efficiency, particularly for patients with diseases at different stages of progression and with varying comorbidities. Once these measures are defined, it will be important to create appropriate provider payment models and access to align incentives and reward stakeholders for creating value.

Creating impact through patient-centric healthcare models

A fee-for-service system reimburses providers, making healthcare a factor of costs and revenues while VBHC, on the other hand, carefully designs the financial incentives for stakeholders, prompting them to increase utilization and quality, and achieve improved performance. The foremost impact of VBHC will reflect in the cost of healthcare. Under VBHC, payments will be based on the quality of care and subsequent improvements in the patient’s health, creating a new standard of value not just for care providers but also for insurance companies. VBHC will enable healthcare to take a proactive approach, as opposed to the reactive approach. Data would no longer remain trapped inside massive repositories and sites, but be utilized to identify specific health risks, improve care coordination, and enhance operational efficiency. Care providers would be empowered by innovative technology, access to data, and financial incentives to coordinate care across the entire healthcare system.

Massive potential to address healthcare challenges in India

The infrastructure is plagued with over-crowding, under-funding, and an acute shortage of resources. 80 percent of the country lacks access to basic healthcare services, and the system is characterized by high out-of-pocket expenses, a strong rural-urban divide, and an inability to meet the rising population healthcare needs. As the United States, Colombia, and other western countries come closer to aligning their healthcare systems to the VBHC model, India offers a unique opportunity for its implementation. A step in the direction was taken through the proposed Clinical Establishment Act. Electronic health records, evidence-based guidelines for healthcare, and national disease registries are also early-stage components of VBHC. Working toward an integrated effort to improve healthcare and reduce cost, VBHC can help reform healthcare in the country by developing a mechanism that rewards those who help achieve these aims.

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