1、The Moment of Truth for Healthcare Spending:How Payment Models can Transform Healthcare SystemsI N S I G H T R E P O R TJ A N U A R Y 2 0 2 3ContentsImages:Getty Images 2023 World Economic Forum.All rights reserved.No part of this publication may be reproduced or transmitted in any form or by any me

2、ans,including photocopying and recording,or by any information storage and retrieval system.Disclaimer This document is published by the World Economic Forum as a contribution to a project,insight area or interaction.The findings,interpretations and conclusions expressed herein are a result of a col

3、laborative process facilitated and endorsed by the World Economic Forum but whose results do not necessarily represent the views of the World Economic Forum,nor the entirety of its Members,Partners or other stakeholders.Executive summaryIntroduction:Value in healthcare then and now1 Moving to a high

4、-value equitable healthcare system:the urgent case for value-based payments2 How value-based payments are used today3 Pathway for payment change4 Barriers to adoption and scaling of value-based payments5 Recommendations to drive payment changeConclusionAppendixContributorsEndnotes357 9586

5、1The Moment of Truth for Healthcare Spending2Executive summary The change to value-based payment models is a vital transformation,albeit a difficult task.There are many hurdles to overcome that require a willingness to leave behind volume-based payments,invest in new data and IT systems,develop new

6、business models around care delivery models,and accept longer-term time horizons.Greater efforts must be made globally to bring together shared understanding of the opportunities,challenges and solutions to make this urgent transformation possible and expedient.BackgroundThe World Economic Forums Gl

7、obal Coalition for Value in Healthcare launched the Global Enablers Payments Community,a multistakeholder network aimed at cultivating collaboration,exchanging experiences and accelerating healthcare transformation for this critical lever for value-based healthcare systems.The community consisted of

8、 experts from sectors including healthcare providers,payers,pharmaceuticals,medtech,governments,consulting and academia,who met regularly to exchange case studies on value-based payment models to bring local and regional learnings to a global platform.Additionally,non-community healthcare sector lea

9、ders were brought into the research to further understand the key issues.This insight report is a thematic exploration by the coalition into payment models as an enabler of value-based healthcare.The purpose is to take current perspectives using real experiences and case studies across healthcare st

10、akeholders to provide guiding principles and concrete recommendations for implementing and deploying value-based healthcare payments across the globe.Specifically,the report aims to:Raise the urgency and need to scale up the adoption of value-based payment models Guide healthcare leaders,including s

11、ystem leaders,payers,providers and policy-makers,towards a common understanding of value-based payment models Create greater awareness and inspiration by sharing success stories,drive increased willingness to participate in value-based payment models and motivate stakeholders to invest time,energy a

12、nd resources Identify the critical barriers and potential solutions to progressing the focus from theory to value-based healthcare implementation.Key findings include:Payment models based on fee-for-service(FFS)and diagnosis-related groups(DRG)contribute to the unsustainable development of todays he

13、althcare systems.Several key opportunities can be fulfilled through value-based payments models:Emphasize quality of care over volume Reduce waste and unnecessary interventions Deliver integrated care Address health equity in outcomes Reduce workforce burnout Motivate high-value innovation Create a

14、more sustainable healthcare systemHealthcare systems worldwide urgently need transformation,but this change is possible only alongside broadscale adoption of value-based payment models.The Moment of Truth for Healthcare Spending:How Payment Models can Transform Healthcare SystemsJanuary 2023The Mome

15、nt of Truth for Healthcare Spending3 Changes in payment models alone are not enough;all levers of change must be addressed.For example,value-based payment models can drive faster change when they help enable a shift in provider behaviour and care delivery.Though value-based payment models have not y

16、et been widely scaled,healthcare stakeholders worldwide are eager to create a reality where the healthcare system focuses on the outcomes that matter to patients.The pathway for payment change requires stakeholders to decide at the leadership level to pursue value-based healthcare,align with partner

17、s on a common mission,design a payment model that will assess outcomes,implement the model to incentivize behaviour change,assess and improve the model and scale-up models across geographies and patient groups.The major barriers to systemwide adoption and scale-up of value-based payment models are t

18、he investment hurdles(near-term financial constraints,short-term focus and resistance to change)and the limited use of levers that tie stakeholders to the current system(policy,care delivery,tools and informatics levers).Solutions to barriers will include increasing transparency,policy direction,edu

