Why the health care system must focus on treatment outcomes

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

The demand for higher added value is becoming ever louder. The value-oriented strategy requires a considerable willingness to change. Five reasons for this:

Almost every healthcare organization in the western world today is committed to implementing a value-based strategy. This means optimizing patient outcomes while reducing costs. Some institutions are already quite successful in this. It turns out that almost every element of their value-based strategy is based on one essential factor: the ability to measure outcomes. Here are five reasons for adopting a results- and value-based approach:

1. results define the goal of an organization and indicate the direction for specialization.

Few healthcare organizations have made it their explicit goal to deliver excellent results. Quality, research or education are often cited as objectives. In Austria I do not know of any health care institution that would measure or report the treatment results of their patients. An example from Hamburg shows why it makes sense to focus the clinical teams and the “market strategy” on achieving excellent results and to invest the resources to document these results.

At the opening of the Martini-Klinik in 2005, urologist Hartwig Huland set himself the goal of providing the best surgical care for prostate cancer patients worldwide and defined this overarching goal in terms of the following criteria: cancer recurrence rates, incontinence, erectile dysfunction. By focusing on clinical excellence and encouraging the team to measure and optimize outcomes, Huland’s clinic has built a strong reputation first regionally, then nationally and ultimately internationally, and has become the prostate cancer center with the highest number of surgical prostate cancer patients worldwide.

2. results provide information about the composition of holistic care teams.

In clinical training, the individual specialties are basically on their own. However, value-oriented health care requires an interlocking of the various care measures around the patient. This is often not easy for specialists because they usually do not work closely with other specialists.

An interdisciplinary bridge can be used here to define and measure results. After all, teams inevitably have to work together to achieve better results. Moreover, disclosed data on poor performance can be a strong motivator to work together to achieve improvements.

3. results motivate clinicians to compare their performance and learn from each other.

Comparison of results is essential for innovation. Unfortunately, quality measurement in medicine usually focuses very one-sidedly on evidence-based processes. However, focusing on processes and results sheds new light on the possibilities for improvement – such as increasing survival rates, long-term reduction of complications or faster regeneration. The transparent and joint comparison of different results can become a strong driving force for improvement.

4. results show possibilities for value-added cost reduction.

Which drugs are prescribed, which treatments are carried out or whether patients should be referred to acute care, all these decisions have an impact on healthcare costs. Physicians tend to offer their patients the full range of care provided by their institution. They have a moral problem with not offering everything – in terms of safety and equity. Even if some of these tests would not be absolutely necessary for individual patients. It is therefore important to familiarise doctors with those data that help to understand which activities and which services have no effect on the outcome of their patients and can be reduced or even omitted in a specific case.

5. results make it possible to shift cash benefits from volume-related to results.

While measuring results was previously considered a “high aspiration”, it is increasingly becoming a business necessity. This is because business models are also changing in the healthcare sector. Outcome-based and bundled payments will bring about a fundamental change in competitive dynamics. It is not yet possible to estimate which institutional providers of health services will hold their own in this new environment and which will make losses. What is certain, however, is that no provider without precise knowledge of results will be able to achieve success with bundled payment contracts.

An example: In Stockholm County, an insurance company wanted to expand the supply of hip and knee prostheses to reduce long waiting times. Equipped with detailed outcome and case mix data from two decades of the national registry, it developed a cost reimbursement model that combined preoperative, surgical and early postoperative treatments into a single price. Although the pricing of this model was 20 percent below the typical market price, the insurance company was able to contract a few small, targeted private providers. With a fixed price, but the advantage of greater flexibility, these providers set out to streamline the efficiency of their operations and take steps to improve results. Within two years, the volume of hip and knee prostheses supplied by those small, specialized hospitals tripled, while the volume supplied by full-service hospitals fell by 20 percent. This initiative was so successful that it has been extended to the entire country – and is now being applied to seven other diseases.

By 2016, 85 percent of all payments in the USA are to be linked to quality. Similar initiatives are being planned in other advanced economies. The turnaround toward value orientation is here. It is now up to us to take control of our destiny by measuring results. (Shahrokh F. Shariat, 22.7.2016) – derstandard.at/2000040373621/Warum-sich-das-Gesundheitswesen-auf-Behandlungsergebnisse-ausrichten-muss

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