INTRODUCTION
The global projected medical spending in 2021 was
8.1%, well above the global inflation rate of 4.35% in the same year (O’Neill, 2022; Watson, 2020). The
overuse of care due to over-recommendations of services or overprescribing by
the medical practitioners continues to be the most significant factor
contributing to the increase in medical expenses (Watson, 2020).
Fee-for-service (FFS), currently the most common payment method for medical
services in the world, is defined as “the fixed payment for each unit of
service without regard to outcomes” (Luca & Paul, 2019; Rice, 2021). It
contributes to increased services utilization, volume, and cost without clearly
improving the quality of care (Luca & Paul, 2019).
Efforts have been made to shift from volume-driven to
value-driven care since the 1990s (Alsever et al., 1995; Beveridge, 1997a, 1997b)
It revolutionized in 2006 when Michael Porter and Elizabeth Teisberg
introduced the concept of value-based healthcare (VBHC). At its fundamental
goal, VBHC aims to improve value for patients. Value is further described as
the health outcomes achieved that are important to the patient relative to the
cost of achieving those outcomes. Value enhancement entails improving one or
more outcomes without increasing costs or reducing costs without compromising
outcomes, or both (Bernstein et al., 2022; Porter & Lee, 2013; Porter & Teisberg,
2006; Teisberg et al., 2020).
Porter described six major elements that are necessary
for a truly value-based system: (1) reorganize care around patient conditions,
into Integrated Practice Units (IPUs), (2) measure outcomes and costs for every
patient, (3) move to bundled payments for care cycles, (4) integrate multi-site
care delivery systems, (5) expand excellent provider reach across geography and
(6) build an enabling information technology platform (Bernstein et al., 2022; Porter & Lee, 2013; Porter & Teisberg,
2006; Teisberg et al., 2020).
Despite the increasing number of peer-reviewed
publications addressing the value-based healthcare, a systematic approach for
implementing this concept is minimal (Bernstein et al., 2022; Porter & Lee, 2013; Teisberg et al., 2020;
Zipfel et al., 2019). It
is crucial to understand the lessons learned from previous implementation
efforts, and when used accordingly, this can drive towards a more successful
transformation to VBHC.
METHOD
Since VBHC is an emerging topic and the previous studies
are heterogenous, we conducted a scoping review to review the implementation of
VBHC and the factors affecting it. We followed the Joanna Briggs Institute
framework for population, concept and context, the framework of Arksey and
O’Malley for scoping review methodology and the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) (Arksey & O’Malley, 2005; Peters et al., 2015; Tricco et al., 2018).
1. Identifying
the research question
This research uses the
population, concept and context (PCC) framework recommended by the Joanna
Briggs Institute for Scoping Reviews (Peters et al., 2015). It
aims to address the following research questions:
a.
Which element of VBHC is the
most commonly implemented?
b.
What are
the key success affecting the transformation to VBHC?
Table
1
The
PCC framework
|
Population
Hospitals
|
|
Concept
Value-based
healthcare
Value-based
care
VBHC
|
|
Context
International
Between
2006-2022
|
2. Identifying
relevant studies
Two databases were used: Scopus and Embase. The articles included were from 2006, the year when
Porter first introduced VBHC, to 2022. The multiple keywords used were shown
below.
Table
2
Search
Strategy
|
No
|
Keywords
|
Search Strategy
|
|
1
|
Value-based
healthcare
|
“value-based
healthcare” OR “value based healthcare” OR
“value-based health care” OR “value based health care” OR “value-based care”
OR “value based care” OR “vbhc”
|
|
2
|
Key
success
|
“key
success*”
|
|
3
|
Hospital
|
“hospital*”
OR “healthcare” OR “health care” OR “health facilit*”
|
To include relevant studies, we included
English, full-text, empirical articles which described the implementation of
VBHC to patients in a hospital setting and explicitly cited Porter’s concept on
VBHC. Articles describing other concepts of value-based healthcare were not
included.
3. Study
selection
The articles were exported to Mendeley,
where duplicates were removed afterward. Two rounds of eligibility screening
were conducted. During the first round, two reviewers screened for titles and
abstracts independently. After every 200 articles, the two reviewers discussed,
and when there were disagreements, the articles in question were raised to the
third reviewer. During the second round, full-text screening was conducted
independently by two reviewers.
4. Charting
the data
The included full-text articles were
imported and summarized using these extraction fields: author(s), year, title,
country, VBHC element, affecting factors. The data were then regrouped to
answer the research questions. Data in the field “VBHC element” were sorted to
indicate which of the six elements of VBHC was most commonly implemented. Data
in the field “affecting factors” were classified and used to describe the
factors affecting a successful transformation to VBHC.
Figure 1. PRISMA flow diagram for the
scoping review process
RESULTS AND DISCUSSION
The
initial identification phase resulted in 800 articles (258 from Scopus and 542
from Embase).