19、cation and standardization.The importance of establishing consensus across stakeholders:value is about outcomes that matter most to patients.Scale will require collaboration and partnerships opportunities lie in systems that are willing to take a multistakeholder approach to ensure that all facets o

20、f the complicated healthcare system can come together simultaneously.Together stakeholders can agree on a set of steps and move forward to implement value-creating systems.The Moment of Truth for Healthcare Spending4Introduction:Value in healthcare then and nowHealthcare delivery needs to transform

21、and re-focus on healthcare that creates value.The healthcare sector is facing three major crises value,evidence and purpose.Across the world,pioneers have shown that value-based healthcare can address all three.Stefan Larsson,Distinguished Fellow,World Economic Forum;Chairman and Co-Founder,Internat

22、ional Consortium for Health Outcomes Measurement(ICHOM)in The Patient PriorityThe global healthcare affordability crisis is not a new topic.Individuals and healthcare systems are reaching the limits of what they can afford to spend on healthcare,and this spend is not correlated with improved patient

23、 outcomes.While many mistakenly assume these issues emerge from a cost crisis in healthcare,they are driven by a global value crisis in healthcare,as stated by Stefan Larsson,Jennifer Clawson and Josh Kellar in The Patient Priority.1There is an urgent need to change the way healthcare is delivered g

24、lobally.Healthcare delivery needs to transform and re-focus on healthcare that creates value,as guided by patient outcomes and accountability for resources in the healthcare systems.Value-based payment models should no longer be considered a leap of faith.The World Economic Forum is advancing this c

25、all to action using a value-based healthcare framework under the purview of the Global Coalition for Value in Health.This patient-centred approach focuses on improving outcomes and costs for defined population segments that receive segment-specific interventions.Healthcare transformation is complex,

26、and its metamorphosis requires the orchestration of many levers of change.The 2017 Value in Healthcare:Laying the Foundation for Health System Transformation report outlined key interdependent levers of change:payments,benchmarking,research and tools,delivery organization,informatics standards and p

27、olicy.2The value in healthcare framework for a value-based health systemFIGURE 1A patient-centered approach focuses on improving outcomes and costs for defined population segments who receive segment-specific interventions.Policies and regulation that support learning and continuous improvement to d

28、rive value-based healthcare.Informatics that permit capture,analysis and sharing of health outcomes and relevant data for each population segmentPayments that reimburse for value,rather than volume of careTools to analyse data and generate insights through benchmarking,clinical decision support,pred

29、ictive analytics,risk stratification,etc.Care delivery models that enable better access to care,ensure continuous improvement and measure performancePaymentsBenchmarkingresearch andtoolsDeliveryorganisationInformaticsSegment-specific interventionsOutcomesCostPopulation segmentsSource:World Economic

30、Forum,Accelerating the Pace of Health System Transformation,2018 The Moment of Truth for Healthcare Spending5Value-based healthcare cannot exist without a focus on outcomes that matter to patientsMichael Porter and Elizabeth Teisberg introduced value-based healthcare in 2006,suggesting a radical tra

31、nsformation of the global healthcare systems,which resonated across stakeholders,given the urgent need for reform.Understanding what value in healthcare means is critical.The widely accepted definition of value in healthcare is the health outcomes that matter to patients relative to the resources or

32、 costs required to deliver those outcomes.Value-based healthcare is an approach that aligns industry stakeholders(payers,providers,pharma/medtech,policy-makers)around a shared objective of improving patient health outcomes,providing the autonomy and accountability to providers to pursue the best way

33、 to deliver healthcare for the money spent.3 The defining aspect of value-based healthcare is that it seeks to address the issues experienced in healthcare today by reminding stakeholders that they all share a singular objective,providing value to the patient.Aligning on“value for the patient”The Wo

34、rld Economic Forums value-based healthcare report series set a comprehensive framework describing the components of a value-based health system,sharing that“a patient-centred approach focuses on improving outcomes and costs for defined population segments who received segment-specific interventions”

35、.There cannot be a value-based healthcare system without being patient-or population-segment-centric in improving outcomes and costs.True value-based healthcare goes beyond reducing costs,seeking to enable integrated patient care aligned with patient outcomes and quality.Payment reform to drive valu

36、e-based healthcareTo enable value-based healthcare across integrated,multidisciplinary teams,incentives and payment models must exist to support it.Transformation will only be financially sustainable if care delivery and payment models are interlinked and if the payment system reinforces value creat

