Value in Healthcare: rethinking quality of care to transform the health system for the long term

The question is no longer “should we transform our health system?” but “how can we do it sustainably, without sacrificing the quality of care or the teams who make it possible?”.

The concept of Value-Based Healthcare (VBHC), or Value in Healthcare, offers a structuring framework for meeting this challenge. Neither a passing fad nor a miracle cure: it is a compass, adopted by hundreds of teams around the world, for putting patients and the outcomes that matter to them back at the centre of care.

Quality care: should we do more… or do better?

For decades, the assessment of care has been based on quantitative criteria: number of procedures performed, bed occupancy rates, cost per procedure. But this approach is reaching its limits.

VBHC offers another definition: quality care is care that achieves the best outcomes for patients, at a cost the system can sustain. Not “more care”, but “more value” – in other words, more real impact.

Value in Healthcare: an approach focused on the outcomes that matter

Formalised by Michael Porter and Elizabeth Teisberg as early as 2006 in Redefining Health Care, VBHC rests on an equation that is simple but demanding:

The central equation of VBHC may seem simple:

📌 Value = Outcomes for the patient ÷ Total cost of achieving them

But these outcomes are not limited to survival or the absence of complications. They extend to three broad, complementary categories:

• Patients’ experience throughout the patient journey (PREMs)
• Clinical outcomes measured objectively by professionals (CROMs)
• Outcomes reported directly by patients (PROMs)

This triad makes it possible to build a more detailed assessment of the quality of care, to identify gaps between perception and clinical reality, and to align the priorities of healthcare professionals, patients and institutions.

Measurable outcomes that drive the transformation of practice

Many traditional indicators remain useful, but on their own they cannot assess what really matters to patients. In addition, Value in Healthcare encourages the measurement of more relevant outcomes to guide clinical decision-making and drive continuous improvement.

These outcomes include:

• Observed functional improvement: independence, mobility, return to an active life
• Lasting reduction of symptoms and prevention of complications
• Health-related quality of life (pain, fatigue, sleep, sexuality, etc.)
• Patient satisfaction, understanding of the treatment and involvement in decisions (PREMs)
• Clinical assessment of observed outcomes (CROMs), such as changes in biological markers, vital signs or validated clinical scores
• The total cost of the care pathway, including complications, readmissions and follow-up and rehabilitation care

These indicators are complementary: they provide a shared view for healthcare professionals and patients, help identify unnecessary care, and support clinical choices that are better aligned with the real priorities of each person being cared for.

A global shift, already under way

For nearly 20 years, hospitals, clinics and care networks have demonstrated the benefits of VBHC:

• In oncology, to structure pathways focused on life after illness¹
• In surgery, with fewer complications and lower costs through IPUs²
• In diabetes care, to integrate prevention, support and therapeutic patient education³

Far from being confined to Nordic or English-speaking systems, this momentum is also gaining ground in France. What our experience at the Value Based HealthCare French Institute shows is that it is possible to act here and now, by structuring transformations grounded in reality.

VBHC is not a theoretical utopia. It is a practical method for bringing together the interests of patients, healthcare professionals, institutions and funders.

By building health outcomes into healthcare organisations’ strategic compass, it becomes possible to move away from management driven by constraints towards a dynamic of continuous, collective and measurable improvement.

References

Porter M., Teisberg E., “Redefining Health Care: Creating Value based Competition on Results”, 2006