Introduces Value-based Healthcare, an important concept for transforming healthcare making it more cost-effective, sustainable, and patient-centered. Strategically, it makes the healthcare providers accountable to the desired patient and health system "valued" outcomes. https://youtu.be/-oOuJfpRFpY

2. Value-based
Healthcare
Systems

3. Agenda
• Background
• Service Models in Health
Care
• What is Value-based Health
Care VBHC
• Principles for success
• Building Blocks
3

4. Evidence-based
Healthcare
Patient-and-
Family
Centered Care
Patient Safety
Competency-
based Medical
Education
Systems
Thinking
Value-based
Healthcare
Technology-
Based
Healthcare
Paradigm Shifts in Healthcare

5. 5 3/30/2020 Add a footer

6. The Paradigm
•VBHC first appeared in 2004
in a Harvard Business Review
article.

7. The Paradigm
• The value-based health care
movement is based on the work of
Harvard University Professor Michael E.
Porter. His landmark book, Redefining
Health Care Creating Value-Based
Competition on Results, was co-
authored by Elizabeth O. Teisberg and
published in 2006 following 10 years of
research into: why the health care
industry did not conform to the
principles of competition seen in all
other sectors of the economy.

9. The Problems
• Increasing healthcare costs-All healthcare systems
today are under pressure to spend their resources
wisely and efficiently: the reasons are outdated
management practices and payment models.
• Variations in Outcomes between different healthcare
centers-no accountability/governance.
• Failed interventions to improve quality: scientific
advances with poor delivery!

10. The Problem
• Examples of failed interventions:
• Evidence-based medicine,
• safety initiatives,
• electronic records,
• ‘lean’ approaches to performance improvement, care coordinators,
• turning patients into paying customers,
• mergers,
• analytics,
• big data,
• personalized or precision medicine etc.

11. The Proposal
• Radical restructuring of health care focused on
competition and improvement.
• One singe AGENDA: a single unifying goal for
health care: to deliver value for the
patient.
Moving from low to high value care!

12. International
Uptake
The number of peer-
reviewed publications
addressing value-based
health care has increased
exponentially.

14. Service Models in Healthcare
Fee-for-
Service
Old
Fee-for
Value
New

15. Service Models in Healthcare
Non-
Volume-
based
Fee-for-
Service
Old
Volume-
based
Fee-for-
Service
Old
Value-based
Fee-for
Value
New

16. Service Models in Healthcare
Non-
Volume-
based
Fee-for-
Service
Old
Non-Volume-based care refers to the
payment health care providers
receives for their services to patients.
Fixed monthly reimbursement (salary)
is paid irrespective of service volume or
load.
Applies to public healthcare services.

17. Service Models in Healthcare
Volume-
based
Fee-for-
Service
Old
Volume-based care refers to the
payment a health care provider
receives for services a patient might
need.
All incentives were driving health
care providers to worry about the
number of patients cared for rather
than the value (Outcome) provided.
Applies to private healthcare services
particularly for senior specialist staff.

18. Service Models in Healthcare
Non-Volume
or Volume-
based
Fee-for-
Service
Old Non-volume or Volume-
based Fee-for-Service care
focuses on the Process and
not Outcomes that are
Patient, Family, Society and
Population relevant and
evidence-based.

19. 19 3/30/2020 Add a footer

20. Non-
Volume-
based
Fee-for-
Service
Old
Volume-
based
Fee-for-
Service
Old
Value-based
Fee-for
Value
New
Service Models in Sudan Healthcare?
X

21. Value-based HealthcareVBHC
Paradigm Shifts in Healthcare

22. What is VBHC?
• Value is that quality of
anything which renders it
desirable or useful.

24. What isVBHC?
Fee for
Service
(Volume)
Shift to
Fee for
Value

25. What is VBHC?
• Value-based healthcare is a healthcare delivery
model.
• The focus is on outcomes of relevance to the
patient (Patient-centered) and society.
• Cost per “relevant” and “valued” Outcomes is the
primary measure for effectiveness, efficiency, safety
etc. i.e. for the quality of service.
• Processes and Volume are no longer the
measures of success.

26. What is VBHC? • Instead of rewarding volume, new
value-based payment models
reward better results in terms of
cost, quality, and outcome
measures.

27. What is VBHC?
• Under value-based care agreements,
providers are rewarded for helping
patients improve their health,
reduce the effects and incidence of
chronic disease, and live healthier
lives in an evidence-based way.

28. What is VBHC? • Sick-care is Transformed to Health care!
• Value-based healthcare (VBHC) is becoming
a leading approach to improving patient and
health system outcomes around the world.
• It is one way of organizing healthcare to
transform health outcomes.