37、ion.Payment models have a powerful influence over healthcare impacting organizational and provider behaviour,health equity and innovation.These three areas are sources of challenges and levers to drive change,and how healthcare systems structure their payments can impact all three.1.Provider behavio

38、ur:Legacy reimbursement systems have created volume-based business models.These payment models influence their sense of accountability for patients and their outcomes,and how they feel about their purpose and value as caretakers.2.Health equity:Updated payment mechanisms have the potential to improv

39、e health equity by incentivizing integrated care models and generating transparency for outcomes.However,if payment models are constructed without an intentional goal of equity or if resources for transformation are not available to traditionally under-resourced provider organizations,any new paymen

40、t model could end up widening disparities.3.Innovation:Healthcare payments received across stakeholders influence their motivations to innovate.At the provider level,a payment model can incentivize or disincentivize the use of innovative treatments on a patient,especially when payers delineate which

41、 activities they will reimburse.Payment models that incentivize higher patient value will drive industry,suppliers and providers to focus on innovation.This report is designed to urge and galvanize a broader scale-up of value-based payment models.It outlines key findings from case studies provided b

42、y experienced organizations and stakeholders,a shared lexicon adopted from Porter/Teisberg,and suggested action to align an environment that enables scale.Transformation will only be financially sustainable if care delivery and payment models are interlinked and if the payment system reinforces valu

43、e creation.The Moment of Truth for Healthcare Spending6Moving to a high-value equitable healthcare system:the urgent case for value-based payments1Understanding todays status quo the predominance of activity-based models(FFS)and making the case for a move to value.The Moment of Truth for Healthcare

44、Spending7Though there are variations across countries in how healthcare is financed and provided,the most common payment model globally is paying for individual services.These payment models share the same limitations that drive the need for payment reform.Limitations of paying for volume of activit

45、yThe current widespread use of activity-based payments(fee-for-service(FFS)and diagnosis-related groups(DRG)contributes to healthcare inefficiencies and limits healthcare transformation.The predominant use of these models creates five main limitations,as depicted in Table 1.Summary of issues and eff

46、ects of widespread use of activity-based paymentTABLE 1Value-based payment models reward stakeholders that positively contribute to outcomes that matter to patients The principles of value-based healthcare can be applied to countries,care settings and diagnoses across the globe.Coronary heart diseas

47、e or schizophrenia are the same conditions whether occurring in Asia,Africa or the US.While system-driven differences impact healthcare delivery in many ways,no matter the healthcare system type,creating the best outcomes for patients in a cost-effective manner is an innate goal of value-based payme

48、nt models.These models motivate behaviours that help address the limitations described above.They incentivize an emphasis on good patient outcomes,care coordination and integration over working independently,an engaged healthcare workforce,innovative solutions and health equity,as detailed in Table

49、2.Value-based payment models present an opportunity for providers,pharma,medtech and payers to drive continuous improvement in care through measuring patient outcomes and efficiently allocating scarce resources.Issues and effects of activity-based payment1Volume incentive2 Lack of accountability for

50、 outcomes3Care fragmentation4Workforce burnout5Obstruction to innovation6Systematic obstacles for health equity Leads to more healthcare services,duplication,and complexity,and reduces valuable non-billable services Contributes to higher healthcare spend Inhibits price transparency for patients with

51、 high care volume Removes accountability for patient outcomes and patient experience Generates income for health systems even if patient outcomes do not improve Disincentivizes collaboration across the patient care pathway Limits pharma and medtech integration into value-based care pathway Leads to

52、clinician burnout due to the misalignment of purpose and incentives Creates administrative burden of billing and coding Limits provider flexibility to experiment with new services and products Limits payer ability to encourage use of innovative products and services when payers assume full risk Disc

53、ourages innovations that may raise costs for one“activity”or department in the care pathway,but save on the total costs for the patient group Creates differential affects for populations with poor access to healthcare Obstructs ability to measure disparities,given limited outcome measurement Limits

54、payment adjustments for patients with disadvantaged social drivers of health,creating provider incentives to prefer patients with adequate insurance coverage or ability to payThe Moment of Truth for Healthcare Spending8Benefits of value-based payment models across stakeholdersTABLE 2StakeholderValue

55、-based model benefitValue-based payment opportunities for the stakeholderPatients/Public:Emphasizes quality of care over volume Has potential to help address health disparities Focuses on patient outcomes and prioritizes patient value Limits waste in the system and can liberate finances for other pu

