Measuring what really matters
It’s time to introduce equity into the value-based healthcare equation and measure what really matters.
In the first in our series on equity in healthcare, we make the case for why equity needs to become a core part of the equation and drive a shift from Value-Based Healthcare to Impact-Driven Healthcare.
Value-based healthcare has brought a welcome focus on improving outcomes from healthcare investments
The concept of ‘value-based healthcare’ (VBHC) has been the prevailing philosophy in healthcare management for more than a decade. Value-based healthcare has brought a much-needed focus on maximising the outcomes achieved from healthcare investments.
This change of emphasis has successfully shifted the focus of healthcare performance management from measuring and driving indicators focused on volume (e.g., number of diabetic patients who have visited their doctor) to a broader set of indicators that include outcomes and cost (e.g., number of diabetic patients with well-regulated blood sugar levels per $1000).
Whilst value-based healthcare has delivered impressive results, it needs a significant upgrade to address critical weaknesses…
Value-based healthcare is silent on the issue of equity
The Martini Klinik in Hamburg is the poster child for value-based healthcare. We often espouse their impressive record for improving outcomes for men who need surgery for prostate cancer. Through a relentless focus on measuring and driving outcomes over decades, the Martini Klinik has dramatically reduced the proportion of men who are incontinent or have sexual dysfunction 1-year after their surgery. This is a fantastic example of ‘measuring what matters’ and making meaningful improvements in people’s lives.
But let’s take a step back and consider the equation of value that is used to define value-based healthcare:
The problem with the value equation is that it fails to answer the question: “Whose lives are we improving?”
In the case of the Martini Klinik, we are improving the lives of affluent and privately insured men. This highlights a critical weakness in value-based healthcare: it is silent on equity.
Taking a leaf out of the ‘quintuple aims’ book
The transition from the quadruple to the quintuple aims has gained widespread acceptance. Equity is universally understood to be essential to progressive and sustainable healthcare.
The quintuple aims have become prevailing healthcare management wisdom, so why are we still happy to drive towards value-based healthcare when it leads to a perverse incentive to distribute outcomes unfairly?
Introducing equity into the equation
We propose a paradigm shift to upgrade the concept of ‘value-based healthcare’ to ‘impact-driven healthcare’. We also suggest a new equation that explicitly considers equity:
If we are serious about improving both the effectiveness and the fairness of healthcare, we believe we must evolve value-based healthcare into impact-driven healthcare.
It’s time to introduce equity into the equation and measure what really matters.
