How can we get value-based healthcare?

February 15, 2019

Louise Hurst, Senior Associate Tutor and Senior Research Fellow in Public Health
Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences

Getting the health outcomes we want depends on how we allocate and use the resources available. The demand for healthcare services is increasing, but the resources we have to respond to this demand are often insufficient. Healthcare leaders need new tools to identify where greater value can be attained at a time when demographic change, patient expectation, increasing multi-morbidity and new technologies are driving ever greater costs. Across the world, programmes and systems are being set up to focus on Value. Value-based healthcare needs healthcare leaders – clinicians, managers, academics, finance professionals, public health specialists – with the right skills and knowledge to deliver it.

Understanding Unwarranted Variation

Increasing healthcare value in any system requires people with the skills and knowledge to identify which aspects of care represent good value, and other areas where value can be increased. “Unwarranted variations” are differences in health outcomes, or in the way that resources are allocated or used, that aren’t explained by illness or patient preference. Identifying unwarranted variation and understanding overuse and underuse of medicine are essential first steps to understanding where greater value can be attained.

Defining and Measuring Outcomes

Focusing on outcomes that matter to the people that will use a service represents a significant change for many healthcare systems. The ability to identify and measure outcomes that are meaningful to patients is an essential skill for value-based care.

Decision-making for Value

Decisions about resource use and allocation for health are made at different levels within healthcare: at the level of the population; at an organisational or departmental level; and in every clinical decision made for or with patients. The “triple value” model of healthcare, developed here in Oxford and adopted by the NHS, describes three aspects of value that must be understood in order to increase value: Allocative Value, Technical Value and Personal Value.

The Healthcare Value course covers these topics and more. The course has been designed to enable health professionals and academics to develop a critical understanding of the case for a paradigm shift to value-based health and social care and to equip them with key conceptual frameworks, analytical methods and skills to participate in the transformation of health care. The course is for people who pay for, plan, manage and research health and social care services, many of whom are also clinicians. The course will also be of interest to people from pharmaceutical industries and IT and technology companies. It runs once a year over eight weeks with a mixture of face-to-face teaching and distance learning – Oxford-based teaching in 2019 will take place 15th-19th July.

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