56、rposes Enables shared patient and provider decision-making Contributes to solutions for health inequitiesProviders Enhances motivation and addresses workforce burnout,reducing waste and unnecessary interventions Addresses care fragmentationProvider organization Offers more financial sustainability a

57、nd flexibility to improve care delivery4 Creates staff motivation when impact of care is reflected in outcomes that matter to patients Enables efficient resource allocation,allowing staff to work smarter and avoid repeat interventions and waste Reduces burnout experienced within organizations and wo

58、rkforce capacity concernsIndividual clinicians Refocuses clinicians on their motivators and drivers as clinicians,helping patients Encourages collaboration and care coordination across clinicians and specialitiesPharma/medtech Encourages and supports high-value innovation Enables conversations regar

59、ding value between pharma/medtech with payers and providers earlier in the development process,focused on innovation that enhances patient outcomes Drives innovation for patients that lead to improved outcomes Enables pharma and medtech to grow“beyond the pill”and engage in the delivery of better ca

60、re Enables innovative evidence-generation processes to evaluate effectiveness within the context of the total patient care pathway Encourages accountability for outcomes deliveredPayers Creates more sustainable healthcare Helps manage increasing healthcare costs and works to reduce the estimated 20-

61、40%of wasted healthcare spend Allows for focus on efficiency and healthcare sustainability Allows payers to buy healthcare-based on outcomes that matter to their beneficiariesThe Moment of Truth for Healthcare Spending9Foundational principles of value-based care and their applicability to value-base

62、d paymentsValue-based payment models encourage behaviour changes that drive the benefits listed in Table 2.They do this by adhering to the three foundational principles as laid out in the 2018 World Economic Forum report,Laying the Foundation of Health System Transformation.A decade of value-based p

63、ayment model experimentation across countriesValue-based payment models have been growing in use worldwide,with more and more examples of payment models across countries.These programmes showed many examples of success but also many with limited impact,particularly those models that did not include

64、outcomes measurement.Where outcomes measurement has occurred,results have been very convincing.Over the last ten years,the US has tested value-based payment models extensively through the Center for Medicare and Medicaid Innovation(CMMI)with the Center for Medicare and Medicaid Services(CMS).CMMI pu

65、blished the Innovation enter Strategy Refresh in 2021,outlining the learnings and way forward.One of the key learnings was to drive accountable care through outcome measures that are meaningful to patients to create meaningful quality improvements.5 Additionally,a 2016 report by the Economist Intell

66、igence Unit(EIU)put forth a global assessment of value-based healthcare.At the time of the assessment,higher-income countries in the European region were leading in adopting value-based healthcare payments(France,Germany,Sweden,Netherlands,UK,Australia and Canada),followed by lower-income countries

67、in the early stages of their journey.6Of the many regions represented in the community,the Kingdom of Saudi Arabia and Singapore have created a focus on value-based healthcare.Saudi Arabias political commitment to transform the health sector was established as a part of its Vision 2030.They made the

68、 key strategic decision to start with value-based care models and involved political sectors beyond healthcare.Singapore created a robust infrastructure and health clusters to enable value-based payments,population health for residents across their entire life span,and capitated payments.In light of

69、 the Kingdom of Saudi Arabias commitment to achieving and sustaining Universal Health Coverage,the Kingdoms health sector transformation agenda explicitly has a strategic goal of shifting to delivering high value.As part of this transformation,a public purchaser and payer entity was established,The

70、Center for National Health Insurance,that aims to apply value-based payment models.Center for Value in Health,Ministry of Health,Kingdom of Saudi ArabiaFoundational principles of value-based healthcareFIGURE 2123The systematic measurement of health outcomes that matter to patients and the costs requ

71、ired to deliver those outcomes across the full cycle of care.Without outcomes measurement,it is impossible to establish the value of interventions or track improvements in outcomes.The identification of clearly defined population segments and the specific health outcomes and costs associated with th

72、ose segments.The unit of analysis is the population of individuals suffering from the same disease(s)or condition(s),which allows for meaningful comparison of outcomes.The development of customized segment-specific interventions to improve value for each population segment.Tracking outcomes for popu

73、lation segments drives care improvement through customized and holistic interventions,innovative medtech and pharma products for subsets within the group.The Moment of Truth for Healthcare Spending10How value-based payments are used today2There are a variety of payment models being explored today th