These articles were then deduplicated, resulting in 724 articles. After
screening by title and abstract, 295 articles were irrelevant and excluded,
leaving 429 articles. From 429 articles, 42 articles were not fully accessible,
14 articles did not mention any implementation in the hospital setting, and 20
articles did not refer to Porter’s concept of VBHC, all of which were excluded.
Subsequently, 30 full-text articles were selected for inclusion in this scoping
review.
The articles included in this study came from various
countries. As many as 9 articles (30%) were from the United States, 7 articles
(23%) were from the Netherlands, 3 articles (10%) were from Sweden, 2 articles
(7%) were from Korea, and 1 article (3%) each from Poland, Australia, UK,
Sweden and Brazil, Spain, Germany, Sierra Leone (West Africa), Italy, and
multiple European countries. A summary of these articles is shown in Figure 2.
Figure
2. Distribution of articles by count
Table 3
Summary
of articles relevant to VBHC implementation
|
No
|
Author
|
Year
|
Title
|
Location
|
VBHC Element
|
Affecting Factors
|
|
1
|
Florence A.C.J. Heijsters et al
|
2022
|
A pragmatic approach for
implementation of value‑based healthcare in Amsterdam UMC, the Netherlands
|
Netherlands
|
Reorganize into IPU
|
Organisational readiness
for change among healthcare professionals, including cultural change. From
the start, the VBHC program in Amsterdam UMC has been directed by a steering
committee chaired by the chief medical officer. The steering committee has
determined the program-wide goals, monitored progress and selected new teams
who wanted to start with VBHC. Value teams executed the VBHC approach.
|
|
2
|
Ewelina Nojszewska and Agata
Sielka
|
2022
|
Macroeconomic and Social
Indicators to Launch the PM-Based
VBHC Model in the Healthcare System in Poland
|
Poland
|
Reorganize into IPU
|
The very operation of
hospitals is a resultant of all determinants, i.e., social behaviour, the
state of the economy, public finances and the healthcare system. it is so
important to create KPIs that provide knowledge about all of the determinants
of achievements/failures in health care.
|
|
3
|
Dane Lansdaal
et al
|
2021
|
Lessons learned on the
experienced facilitators and barriers of implementing a tailored VBHC model
in a Dutch university hospital from a
perspective of physicians and nurses
|
Netherlands
|
Reorganize into IPU;
measure outcome and cost
|
Structured implementation
methodology: well-led strong team, shaping patient involvement, alignment
with other departments, and attention to digitisation
|
|
4
|
Claudia Rutherford et al
|
2019
|
Implementing
Patient-Reported Outcome Measures into Clinical Practice Across NSW: Mixed
Methods Evaluation of the First Year
|
Australia
|
Measure outcome and cost
|
Issues with Information
and Communication Technologies (ICT), especially lack of integration with
existing data systems, consistently impacted on successful program
implementation. ICT issues led to decreased clinician (and sometimes patient)
engagement, as potential benefits of PROMs were not considered substantive to
justify the additional burden (e.g. time) placed on clinicians (and
patients), particularly in fast-paced, business-oriented primary care
settings who often see many patients in short periods.
|
|
5
|
Dennis van Veghel et al
|
2020
|
Improving clinical
outcomes and patient
satisfaction among patients with coronary
artery disease: an example of enhancing
regional integration between a cardiac
centre and a referring hospital
|
Netherlands
|
Measure outcome and cost;
integrate multi-site care delivery system; expand reach across geography
|
Intensive community based
care requires a highly complex organization, which is reflected by the
diversity of the clusters. The
emphasis on cooperation with other institutes is significant, and this should
ideally be characterized as a chain
of care. This means that single services provided by separate institutes need
to be strongly linked and that interorganisational and interdisciplinary
service is essential
for an intensive community-based care. The care chain includes care at both
locations and the interaction
between both hospitals.
|
|
6
|
Dennis van Veghel
|
2020
|
Organization of
outcome-based quality improvement in Dutch heart centres
|
Netherlands
|
Measure outcome and cost
|
(i)
data infrastructure, (ii) a systematic approach for the identification of
improvement potential and the selection
and implementation of improvement initiatives, (iii) governance in which
roles and responsibilities of physicians
regarding outcome improvement are formalized, and (iv) implementation of
outcomes within hospital strategy, policy
documents, and the planning and control cycle.
|
|
7
|
Christian Colldén et al
|
2018
|
Value-based healthcare
translated: a
complementary view of implementation
|
Sweden
|
Measure outcome and cost
|
It can be more fruitful
to view implementation as a dynamic
process rather than seeing it as a matter of planning and execution.
translation theory
perspective accepts that the local application of an MI (management
innovations) may differ from its original form and, rather, encourages
managers to seize the opportunity to contextualize the MI
to fit their own organizations.