29. What is VBHC?
• Value-based healthcare is about linking how much
money is spent on healthcare programs or services
for a specific patient’s journey to the outcomes that
matter most to patients – rather than focusing
primarily on the amount of services (Volume-based
Healthcare), or on specific processes or products.
• VBHC focuses on the whole patient journey, not
the parts.

30. What is VBHC? • VBHC: For the first time, the healthcare
providers, administrators, minister of
health etc. are made accountable and
have to deliver the “right outcomes”
otherwise their employment or re-
imbursements may be at risk!

31. Add a footer

32. Benefits ofVBHC?

33. Value-based Health Care
Outcomes
that Matter
Cost-effectiveness
Staff
Accountability

34. 34 3/30/2020 Add a footer
EnablingValue Based HealthCare: Basic Principles

36. Focus on Quality to reduce Cost

37. VBHC Building Blocks

39. •Establish Integrated Practice Units
IPUs: Care must be organized around
medical conditions over the full cycle
of care and delivered in IPUs.
•Integrated practice units will achieve
scope and scale by growing locally
and geographically in their areas of
strength.
Focused Care for
Perfection:
Centers of
Excellence
1 Organize
Care Around
Medical
Conditions

40. • Develop Expertise: To deliver more value,
providers need to focus on deepening their
expertise, and expanding their ability to serve
the complex and interrelated needs of each
patient over the full cycle of care.
• OptimizeVolume: There is a well-recognized
relationship between volume of cases treated
and multidisciplinary specialized teams
inputs and the health outcomes achieved.
Focused Care for
Perfection:
Centers of
Excellence
1 Organize
Care Around
Medical
Conditions

41. 1. ONE Medical Condition: DM, Heart Failure, Epilepsy, Back
pain etc.
2. Comorbidities are catered for.
3. Multidisciplinary.
4. Strategic Location.
5. Patient-focused & Led.
6. Patient Monitors.
7. IPU is a complete System- administratively, financially etc.
8. Outcome Monitoring is vital.
9. Focused Patient Journey Analysis-part by apart.
Focused Care for
Perfection:
Centers of
Excellence
Essential
elements that lead
to the best
results.
1 Organize
Care Around
Medical
Conditions

43. • MIGRAINE CARE Germany
• By restructuring to create an IPU, a West German migraine headache
center was able to...
• This success enabled them to expand, opening more centers in other
cities and developing new programs in conditions such as vertigo,
rheumatoid arthritis, and acute back pain.
Case Study
20%
lower costs
54%
improvement
in symptoms
in patients

44. 2 Measure
Outcomes &
Cost
• Standardized outcomes, transparently
reported by condition, are essential for
both care improvement and for making
informed choices by patients, payers, and
other provider organizations.
• Outcomes represent the ultimate measure
of quality.
• Avoid surrogates for patient centered
outcomes.
• Cost should be aggregated over the full
cycle of care for the patient’s medical
condition, not for departments, services, or
line items
Measure
Outcomes & Cost
for Every Patient

46. 3 Aligning
Reimbursement with
Value
• Bundled payments are risk adjusted single payments
covering the full cycle of care for a condition from
diagnosis through rehabilitation.
• The payment is contingent on achieving good outcomes,
and allow providers to directly benefit by improving
efficiency.
• Early evidence suggests that bundled payments lead to
both outcomes and cost improvement.
Aligning
Reimbursement
with Value

48. 4 Systems Integration
• Effectively integrated care in multiple locations is an
essential element of value-based health care delivery
system.
• Concentrating volume by medical condition and moving
non-acute care out of heavily resourced hospital facilities
improves outcomes and reduces costs.
• Integration (not merger) assists in sharing resources,
staff, expertise (shared excellence).
Systems
Integration

49. 5 Geography of Care
• Today’s top health care providers can help lead the way
toward a nationwide value-based health care delivery
system that dramatically improves outcomes and controls
health care costs.
• By expanding strategically and integrating with
community providers, can widen access, improve
treatments, and help reduce fragmentation and
geographic “gaps” in services.
Centers of
Excellence-
Expanding their
reach.

50. 6 Information
Technology
To make the transformation to value-
based health care delivery, a new
generation of enabling information
technology (IT) is needed.

51. How to Do It? The SIX Building Blocks

53. 53 3/30/2020 Add a footer

55. Thank You
Moving to Value-based Healthcare

57. What is NEXT?
•Join Al Tababa Training!
•Become an EXPERT in VBHC!

58. Please visit and subscribe to
altababa.org