74、at create a focus on value.The Moment of Truth for Healthcare Spending11Value-based payment models tend to organize across three types:activity-based with links to quality and value,bundled payments and capitated payments.Activity-based with links to quality and value:These payment models still use

75、some level of an activity-based payment but adjust the payment based on the activitys link to pre-determined quality and/or value metrics,improvements in infrastructure,and/or the act of reporting of outcomes data.At the pharma or medtech level,this payment model would look like a risk-or gain-shari

76、ng agreement with a payer or a provider.An outcomes-based agreement that links payments to manufacturers for predefined outcomes over time.Medtronic uses outcomes-based agreements for its Tyrx antibacterial sleeve that requires Medtronic to reimburse hospitals for a portion of the cost if the antiba

77、cterial sleeve fails to prevent infection in cardiac implant patients.Bundled payments:A bundled payment model links the payment to the effective management of a patient condition,as opposed to payment for each individual service provided to the patients across their care journey for an acute condit

78、ion or for a period of time for a chronic condition.These agreements hold providers financially accountable for the outcomes of the defined patient segment with the condition while offering opportunities for increased autonomy in decision-making and participating in risk and reward.There are two com

79、mon types of bundled payments:episode of care bundles and condition-based bundles.Episode of care bundles often have a short time horizon anchored in a surgical event and lasting for 30-90 days.Episode-based bundles are often used to cover multiple services and supplies included in a surgical proced

80、ure.For example,in Sweden,a procedure-based bundled payment called OrthoChoice was implemented for hip and knee replacements.The bundle negotiating points and components were critically important,as was the involvement of providers and clinicians in the creation of the bundle.The bundled payment hel

81、d 3.2%of the cost back and was paid only if the provider met the outcome goals.Providers added follow-up visits,education and earlier physical therapy.Complications and revisions decreased by 20%.Total costs for the surgical procedure and rehab declined by 17%in 2011 versus 2008.7 Outcomes were asse

82、ssed two years post-surgery.Thus,the accountability for longer-term outcomes created stronger care coordination between the professional groups.However,bundled payments that create the most impact are those designed around a condition segment and group all services required,including both surgical a

83、nd non-surgical pathways,to treat a patient over the course of their condition.In the case of chronic condition-based bundles,the payment model includes treatment of the condition and its most relevant co-morbidities for a period of time and is renewed for the patient as needed.UT Health Austin,the

84、clinical arm of Dell Medical School in the US,uses value-based payment models in the form of condition-based bundled payments for musculoskeletal conditions.These bundles include all outpatient services and surgical professional fees for upper or lower limb extremities.For example,UT Health Austin u

85、ses a lower extremity bundle.This payment encompasses a set of musculoskeletal conditions in the lower extremities,the only exclusions being the obvious high-risk carve-outs like patients with cancer in the lower extremities.If a patient comes in with knee pain and the provider accepts them,their ca

86、re will be covered under the lower extremity bundled payment.UT Health Austin is responsible for recording patient-reported outcomes(PROs)bi-annually and has incorporated other specialities into their practice,like rheumatologists,chiropractors,physical therapists and sports medicine physicians,to t

87、reat patients holistically.Bundled payments that create the most impact are those designed around a condition segment and group all services required.The Moment of Truth for Healthcare Spending12Capitated payments:Bundled payments tend to exist for specific conditions whereas,capitation often comes

88、into play as payment models for overall health issues.Capitated payments provide a predetermined rate for all the health needs of an individual in a defined patient group or population segment.Risk and risk adjustment are important for providers with capitated payments.Thus,typical capitated payment

89、 models are implemented across a sub-segment of the population with similar needs for health maintenance and care,like the frail elderly.The focus on a sub-segment,like the multimorbid elderly,allows for standard outcome measures and cost estimates to be benchmarked for that patient population.Oak S

90、treet Health is a network of primary care centres in the US for older adults covered by Medicare Advantage.Oak Street has a global primary care capitated payment model that gives them a fixed payment“by patient”adjusted for risk factors.The model was built to address social drivers of health in whic

91、h primary care plays a large part.As a part of the value-based care model,they can use the funds flexibly to provide the best outcomes for their patients.They have been able to invest savings into unique services that drive patient outcomes,for example,providing transport to and from the centres to