|
|
8
|
Nicholas Schraut et al
|
2021
|
High variability in
patient reported outcome utilization following hip
fracture: a potential barrier to value‑based care
|
United States
|
Measure outcome and cost
|
we do not appear to be
converging toward a consensus measure or set of measures that capture
meaningful
outcomes beyond mortality. A real difference between specialties in the
perception of what outcomes are
felt to be relevant.
|
|
9
|
Andrew St John et al
|
2021
|
Implementation of medical
tests in a Value-Based healthcare environment:
A framework for delivering value
|
UK
|
Measure outcome and cost
|
The outcome measures
employed in the implementation protocol should be based on Donabedian’s
quality measures of outcomes, process and structure (resources), together
with the balancing
measures to cover unintended consequences in the care pathway. This
information may be better served by the use of real-world data, where
the necessary changes are informed by the value proposition, with
implementation by a care pathway-based business case.
|
|
10
|
Marzyeh Amini et al
|
2021
|
Facilitators and barriers
for implementing patient-reported outcome measures in clinical care: An
academic center’s initial experience
|
Netherlands
|
Measure outcome and cost
|
Commonly reported
facilitators for implementing PROMs in routine clinical care were the
presence of a coordinator, intrinsic motivation of members within a
multidisciplinary disease team, and the integration of PROMs in the EHR. On
the other hand, frequently reported barriers were time constraints, IT
issues, and language barriers for patients with a primary language other than
Dutch.
|
|
11
|
Pedro Ramos et al
|
2021
|
It takes two to dance the
VBHC tango: A multiple case study of the adoption
of value-based strategies in Sweden and Brazil
|
Sweden and Brazil
|
Measure outcome and cost;
move to bundled payment
|
It appears difficult to
strike a balanced approach from the start, and context seems to influence
whether quality or cost becomes the focus. A path forward could be to find
balance through conversation
(instead of conflict), informed by
aligning these answers with organizational business models
|
|
12
|
Maggie E. Horn et al
|
2021
|
Electronic health
record–integrated
approach for collection of patient-reported
outcome measures: a retrospective
evaluation
|
United States
|
Measure outcome and cost
|
Future steps for PROMs
collection should focus on improving the robustness of PROMs response rate by
updating utilities within the EHR that improve communication with patients
and demonstrate how PROMs support shared decision-making with providers.
|
|
13
|
Casey J. Allen et al
|
2021
|
Developing a Value
Framework: Utilizing
Administrative Data to Assess an Enhanced Care
Initiative
|
United States
|
Measure outcome and cost
|
We also emphasize the
current lack ofdand thus the importance of
collecting and reporting better cost data, as well as longterm
and patient-centric outcomes. The ability to communicate value through a
standardized framework is needed to
facilitate shared decision-making among all stakeholders involved in
value-based health care.
|
|
14
|
Kelly R. Stiegel et al
|
2020
|
Value-Based Care for
Nonoperative Management of Hip and Knee
Osteoarthritis: Current Landscape Not Ripe for Implementation
|
United States
|
Move to bundled payment
|
Payment reforms have been
proven to be effective at reducing costs of surgical care without
compromising outcomes. Our next
challenge as a community is to take these principles and apply them to
nonoperative management of common chronic conditions, such as OA. Increasing
value of care is aworthwhile goal, but it cannot be
accomplished until our evidence-based CPGs are familiar to and followed by
all health-care providers who would be providing nonoperative management for
our patients. This has important implications beyond value, and it extends to
providing equitable care to all patients. Regardless of where patients enter
the healthcare system, receiving consistent and evidence-based care is
critical.
|
|
15
|
Kevin Hines et al
|
2021
|
Bundled Payment Models in
Spine Surgery
|
United States
|
Move to bundled payment
|
To optimize this payment
method, stringent risk stratification, development of evidence-based
pathways, and dissemination of detailed outcome-based data must be
implemented. In addition, hospital systems must evaluate risk allocation as
repayment models are defined to avoid financially incentivizing spinal
surgeons to select for only healthy patient with low risk pathology.
|
|
16
|
Rahul Annabathula
et al
|
2021
|
Value‑based assessment of
implementing a Pulmonary Embolism
Response Team (PERT)
|
United States
|
Reorganize into IPU
|
Teamwork
|
|
17
|
Carolina Varela-Rodríguez
et al
|
2022
|
Value-Based Healthcare
Project
Implementation in a Hierarchical
Tertiary Hospital: Lessons Learned
|
Spain
|
Reorganize into IPU;
measure outcome and cost
|
(1) a minimum amount of
90.000 euros was
required to implement VBHC in medium to high complex
medical conditions processes.
(2) In the process of data appropriateness and datarecording
tools adaptation for outcome measures within the
local system, 6 months were spent for the first medical
condition to be considered.
