Value in Healthcare: revolution or evolution for a high-quality future?

Guaranteeing high-quality care while preserving the sustainability of the health system is a major challenge for everyone in the sector. How can we define “quality care”? Does “more” mean “better”? Or, as Value based Healthcare (VBHC) proposes, should we focus on the health outcomes that matter most to patients?

Value in Healthcare: an outcome-focused approach

The concept of Value in Healthcare (Value-Based Healthcare – VBHC) offers an innovative method for evaluating care, at both individual and population level.

For almost 20 years, many teams around the world have been presenting real-world cases in oncology 1, cardiac surgery, cataracts 2, diabetes 3, etc., demonstrating the benefits of this approach from the point of view of patients, healthcare professionals and payers alike. Its adoption varies from country to country, but it represents a major trend aimed at improving the quality and efficiency of healthcare worldwide.

VBHC aims to transform healthcare by focusing on value, that is, achieving better outcomes for patients at reasonable cost.

Measuring health outcomes: a comprehensive approach

Today, the quality of care is often measured through standardised processes and traditional performance indicators:

• Volume indicators: number of beds occupied, number of procedures…
• Financial indicators: cost per patient, profitability of departments…
• Operational indicators: bed occupancy rate, waiting times, average length of stay…
• Process quality indicators: medical error rates, hospital-acquired infection rates…

However, these criteria do not always reflect the real effectiveness of interventions. VBHC proposes indicators that are more focused on the value of care for the patient and on health outcomes:

• Specific clinical outcomes: symptom reduction, cure rates and the management of complications
• Health-related quality of life: for example, pain felt after a procedure, level of mobility, return to normal daily life
• Overall cost per episode of care: total cost across the entire care pathway for a patient with a specific condition, taking into account complications, readmissions and follow-up care.
• Patient experience and satisfaction: for example, satisfaction with end-of-life care or pain management; experience in terms of the services received and communication with medical staff, understanding of treatment, and involvement in decisions

Performance indicators make it possible not only to identify inappropriate treatments, but also to reduce unnecessary care and, as a result, lower costs. Beyond traditional indicators such as life expectancy, patients report more personal outcomes, such as functional recovery or quality of life after a procedure. Traditional indicators are often geared towards the efficiency of hospitals and health systems, whereas VBHC puts the patient at the centre of the evaluation. These elements are essential to the transition towards truly value-based medicine.

A fundamental transformation, not just a fad

Introduced by Michael Porter and Elizabeth Teisberg in Redefining Health Care 4, published in 2006, VBHC is based on a simple ratio: the outcomes that matter to patients, divided by the cost required to achieve them.

Outcomes include essential elements such as survival, functional recovery and quality of life, while costs cover the entire care pathway, from diagnosis to recovery. According to VBHC, if we rely solely on clinical indicators without incorporating Patient-Reported Outcome Measures (PROMs) and Patient-Reported Experience Measures (PREMs) – in other words, the outcomes perceived directly by patients – the value created is limited and it is not possible to build a model that aligns the interests of patients and healthcare professionals, as well as those of stakeholders such as industry or private and public payers. By combining measures that speak to all stakeholders in the health system, it is possible to obtain a more complete and relevant assessment of the quality of care and, therefore, to improve care at both population and individual level.

A real-world example in the heart of Paris

AP-HP (Assistance Publique – Hôpitaux de Paris) has launched a VBHC pilot programme in breast cancer care at the Hôpital Européen Georges-Pompidou 5. This project aligns incentives with the quality of care: breast cancer generally has a good prognosis, but treatments can often affect patients’ physical, sexual and psychological quality of life. Unfortunately, this aspect is often overlooked when choosing the treatments offered to them. By systematically collecting PROMs and cross-referencing them with Clinical Reported Outcome Measures (CROMs), the programme set up by Dr Nguyen Xuan and Dr Koural enables a comprehensive, personalised assessment of the effects of treatments on patients’ quality of life, through the collection of PROMs before and after surgery, with follow-up of up to 10 years. Implementation difficulties in terms of interoperability limited the amount of data; however, interviews conducted during follow-up consultations revealed a genuine desire among patients to have their satisfaction and quality of life taken into account. Likewise, the collection of PROMs made healthcare professionals more aware of the importance of considering this crucial aspect of care, which made it possible to adjust treatments according to their real impact on patients’ lives.

A necessary revolution, not a passing fad

Value in Healthcare is not a short-lived fad, but a pragmatic and necessary response to the structural challenges facing health systems around the world. In the face of an ageing population and the rising prevalence of chronic diseases, this approach offers a sustainable solution. By focusing care on the outcomes that really matter to patients and making the best use of available resources, VBHC is establishing itself as an essential evolution to ensure the long-term sustainability of health systems. Far from being just a trend, it is an essential revolution for combining quality of care with cost control, guaranteeing a fairer and more effective future for all.

References

1. van Erning FN et al., “Achievements in colorectal cancer care during 8 years of auditing in The Netherlands”. Eur J Surg Oncol. Sept 2018
2. Katz G, “PromCat – Valorisation de la transparence et de la pertinence pour la chirurgie de la cataracte” Journal Officiel de la République Française, Nov 2023
3. Nano J. et al., “A standard set of person-centred outcomes for diabetes mellitus: results of an international and unified approach”. Diabet. Med. 2020
4. Porter M., Teisberg E., “Redefining Health Care: Creating Value based Competition on Results”, 2006
5. Nguyen Xuan et al. “Cancérologie sénologique. Un programme pilote VBHC de l’APHP”. Revue hospitalière de France. March–April 2024