92、allow patients to be seen in primary care and offering remote home monitoring to handle any concerns that might put a patient in the hospital.Oak Street says they have cut hospital readmissions by 40%and changed the way care is delivered.8Ongoing value creation and contracting innovationsPharma and

93、medtech have also been experimenting with innovative contracting agreements that address short-term affordability and cost issues.These contracting agreements include discounts and rebates,price/volume agreements,use or price capping,subscription services(where providers contract technology),managem

94、ent services(where providers outsource labs/clinics)and annuities payments that are standalone models.While these address urgent cost concerns,in most cases,these agreements do not track outcomes in the way value-based payment models do,which could be for reasons beyond their control.While these wou

95、ld not be considered value-based payments for the purposes of this report,they do offer innovative solutions to the pressing affordability issues.9,10Value-based procurement has also been used as a means of creating value.The European procurement legislation mandated an appropriate price-to-quality

96、ratio for products and services.As most technologies delivered in the public provider sector need to go through public procurement processes,the inclusion of value criteria in the tender specification,for example outcomes that matter to the patient,has been a very effective stepping-stone to value-b

97、ased care delivery.These models must measure outcomes to improve patient health for the same or lower spend.Behaviour change wont be enabled without transparency of outcomes.A bundled or capitated payment without outcomes measurement could lead to a rationing exercise that does not put patient outco

98、mes at the centre.These payment models have proven to make a difference in driving patient outcomes and improving healthcare sustainability.They are no longer a leap of faith.The Moment of Truth for Healthcare Spending13Pathway for payment change 3Healthcare stakeholders around the world are eager t

99、o use value-based payment models,with many organizations considering how to progress their experience.The Moment of Truth for Healthcare Spending14Using the value-based payment model case studies explored within the community,key stages and learnings of the value-based payment model journey have bee

100、n identified and synthesized into a practical pathway for payment change for any stakeholder.Pathway for payment changeFIGURE 3Commit to pursuing value-based payments with a clinical and business case to support itDrive common understanding of objective and establish trust across internal and extern

101、al partnersDesign a payment model that will measure and assess outcomes that matter to patientsImplement a value-based payment model that incentivizes behaviours that drive value for patients through improved outcomesScale the use of value-based payments across larger geogra-phies,patient segments a

102、nd conditionsTitle 1Assess and improveAlignDesignImplementScaleDecideStage 1:DecideObjective:Commit to pursuing value-based payments with a clinical and business case to support it.Additionally,to define the specific(or initial)patient population,care journey,condition or segment to which the value-

103、based payment model will be applied.Challenges:Typical challenges within this stage include an organizations ability to commit to value-based payment.Committing to a change requires internal resource investment in the form of a dedicated team.The pathway to change can be labour-intensive.Second,beca

104、use the dissemination of success stories and evidence of improved outcomes and potentially reduced costs has been somewhat limited in the past,it can be challenging for organizational leadership to convince their teams to pursue value-based payment models.Key considerations:1.Ensure commitment to va

105、lue-based healthcare:Ensure internal leadership is committed to value-based healthcare and that it is aligned with the organizational strategy centred around creating value for patients.See case study 1 for an example from NHS Wales regarding commitment to value-based healthcare payments.2.Decide wh

106、ere and when to use value-based payments:Identify the specific conditions,other patient segments and geographies applicable for value-based payments.Given the investments needed in effort and resources,prioritize areas with large overall spend,high volume of patients,opportunity for clinical or outc

107、omes improvement and clear ability to measure outcomes.See case study 2 for an example from the US Navy on the learnings relating to selecting a value-based payment model.3.Consider how models will:address health inequity,be affected by legal and regulatory barriers and unite partners.Key success fa

108、ctors:The involvement of clinicians is critical in the decision to move forward with value-based payment models.Additionally,two organizational capabilities are crucial in the decide stage:A cross-functional team including finance,legal,regulatory,sales and marketing teams to push the initiative for

109、ward and ensure sustainability.Expertise in economic evaluation to drive confidence in the ability to assess the long-term economic value of the intervention and the downstream financial impacts.Lastly,experienced organizations highlight the importance of getting started.There is a point of diminish

110、ing marginal returns in preparing for value-based payment models.The Moment of Truth for Healthcare Spending15NHS Wales is taking a broad system-level approach through to a specific pathway or condition-level approach,to support the transition that balances volume and the delivery of outcomes that m