(3) Clinical-reported outcomes measures (CROM)
have to be normalized and standardized by international
standards.
|
|
18
|
Ellen van der Vlies et al
|
2020
|
Implementation of a
preoperative multidisciplinary team approach
for frail colorectal cancer patients: Influence on patient selection,
prehabilitation and outcome
|
Netherlands
|
Reorganize into IPU
|
Implementation of MDT
evaluation
can be used to improve the management of frail older patients
with CRC, including shared decision making and tailored perioperative
care. Thismay lead to favorable
postoperative outcomes in frail patients
despite an increased preoperative risk.
|
|
19
|
Y.J.L. Bodar et al
|
2020
|
Time-Driven
activity-based costing
identifies opportunities for process
efficiency and cost optimization for
robot-assisted laparoscopic pyeloplasty
|
United States
|
Measure outcome and cost
|
TDABC costs for RALP
successfully presented
opportunities for more than 20% cost reduction when
compared to traditional accounting, even without any
alteration in ongoing RALP care pathways at our institution.
|
|
20
|
David Kuklinski et al
|
2020
|
The use of digitally
collected patientreported
outcome measures for newly
operated patients with total knee and hip
replacements to improve post-treatment
recovery: study protocol for a randomized
controlled trial
|
Germany
|
Measure outcome and cost
|
The
collection of PROMs on paper has been not effective and
there have been low follow-up return rates and the burden
of additional documentation work for hospitals.
|
|
21
|
Claudia Marotta et al
|
2020
|
Cost-Utility of
Intermediate Obstetric Critical Care in a Resource-Limited Setting: A
Value-Based Analysis
|
Sierra Leone, West Africa
|
Measure outcome and cost
|
it is known that critical
care absorbs the highest quota of hospital budgets
|
|
22
|
Nina Zipfel
|
2019
|
The implementation of
change model adds
value to value-based healthcare: a
qualitative study
|
Netherlands
|
Measure outcome and cost
|
Several success factors
were identified: intrinsic versus
extrinsic motivation, a multi-centre intervention compared
to a single-centre intervention, the name of the
intervention, speed of the implementation process, complexity,
continuous feedback and output.
|
|
23
|
Sean P. Ryan et al
|
2019
|
Value-Based Care Has Not
Resulted in Biased Patient Selection:
Analysis of a Single Center’s Experience in the
Care for Joint
Replacement Bundle
|
United States
|
Move to bundled payment
|
In the present study,
our investments surrounding the bundle provided a reduction in
LOS and improved discharge disposition; however, no difference in
total hospital costs was seen.
|
|
24
|
Zunirah Ahmed et al
|
2019
|
Value-Based Health Care
in Inflammatory Bowel Disease
|
United States
|
Measure outcome and cost
|
the biggest challenges to
scalability is in securing the provider–
payer partnership. not all health systems have adequate
infrastructure or willingness to leverage health information
technology, personnel to help with patient education and care
coordination, and administrative support to meet the required
eligibility criteria and take advantage of these payment models. This process
may be complicated for practices that accommodate
multiple payer types, as multiple eligibility requirements
will have to be met and multiple provider–payer agreements
will need to be forged.
|
|
25
|
Yolima Cossio-Gil et al
|
2021
|
The Roadmap for
Implementing Value-Based Healthcare in European
University Hospitals—Consensus Report and Recommendations
|
Multiple European countries
|
Reorganize into IPU;
measure outcome and cost; build enabling IT platform
|
Access to
standardized outcome data might be a key element in the transition
toward VBHC. Accordingly, it could be more practical to start
the process through a well-designed pilot to evaluate risks and
opportunities on real-life circumstances.
|
|
26
|
Kerstin Nilsson et al
|
2017
|
Experiences from
implementing valuebased
healthcare at a Swedish University
Hospital – a longitudinal interview study
|
Sweden
|
Reorganize into IPU
|
The implementation of
VBHC was not a straight linear process; the process moved forwards and
backwards, sometimes with interruptions. Healthcare organizations
implementing management innovations such as VBHC therefore need to be aware
of recognizing the intrinsic drive of healthcare practitioners, and to
understand
the complexity in healthcare itself as well as in the process of
implementation.
|
|
27
|
Annette Erichsen Andersson et al
|
2015
|
Understanding value-based
healthcare – an interview
study with project team members at a Swedish
university hospital
|
Sweden
|
Measure outcome and cost
|
The findings indicate
that health professionals
still seem to have a preferential right to interpret what
is valuable for the patients. Patient-centred care has been
studied for several decades but there is great variation when it
comes to the effect on outcome measures. It is clearly essential to know how
patients define
value, otherwise the risk exists that care development will
focus on what is easy to measure instead of what is most
important and of greatest value to the patients.
|
|
28
|
Joon Hurh
|
2017
|
Value-based healthcare:
prerequisites and
suggestions for full-fledged implementation in the
Republic of Korea
|
Korea
|
Move to bundled payment
|
First, Korea must secure
the commitment and support from healthcare providers by normalizing payment
rates for healthcare providers. Second, more critical pathways must be
developed and disseminated. Third, it is critical to start implementing
performance-based risk-share programs. Fourth, more focus on registries and
coverage with evidence development is critical, and last but not least,
bundled payments with proven critical pathway care are some of the
prerequisites to pressure-test the readiness of the healthcare system for
establishing a full-fledged VBHC system.
|
|
29
|
Giulia Goretti
|
2020
|
Value-Based Healthcare
and Enhanced Recovery After Surgery
Implementation in a High-Volume Bariatric Center in
Italy
|
Italy
|
Reorganize into IPU;
measure outcome and cost
|
Communication among IPU
members, patients, and board management staff has been crucial during this
process.
