Our healthcare system needs comparative data

Shahrokh Shariat | © feelimage / F. Matern
Shahrokh Shariat | © feelimage / F. Matern

Why we could benefit from Value Based Health Care Management in Austria.

In order to bring about a sustainable change in the structure of the health care system, we have been asking ourselves for some time now: Why is it so difficult for health care facilities to improve outcomes and efficiency despite the best of intentions? It really is an unsolved mystery, considering that we have many smart people working so hard. When we believe we know the new needs of patients. And we meet the challenges of healthcare costs with the greatest social responsibility. I have already dealt with these questions in detail in my blog in Online Standard1-3.

I think that possible answers lie in an approach that puts the patient first – and breaks up the old fragmented structures: Value Based Health Care Management. In the following I would like to address the topics of costs, data and IT systems, because these are crucial in times of change.

Data and cost issues

If there is no data on how patients are actually doing, whether new interventions or practices are improving outcomes or reducing costs, performance improvement initiatives have no fertile ground. We lack data on the actual costs per patient with a given condition – over the entire care cycle. We have few comparisons, and this significantly slows down our efforts to add value for patients (improving outcomes).

Most clinicians also have no way of knowing what things actually cost or how much time recovery processes take from the beginning to the end of a disease. Unfortunately, resources tend to flow into services that appear to be the most profitable, i.e. based on partial personal assessments, or into areas whose advocates are politically most active. Here we need an overarching way of thinking that leads away from fragmented thinking (e.g. from the perspective of individual departments) and instead towards a patient-centred, integrative approach, including interdisciplinarity.

IT Systems

Most clinical information systems have been developed on the basis of specialties, procedures or care facilities and focus on planning and billing. Few systems have been designed to maintain an overview for the individual patient over a complete care cycle and to provide comprehensive patient information to all treating nurses.

Too few clinicians involved in the care of a patient have complete information. Highly relevant data is not recorded at all in electronic records, and much outcome information is buried in free text or note fields. This makes it difficult to extract, search for or evaluate the information.

Health insurance companies’ information systems are designed to create invoices for individual services, but not to capture and measure the overall care process and value to patients. Fragmented IT solutions work against multidisciplinary models instead of simplifying them. Misunderstandings about profitability due to inaccurate calculations lead to excessively wide cost margins – a problem exacerbated by the fact that doctors try to solve all needs in their own specialty.

Health informatics as a motor for renewal

With the increasing digitization in the health care system, the situation will improve in a few years. I am convinced that we have a unique opportunity to standardize the VBHC and use it in a meaningful way. The reason for my optimism is the continuous integration of sophisticated information technology in the healthcare sector: It seamlessly links clinical processes and workflows, enables doctors to interpret information from different sources and make decisions in real time.

The three positive effects of a value-oriented approach are:

Health informatics supports medical staff in decision-making, teamwork and communication and raises clinical excellence to new heights.
Health informatics helps network operational processes – system administrators can optimize almost every operational aspect of the health care system.
For value-based payments, health informatics can support the systematic measurement of the results reported by the patient. This is crucial to drive performance-based payments and to achieve much needed gains in terms of quality, safety and patient orientation.

Too few clinicians involved in the care of a patient have complete information. Highly relevant data is not recorded at all in electronic records, and much outcome information is buried in free text or note fields. This makes it difficult to extract, search for or evaluate the information.

Health insurance companies’ information systems are designed to create invoices for individual services, but not to capture and measure the overall care process and value to patients. Fragmented IT solutions work against multidisciplinary models instead of simplifying them. Misunderstandings about profitability due to inaccurate calculations lead to excessively wide cost margins – a problem exacerbated by the fact that doctors try to solve all needs in their own specialty.

Health informatics as a motor for renewal

With the increasing digitization in the health care system, the situation will improve in a few years. I am convinced that we have a unique opportunity to standardize the VBHC and use it in a meaningful way. The reason for my optimism is the continuous integration of sophisticated information technology in the healthcare sector: It seamlessly links clinical processes and workflows, enables doctors to interpret information from different sources and make decisions in real time.

The three positive effects of a value-oriented approach are:

Health informatics supports medical staff in decision-making, teamwork and communication and raises clinical excellence to new heights.
Health informatics helps network operational processes – system administrators can optimize almost every operational aspect of the health care system.
For value-based payments, health informatics can support the systematic measurement of the results reported by the patient. This is crucial to drive performance-based payments and to achieve much needed gains in terms of quality, safety and patient orientation.

The dissemination of the VBHC requires openness, trust and strong collaboration between all stakeholders in the health care system. Technology and IT implementations, legal and regulatory frameworks, clinical skills, education and payment reform must each be managed in a comprehensive and progressive approach to healthcare reform. It is a challenging and long road, but it is important that we seize the opportunity.

The transition period will take some time and it will be difficult. The transition from a single service payment scheme to the new value-centred payment scheme is the best way to reduce health costs while improving the quality of care for a healthier life.

This commentary is the second of two parts on the topic “Changes in structure are inevitable” (See Part 1: “Unser Gesundheitswesen braucht einen Neustart“)

Bibliography

  1. Shariat, Shahrokh. 2015: Qualitätsmessung im Gesundheitswesen hilft Patienten – und senkt Kosten. Blog „Gedanken zur Medizin“, derStandard, 04.05.2015
  2. Shariat, Shahrokh. 2016: Wert und Nutzen statt blindes Leistungsdenken. Blog „Gedanken zur Medizin“, derStandard, 11.03.2016
  3. Shariat, Shahrokh. 2016: Warum sich das Gesundheitswesen auf Behandlungsergebnisse ausrichten muss. Blog „Gedanken zur Medizin“, derStandard, 22.07.2016

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