111、atter to patients.NHS Wales took a system-level approach during the decide and implement stages whereby they secured resources to elevate the current infrastructure,learnings,education,patient-reported outcome measures(PROMs)and financing to facilitate their journey from decide to scale.They have be

112、gun implementing a structure for PROMs at the national level and are building the capability for local adaptation that meets the national centralized key performance indicators(KPIs)for outcomes.They have also established a value team in each health board that geographically covers the entire nation

113、.NHS Wales has decided to invest in value-based healthcare and is taking steps to ensure value-based payments are possible.The United States Navy launched a value-based healthcare pilot in 2016 focused on integrated practice units(IPUs)to better enable the mission of readiness for active duty person

114、nel.Lower back pain,osteoarthritis,diabetes and high-risk pregnancy were identified as initial areas of focus based on high spend,volume and ability to improve outcomes and access to care.Three of the four conditions piloted saw improved outcomes.However,one pilot was considered unsuccessful and not

115、 continued due to the narrowing of scope to high-risk pregnancy.The number of high-risk pregnancy patients in this population was too small to detect meaningful results within 12 months.Condition selection for measurable outcomes played a key role in the success of the pilots.When deciding whether t

116、o use a value-based payment model,it is vital to consider the achievable volume of data that would be large enough to measure statistically significant changes in outcomes.11Alcon committed to personalizing care in cataract and refractive surgery and involving patients in care decisions that matter

117、to them.Cataract surgery is one of the most performed operations,and the procedure using standard mono-focal lenses is fully covered across European healthcare systems and beyond.Many cataract patients independently experience presbyopia or astigmatism and are required to wear glasses,for which they

118、 usually pay out of pocket.Technology options exist for the patient to simultaneously have cataract surgery and refractive correction and reduce or eliminate dependence on spectacles.Often these advanced options are not proposed to the patient,however,as they are not reimbursed.Patients wishing to p

119、ursue cataract refractive surgery typically must forfeit public reimbursement for their standard cataract and pay for everything out of pocket.Alcon has been advocating for patients right to be informed of their treatment options and to co-pay for additional astigmatism or presbyopia correction with

120、out losing the reimbursement for the cataract procedure.In 2012,Germany was the first European country to develop the legislation,entrenching the patients right to cataract reimbursement and allowing co-payment for additional outcomes.Alcon has been collaborating with policy-makers and providers to

121、adapt the patient journey and awareness and training medical staff to deliver care that provides patient-centric options.CASE STUDY 1How NHS Wales committed to value-based healthcare laying the foundation for new payment modelsCASE STUDY 2What the US Navy learned about selecting a condition for valu

122、e-based healthcare CASE STUDY 3How Alcon focused on patient participation in their health decisions and co-payment for personalized outcomesThe Moment of Truth for Healthcare Spending16Stage 2:AlignObjective:Drive a common understanding of the objective and establish trust across internal and extern

123、al partners.Challenges:During the align stage,partner organizations must consider their investments impact on a future value-based payment model approach.It is a challenge in the align stage to identify partners that understand the potential for upfront investment to support the long-term value-base

124、d mission(see case study 4).If the partner isnt fully aligned,the move to value-based payment could be at risk.In some situations,other external partners should be considered to bring value.Key considerations:Two key considerations were discussed across case examples:1.Spend time creating buy-in bot

125、h internally and externally:The importance of spending time educating cross-functional groups(e.g.finance teams,marketing teams,IT,public affairs and others)within your organization should not be underestimated as they play a valuable role in later stages to enable the design and implementation stag

126、es.Additionally,taking the time to truly understand and map individual external partners,their needs,concerns and goals enables strong partnership and coordination throughout the pathway based on trust.2.Use targeted communication based on stakeholder goals:Discuss early how partners see value-based

127、 healthcare within their organization and how it relates to their overall mission and vision.This helps establish their commitment as partners to a common purpose and a general agreement across key considerations within the align stage.Key success factors:Investing in onboarding and relationship bui

128、lding across internal and external partners enables the organization to build trust and partnership.The investment helps in understanding the concerns related to cross-functional teams within an organization,partner organizations and even patients.Within this stage,the most critical capability will

129、be building relationships.Trusted relationships are key to managing risks,as value-based payment models require organizations to step out of the status quo and into the unknown.Diabeter closed a groundbreaking ten-year value-based healthcare partnership with Zilveren Kruis,the largest insurance comp