Dedicated meetings were organized to share results and progress.
|
|
30
|
Dae Seog Heo et al
|
2022
|
Hospice-Palliative
Medicine as a Model of Value-Based Healthcare
|
Korea
|
Move to bundled payment
|
Medical technologies that
rely on a high level of evidence and have high social values are essential.
The hospice palliative care system reflects patients’ values, which are
informed by social values.
|
Although the concept of six elements of VBHC has
been around since 2006, the standard interpretation of how it should be
implemented is still rarely described. Most hospitals implemented only one
element of VBHC. Of the 30 articles included, most articles (24 articles)
reported the implementation process of only one element of VBHC, 4 articles
reported implementation of 2 elements of VBHC, and 2 articles reported
implementation of 3 components.
The number of articles describing each element of
VBHC is as follows: 9 articles implemented the reorganization to integrated
practice units (IPU), 20 articles implemented the measurement of outcome and
cost, 6 articles implemented the movement to bundled payments, 1 article
implemented the integration of multi-site care delivery system, 1 article
implemented the reach expansion across geography, and 1 article implemented
enabling IT platform.
In reorganizing into IPU, the organizational
readiness for change among healthcare professionals is crucial. The
organization has to be able to provide and support teamwork environment that
allows healthcare professionals from any specialty, with any typical work
rhythm, to work with other healthcare professionals whose work rhythm are
different. One article from the Netherlands described how the IPU was formed
through a great effort from the steering committee chaired by the chief medical
officer, who had determined the program-wide goals, monitored progress and
selected new teams who wanted to start with VBHC. Another study mentioned that
a set of Key Performance Indicators (KPI) for healthcare professionals need to
be created to provide knowledge about all of the achievements/failures in
health care. This way, the awareness of the importance of IPU can increase
among the healthcare professionals (Annabathula
et al., 2021; Cossio-Gil et al., 2022; Goretti et al., 2020; Heijsters et al.,
2022; Nilsson et al., 2017; Nojszewska & Sielska, 2022; Varela-Rodríguez et
al., 2021).
In measuring outcome and cost, it is of essence to
measure the outcome that the patients prefer. Some studies still indicate that
health professionals still seem to have a preferential right to interpret what
is valuable for the patients. Patient-centred care
has been studied for several decades but there is great variation when it comes
to the effect on outcome measures. It is clearly essential to know how patients
define value, otherwise the risk exists that care development will focus on
what is easy to measure instead of what is most important and of greatest value
to the patients. Some major factors affecting the implementation of measuring
outcome and cost are (i) data infrastructure, (ii) a
systematic approach for the identification of improvement potential and the
selection and implementation of improvement initiatives, (iii) governance in
which roles and responsibilities of physicians regarding outcome improvement are
formalized, and (iv) implementation of outcomes within hospital strategy,
policy documents, and the planning and control cycle (Ahmed
et al., 2019; Allen et al., 2021; Amini et al., 2021; Bodar et al., 2020;
Colldén & Hellström, 2018; Cossio-Gil et al., 2022; Goretti et al., 2020;
Kuklinski et al., 2020; Lansdaal et al., 2022; Marotta et al., 2020; Nilsson et
al., 2017; Ramos et al., 2021; Rutherford et al., 2021; Schraut et al., 2022;
St John et al., 2021; Van Veghel et al., 2020; Varela-Rodríguez et al., 2021;
Zipfel et al., 2019).
In moving to bundled payments, many current
initiatives have been successfully centered on creating bundled payments for
surgical care to reduce cost. The next challenge is to take these principles
and apply them to nonoperative management of common chronic conditions. To
optimize this, stringent risk stratification, development of evidence-based
pathways, and dissemination of detailed outcome-based data must be implemented.
In addition, hospital systems must evaluate risk allocation as repayment models
are defined to avoid financially incentivizing doctors to select for only
healthy patients with mild chronic conditions. Furthermore, moving to bundled
payment may be complicated for practices that accommodate multiple payer types,
as multiple eligibility requirements will have to be met and multiple
provider–payer agreements will need to be forged (Heo
et al., 2022; Hines et al., 2021; Hurh et al., 2017; Ryan et al., 2019; Stiegel
et al., 2021).
In integrating multi-site care delivery system and
expanding reach across the geography, the emphasis on cooperation with other
institutes is significant, and this should ideally be characterized as a chain
of care. This means that single services provided by separate institutes need
to be strongly linked and that interorganisational
and interdisciplinary service is essential for an intensive community-based
care. The care chain includes care at both locations and the interaction
between both hospitals (Van
Veghel et al., 2020).
