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Global health challenges require confident commissioning responses

Across the globe, people are living longer, and this demographic truth is putting increasing stress on health systems

While there has been unquestionably a focus on healthy living in recent years, the Covid-19 pandemic has reminded the world of the necessity of effective public health management. People who are living longer will typically need to manage and cope with multiple chronic conditions.

There is also recognition of the importance of bringing a parity of esteem between mental and physical health. Early intervention is also critical to tackling the most significant life-long mental health risks and crisis episodes. Moreover, such early interventions require complex care coordination across primary, community and social sectors, often using third sector agencies, support groups and family and friendship networks.

Health systems have been designed as a function of history, not need

Health systems consist of a ‘patchwork quilt’ of service providers that have evolved out of the post-war era to treat acute episodic illness. Healthcare is typically organised around institutional care rather than the integrated care patients expect and need.

While co-morbidities and the need for holistic care are the norms rather than the exception, efficient and effective integrated care remains the holy grail of many health systems. The quest for its resolution is typically thwarted by institutional focus, fragmented information systems and a system leadership ethos that is more competitive than cooperative.

There is a need to tune health systems for transformation

We see significant opportunities for reshaping healthcare to improve outcomes sustainably:

• Rebalancing expenditure – Shifting the balance of expenditure away from acute hospitals to primary and community settings.
• Providing care in more appropriate settings – Realising the dividend on clinical and pharmaceutical technologies and genomics to improve the efficiency of acute care by providing more treatment in less acute settings. Surgical treatments requiring inpatient stays can increasingly be undertaken as day cases or even in ambulatory care settings.
• Reducing unwarranted clinical variation – There is a global focus on the costs and consequences of unwarranted clinical variation, which creates waste and negatively impacts clinical outcomes and patient experiences. Healthcare organisations can reduce unwarranted clinical variation with systematic and technological responses using artificial intelligence and clinical decision support systems.
• Considering integrated health and social care responses to complex care needs – The divide between health and social care is artificial and arbitrary. Patients and carers have clarity about their care needs; they expect ‘joined up’ and culturally responsive support where they are active participants. They want to work with an integrated team that understands their life goals, changing conditions, and health risks. They also expect a single treatment plan supported by the multiple care professionals that they might encounter.
• Investing in solutions that provide integrated care closer to home or in the home – Telecare and telemedicine using telemetry and remote diagnostic devices can predict avoidable health emergencies and offer more accessible specialist services in more convenient and appropriate settings.
• Supporting health coaching and education – This enables people to make informed choices about their lifestyle, care, and treatment options. Global exemplars have demonstrated that ‘one size fits all’ health coaching is ineffective. A better solution is to place this responsibility within the integrated care team as part of a holistic care plan.

System reform will not be effective if attempted by care providers acting alone

Improved efficiency of care delivery will only go so far. The real danger is that major acute providers’ financial and corporate ‘might’ will dominate system transformation themes. This will inevitably hamper the drive towards a patient and person-centred health and care system.

Patients want to feel in control of their health choices and treatment plans. Health commissioners can use this enthusiasm to engage people and encourage co-design to improve services, experiences and outcomes.

System leaders need to co-design a compelling system vision and blueprint

A clear, coherent and confident commissioning response is needed from system leaders to create a blueprint and vision for a system centred on the current and predicted demands that will be placed upon it.

This commissioning response needs to tune the relative shares of expenditure in health settings to reflect health needs and inequalities. The commissioning response also needs to consider the likely return on health investments to reduce health risks and improve outcomes and experiences for people.

Value-based commissioning delivers lasting improvements to people’s lives

Value-based commissioning facilitates a deeper understanding of the interplay of healthcare provision and healthcare demand. It provides the basis for a uniting coalition for change that can seize opportunities for improvement through well-orchestrated change management.
Moreover, it provides an interwoven set of disciplines that enables the system to remain ‘tuned in’ to supply and demand changes and react accordingly to keep it in balance.

Across the globe, commissioning exemplars are grasping the opportunities. We believe that this is an exciting and bold movement, and we are passionate about the potential for improvement. We know innovative commissioning makes a lasting impression on health systems and the lives of citizens and care professionals.

We are committed to applying the best of global solutions to the challenges facing your population