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Value Based Health Care at King's College Hospital

Research output: Other contribution

Original languageEnglish
TypeTechnical report
Number of pages36
StateUnpublished - 9 Apr 2015

Documents

  • VBHC Evaluation Full Report 090415

    VBHC_Evaluation_Full_Report_090415.docx, 431 KB, application/vnd.openxmlformats-officedocument.wordprocessingml.document

    14/09/2016

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King's Authors

Abstract

The Value Based Health Care (VBHC) Project was funded by the Health Foundation as part of its Shared Purpose Programme and undertaken between 2012 and 2015 at King’s College Hospital, London (KCH). The aim of the Project was to put into practice the concept of value in health care, developed in the United States by Michael Porter, by developing and implementing a new system of value-based reporting at KCH. The aim of this evaluation was to assess the extent to which and ways in which the Project achieved its aims and to examine the organisational and technological influences on the progress and achievements of the Project. The evaluation used a combination of quantitative and qualitative methods to collect and analyse data about the Project.
The Project aimed to produce three main sets of deliverables (data collection; the development of value-based reporting tools; and the development of value-based management systems) that would lead to and support improvements in the quality and value of clinical services. Value was defined as outcomes divided by cost. Our evidence indicates that these deliverables have been substantially produced, but not in the ways or to the full extent that was intended in the original Project planning. The Project developed new methods of extracting and reporting information about the provision, costs and outcomes of health care, but these at the time of writing were required further modification if they were to be embedded in routine organisational practice in the Trust.
The Project led to changes and improvements in the delivery of care for patients, including for example the introduction of ward rounds and out-patient clinics with a specialist focus on endocarditis, the assessment of anxiety and mood among stroke patients, and the development of leaflets with specific information for different groups of hepatitis patients. We could see in our evaluation no quantified evidence of improvements in the overall value of services resulting from these changes.
Our evaluation suggests eight main implications for the development of value-based health care in the National Health Service or other settings.
1. The idea that value in health care is the relationship between outcomes and costs, which is at the heart of Porter’s analysis and the VBHC Project, appears to us to be of fundamental importance. Despite the difficulties with any one conceptualisation of value, further design and development work is needed to build ideas about value into the delivery of health care and the management of health services.

2. Porter (2010) argued that value, defined as the relationship between outcomes (the actual results in terms of patients’ health) and costs, can be expressed as a value equation (Value = Outcomes / Costs). But he also argued in the same paper that the different domains of outcome should be maintained as separate entities and not collapsed into a single composite measure of outcome. This apparent inconsistency in Porter’s argument needs to be addressed in any future work on the development of value-based health care. The value equation (V=O/C) formed a starting point of the VBHC Project; the KCH Project team took it to mean that value should be represented by a single outcome score and numerical rating of value.

3. The basic idea of value as being the relationship between outcomes and costs of services was central to the Project, but it was the detailed outcome, activity and cost information rather than the value metric (V=O/C) in itself that was used to inform service improvements. Although the value metric appeared to be more important as an organising and legitimising principle than as a specific piece of information, it may still help stimulate worthwhile developments in health care.

4. A major part of the Value Based Health Care Project has been the collection of information and development of reporting systems based the idea of value. The Project encountered substantial challenges in identifying, defining, processing and analysing the relevant information from within one hospital. The published literature indicates that these challenges are likely to exist in most other settings; they should be taken into account and addressed in planning any future initiatives to develop value-based health care.

5. A substantial aim of the Project has been to use value-based information to stimulate improvements in the quality and value of health care for patients. As noted, we found that information about value in itself did not lead to service improvements. Further work is needed to identify and develop explicit criteria and standards for improvement (perhaps using benchmarking or Best Practice methodologies) that can be applied using value based data.

6. Porter advocated the analysis of value across the whole cycle of care for individual patients. ‘Integrated care providers’ would develop and provide high quality care for patients across the whole cycle of care and aftercare. Organisational boundaries, within the NHS and between the NHS and other bodies, and the design of information systems based on existing organisations are a significant barrier to the development of value-based care that covers the whole cycle of care. Future initiatives in the development of value-based health care should address these issues as a matter of central importance at an early stage in any development work.

7. The VBHC Project has raised complex issues about the relationship between information, clinical leadership and general management processes in the delivery of health care. The use of value-based information helped develop positive working relationships between clinicians, project staff and finance and other managers. But greater ownership and commitment by directors and others with high levels of authority and with control over resources of staff, time and money are also needed in advance if a substantial new idea such as value based health care is to be successfully translated into operational practice and is to modify existing line management systems.

8. Porter argued that value-based information would enable physicians and individual patients to choose between different integrated providers of care. This would stimulate competition based on value between providers and further improvements in the quality and value of services. We found no evidence of influence of market-based competition and choice on the VBHC Project. The Project did not explore the potential of value-based information for benchmarking or other kinds of activities that might lead to non-market forms of competition. At present, the potential of value-based analysis, in the context of rising expectations and rising costs in health care, to improve quality and control costs in a managed health care system such as the NHS would appear to depend more on professional commitment and the exercise of formal authority and leadership by policy-makers and senior managers than on competition.

(Source: Executive Summary of Unpublished Summary Report)

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