In building enabling IT platform, issues with Information and
Communication Technologies (ICT), especially lack of integration with existing
data systems, consistently impacted on successful program implementation. ICT
issues led to decreased clinician (and sometimes patient) engagement, as
potential benefits of PROMs were not considered substantive to justify the
additional burden (e.g. time) placed on clinicians (and patients), particularly
in fast-paced, business-oriented primary care settings who often see many
patients in short periods. Furthermore, the IT platform should be able to
provide a robust data warehouse where all the standardized outcome and cost
data are integrated into the electronic medical record to give better
visibility to healthcare professionals treating the patients and all other
relevant stakeholders (Cossio-Gil
et al., 2022).
DISCUSSIONS
Initially,
Porter described the idea of VBHC to increase the value of health care
delivery. This article reviewed the academic literature on the perceived
concept of value elements from the hospital leaders
perspective, and the key success when VBHC is implemented. The present study
produces three main findings, which are discussed below.
First,
no single study seems to truly succeed in implementing the concept how Porter
has intended it . Our review identified differences in
perceived concept of VBHC. Some authors conceptualized the overall concept of
VBHC, some others only defined selected elements of VBHC. VBHC is interpreted
differently across hospitals and heavily depends on the decisions from local
hospital leaders.
Second,
as a result of variable conceptualization of VBHC, this study found that
hospitals do not approach all elements as integral parts of the VBHC. There are
only two most commonly implemented elements: “measurement of outcome and cost”
and “the reorganization to integrated
practice units.” These findings suggest that hospital leaders only pick
selected element which best suits them, which in turn might cause fragmentation
of the VBHC. When taken as a fragmented element, this could lead to a “false
value.” For example, pursuing cost reduction without regards to outcome will
limit the ability to reach effective care.
Third, the outcome measures that Porter initially
described stressed the importance of patient-centric measurement. This includes
three tiers of patient outcomes: (a) the attained health status, (b)
care-related outcomes, and (c) the sustainability of patient’s health. Although
many articles describe the implementation of the clinical outcome measurement, only
a few measure this three-tier outcome elements.
Therefore, it is relatively premature to conclude that the value is increased
without measuring the comprehensive three-tier clinical outcomes.
CONCLUSION
The
true VBHC system can only be reached when all the six elements are achieved.
Although the journey to reach the true VBHC still seems so far, many efforts
have been done in different parts of the world to increase the value of health
care delivery. Some efforts are successful, some are not, but the first step in
the right direction has been taken.
The
implementation of VBHC was not a straight linear process; the process moved
forwards and backwards, sometimes with interruptions. Healthcare organizations
implementing VBHC therefore need to be aware of recognizing some key success in
the implementation of VBHC: (1) support from the organization’s leadership to
provide cultural change that supports multidisciplinary teamwork, (2) set of
KPI that provides knowledge of about all of the achievements/failures in health
care, (3) outcome measurement that is centered on patient’s preference, (4)
solid hospital-payer partnership to support bundled payment, (5) high
connectivity among hospitals in the same region to foster value-based care, and
(6) strong data infrastructure for monitoring and evaluation.
REFERENCES
Ahmed, Z., Sarvepalli, S., Garber, A., Regueiro, M.,
& Rizk, M. K. (2019). Value-based health care in inflammatory bowel
disease. Inflammatory Bowel Diseases, 25(6), 958–968. Google Scholar
Allen,
C. J., Eska, J. S., Thaker, N. G., Feeley, T. W., Kaplan, R. S., Huey, R. W.,
Tzeng, C.-W. D., Lee, J. E., Frank, S. J., & Aloia, T. A. (2021).
Developing a value framework: utilizing administrative data to assess an
enhanced care initiative. Journal of Surgical Research, 262,
115–120. Scopus
Alsever,
R. N., Ritchey, T., & Lima, N. P. (1995). Developing a hospital report card
to demonstrate value in healthcare. Journal for Healthcare Quality, 17(1),
19–28. Google Scholar
Amini,
M., Oemrawsingh, A., Verweij, L. M., Lingsma, H. F., Hazelzet, J. A.,
Eijkenaar, F., & van Leeuwen, N. (2021). Facilitators and barriers for
implementing patient-reported outcome measures in clinical care: An academic
center’s initial experience. Health Policy, 125(9), 1247–1255. Scopus
Annabathula,
R., Dugan, A., Bhalla, V., Davis, G. A., Smyth, S. S., & Gupta, V. A. (2021).
Value-based assessment of implementing a Pulmonary Embolism Response Team
(PERT). Journal of Thrombosis and Thrombolysis, 51(1), 217–225. Google Scholar
Arksey,
H., & O’Malley, L. (2005). Scoping studies: towards a methodological
framework. International Journal of Social Research Methodology, 8(1),
19–32. Google Scholar
Bernstein,
D. N., Calfee, R. P., Hammert, W. C., Rozental, T. D., Witkowski, M. L., &
Porter, M. E. (2022). Value-Based Health Care in Hand Surgery: Where Are We
& Where Do We Go From Here? The Journal of Hand Surgery. Scopus
Beveridge,
R. N. (1997a). Creating value-focused healthcare delivery systems: Part one. The
Journal of Oncology Management: The Official Journal of the American College of
Oncology Administrators, 6(4), 19–24.
Beveridge,
R. N. (1997b). Creating value-focused healthcare delivery systems: Part
three--Core competencies. The Journal of Oncology Management: The Official
Journal of the American College of Oncology Administrators, 6(6),
16–23. Google Scholar
Bodar,
Y. J. L., Srinivasan, A. K., Shah, A. S., Kawal, T., & Shukla, A. R.
(2020). Time-Driven activity-based costing identifies opportunities for process
efficiency and cost optimization for robot-assisted laparoscopic pyeloplasty. Journal
of Pediatric Urology, 16(4), 460-e1. Scopus
Colldén,
C., & Hellström, A. (2018). Value-based healthcare translated: a
complementary view of implementation. BMC Health Services Research, 18(1),
1–11. Google Scholar
Cossio-Gil,
Y., Omara, M., Watson, C., Casey, J., Chakhunashvili, A., Gutiérrez-San Miguel,
M., Kahlem, P., Keuchkerian, S., Kirchberger, V., & Luce-Garnier, V.
(2022). The roadmap for implementing value-based healthcare in European
university hospitals—consensus report and recommendations. Value in Health,
25(7), 1148–1156. Scopus
Goretti,
G., Marinari, G. M., Vanni, E., & Ferrari, C. (2020). Value-based
healthcare and enhanced recovery after surgery implementation in a high-volume
bariatric center in Italy. Obesity Surgery, 30(7), 2519–2527. Google Scholar
Heijsters,
F. A. C. J., van Breda, F. G. F., van Nassau, F., van der Steen, M. K. J., Ter
Wee, P. M., Mullender, M. G., & de Bruijne, M. C. (2022). A pragmatic
approach for implementation of value-based healthcare in Amsterdam UMC, the
Netherlands. BMC Health Services Research, 22(1), 1–11. Google Scholar
Heo,
D. S., Yoo, S. H., Keam, B., Yoo, K., Choi, I., & Kim, M.-J. (2022).
Hospice-Palliative Medicine as a Model of Value-Based Healthcare. Journal of
Korean Medical Science, 37(15). Google Scholar
Hines,
K., Mouchtouris, N., Getz, C., Gonzalez, G., Montenegro, T., Leibold, A., &
Harrop, J. (2021). Bundled payment models in spine surgery. Global Spine
Journal, 11(1_suppl), 7S-13S. Google Scholar
Hurh,
J., Ko, Y.-H., & Lee, S.-S. (2017). Value-based healthcare: prerequisites
and suggestions for full-fledged implementation in the Republic of Korea. Journal
of the Korean Medical Association, 60(10), 826–840. Google Scholar
Kuklinski,
D., Oschmann, L., Pross, C., Busse, R., & Geissler, A. (2020). The use of
digitally collected patient-reported outcome measures for newly operated
patients with total knee and hip replacements to improve post-treatment
recovery: study protocol for a randomized controlled trial. Trials, 21(1),
1–10. Google Scholar
Lansdaal,
D., van Nassau, F., van der Steen, M., de Bruijne, M., & Smeulers, M.
(2022). Lessons learned on the experienced facilitators and barriers of
implementing a tailored VBHC model in a Dutch university hospital from a
perspective of physicians and nurses. BMJ Open, 12(1), e051764. Google Scholar
Luca,
L., & Paul, O. (2019). Price Setting and Price Regulation in Health Care
Lessons for Advancing Universal Health Coverage: Lessons for Advancing
Universal Health Coverage. OECD Publishing. Google Scholar
Marotta,
C., Di Gennaro, F., Pisani, L., Pisani, V., Senesie, J., Bah, S., Koroma, M.
M., Caracciolo, C., Putoto, G., & Amatucci, F. (2020). Cost-utility of
intermediate obstetric critical care in a resource-limited setting: a
value-based analysis. Annals of Global Health, 86(1). Google Scholar
Nilsson,
K., Bååthe, F., Andersson, A. E., Wikström, E., & Sandoff, M. (2017).
Experiences from implementing value-based healthcare at a Swedish University
Hospital–a longitudinal interview study. BMC Health Services Research, 17(1),
1–12. Google Scholar
Nojszewska,
E., & Sielska, A. (2022). Macroeconomic and Social Indicators to Launch the
PM-Based VBHC Model in the Healthcare System in Poland. International
Journal of Environmental Research and Public Health, 19(3), 1712. Google Scholar
O’Neill,
A. (2022). Global inflation rate 2014-2024. Statista.
https://www.statista.com/statistics/256598/global-inflation-rate-compared-to-previous-year/
Peters,
M. D. J., Godfrey, C. M., McInerney, P., Soares, C. B., Khalil, H., &
Parker, D. (2015). The Joanna Briggs Institute reviewers’ manual 2015:
methodology for JBI scoping reviews. Google Scholar
Porter,
M. E., & Lee, T. H. (2013). The strategy that will fix health care. Harvard
Business Review, 91(12), 24. Google Scholar
Porter,
M. E., & Teisberg, E. O. (2006). Redefining health care: creating
value-based competition on results. Harvard business press. Google Scholar
Ramos,
P., Savage, C., Thor, J., Atun, R., Carlsson, K. S., Makdisse, M., Neto, M. C.,
Klajner, S., Parini, P., & Mazzocato, P. (2021). It takes two to dance the
VBHC tango: A multiple case study of the adoption of value-based strategies in
Sweden and Brazil. Social Science & Medicine, 282, 114145. Scopus
Rice,
T. (2021). Key components of national health insurance systems. Health
Insurance Systems, 9–33. https://doi.org/10.1016/B978-0-12-816072-5.00004-3
Google Scholar
Rutherford,
C., Campbell, R., Tinsley, M., Speerin, R., Soars, L., Butcher, A., & King,
M. (2021). Implementing patient-reported outcome measures into clinical
practice across NSW: mixed methods evaluation of the first year. Applied Research
in Quality of Life, 16(3), 1265–1284. Google Scholar
Ryan,
S. P., Plate, J. F., Black, C. S., Howell, C. B., Jiranek, W. A., Bolognesi, M.
P., & Seyler, T. M. (2019). Value-based care has not resulted in biased
patient selection: analysis of a single center’s experience in the care for
joint replacement bundle. The Journal of Arthroplasty, 34(9),
1872–1875. Scopus
Schraut,
N., Bango, J., Flaherty, A., Rossetti, V., & Swart, E. (2022). High
variability in patient reported outcome utilization following hip fracture: a
potential barrier to value-based care. Archives of Osteoporosis, 17(1),
1–8. Google Scholar
St
John, A., O’Kane, M., Christenson, R., Jülicher, P., Oellerich, M., &
Price, C. P. (2021). Implementation of medical tests in a Value-Based
healthcare environment: A framework for delivering value. Clinica Chimica
Acta, 521, 90–96. Scopus
Stiegel,
K. R., Harrington, M. A., & Halawi, M. J. (2021). Value-Based Care for
Nonoperative Management of Hip and Knee Osteoarthritis: Current Landscape Not
Ripe for Implementation. Arthroplasty Today, 9, 58–60. Google Scholar
Teisberg,
E., Wallace, S., & O’Hara, S. (2020). Defining and implementing value-based
health care: a strategic framework. Academic Medicine, 95(5),
682. Google Scholar
Tricco,
A. C., Lillie, E., Zarin, W., O’Brien, K. K., Colquhoun, H., Levac, D., Moher,
D., Peters, M. D. J., Horsley, T., & Weeks, L. (2018). PRISMA extension for
scoping reviews (PRISMA-ScR): checklist and explanation. Annals of Internal
Medicine, 169(7), 467–473. Google Scholar
Van
Veghel, D., Daeter, E. J., Bax, M., Amoroso, G., Blaauw, Y., Camaro, C.,
Cummins, P., Halfwerk, F. R., Wijdh-den Hamer, I. J., & De Jong, J. S. S.
G. (2020). Organization of outcome-based quality improvement in Dutch heart
centres. European Heart Journal-Quality of Care and Clinical Outcomes, 6(1),
49–54. Google Scholar
Van
Veghel, D., Soliman-Hamad, M., Schulz, D. N., Cost, B., Simmers, T. A., &
Dekker, L. R. C. (2020). Improving clinical outcomes and patient satisfaction
among patients with coronary artery disease: an example of enhancing regional
integration between a cardiac centre and a referring hospital. BMC Health
Services Research, 20(1), 1–8. Google Scholar
Varela-Rodríguez,
C., García-Casanovas, A., Baselga-Penalva, B., & Ruiz-López, P. M. (2021).
Value-Based Healthcare Project Implementation in a Hierarchical Tertiary
Hospital: Lessons Learned. Frontiers in Public Health, 9. Google Scholar
Watson,
W. T. (2020). Global Medical Trends Survey Report. Willis Towers Watson.
Google Scholar
Zipfel,
N., van der Nat, P. B., Rensing, B. J. W. M., Daeter, E. J., Westert, G. P.,
& Groenewoud, A. S. (2019). The implementation of change model adds value
to value-based healthcare: a qualitative study. BMC Health Services Research,
19(1), 1–12. Google Scholar
KEY SUCCESS IN THE TRANSFORMATION FROM VOLUME-BASED TO VALUE-BASED HEALTHCARE: A SCOPING REVIEW