130、any in the Netherlands.This is the first value-based agreement that includes short-and long-term complications for type 1 diabetes.The partnership is based on a shared ambition of a complication-free life for type 1 diabetes patients now and in the future at a minimal cost.Diabeter credits the succe

131、ss in implementing this value-based payment model to the significant time spent on the alignment stage with internal stakeholders,Medtronic,Dutch Health Authority,and the insurance company.Diabeter ushered partners through change management processes to create alignment on a shared objective of impr

132、oved patient value,enabling their value-based payment model pathway.The partnerships helped the organizations involved deliver superior outcomes for patients.They were able to set ambitious outcomes targets,incentivize improvements in value and shared savings,share integral responsibility of the dia

133、betes care pathway,commit to long-term innovation,share data on outcomes and costs to improve value,and gain mutual trust and understanding.CASE STUDY 4How Diabeter engaged with stakeholders to create alignment The Moment of Truth for Healthcare Spending17Novo Nordisk,a company oriented around provi

134、ding care to individuals with diabetes and obesity,sought to explore how payment for value can play a role in the design of care beyond medicines and attract new funding to expand the quality of services and increase the number of citizens supported.Novo Nordisk helped develop a social impact bond p

135、roject to invest in preventing type 2 diabetes complications,reducing future health burden and cost impact.The solution aligns actors(city administrators,local community and healthcare)on the intervention protocol for diabetes and boosts diabetes management in the community,closely linked to each ci

136、tizens general practitioner.The partners engaged third-party investors and a national and local social investment fund to fund the initiative.This enabled the city to commit to an upfront investment that will lead to cost savings despite tight budgets.The investment fund loans finances to the city a

137、nd service providers who run the programme and evaluate if agreed outcomes measures are achieved.The city will pay the loan with interest if the programme succeeds after three years.If the city does not meet its goals,it will not repay the loan.The city has since allocated considerable additional bu

138、dgets to make more initiatives like this that are attractive for third-party investment,preferably at a much larger scale.Medtronic and Estar,the regional purchasing body in the Italian region of Tuscany,worked together on the first outcomes-based agreement in the public procurement environment in I

139、taly.Like Medtronic,Estar sought to move towards a healthcare system with a strong emphasis on patient outcomes.Physicians were already beginning to monitor clinical outcomes and,at times,were doing so through a tool supplied by Medtronic.Medtronic and Estar found alignment through a common goal.The

140、 outcomes-based agreement has been established on the tender for cryoablation in atrial fibrillation.Estar added performance measures relevant to them,including the most relevant clinical outcomes for the selected patient population.Through this partnership,Medtronic,and the region of Tuscany,entere

141、d a longer-term agreement(of three years)that is more suitable to value-based payment models that seek to improve patient outcomes.CASE STUDY 5How Novo Nordisk leveraged a unique third-party partnership to align stakeholders CASE STUDY 6How Medtronic partnered with an Italian payer Stage 3:DesignObj

142、ective:Design a payment model that will measure and assess outcomes that matter to patients based on an agreed-upon disease and patient segment-defining criteria,risk adjustment,outcome targets,warranty terms and price.Challenges:During the design stage,challenges related to data(i.e.standardization

143、 of data types like PROMs,sources,minimum volumes,etc.)are likely to emerge.Non-unified data standards will likely require an investment in informatics and data processes to measure and track outcomes data broadly.In addition,a minimum volume of patients will be required to measure impact.This can b

144、e an issue with lower patient volumes among certain providers.It is important to understand these challenges when aligning the key design elements of the payment model.Key considerations:Including all the key design elements of a payment model and the appropriate governance are the key consideration

145、s for the design stage.Key design elements of a payment model(adapted from Harvard Business School workshops and white paper The State of Bundled Payments):1.Scope:Define the medical condition and cycle of care(for condition-based bundles)or the primary care patient segment(for a primary care capita

146、tion).The scope will also include the timing and geography to be included in the payment model.For example,instead of a bundle for“knee replacement”,the bundle could be for“severe knee pain with osteoarthritis”.2.Stakeholders:Assign an accountable entity responsible for taking on the risk of deliver

147、ing outcomes within the value-based payment model.The Moment of Truth for Healthcare Spending183.Patient population:Define the patient population,appropriate inclusion criteria and risk adjustment,including socioeconomic drivers of health.4.Outcomes measures:Define the minimum set of outcome measure

148、s and/or quality metrics used for contracting.Value-based payments are ideally tied to achieving patient outcomes targets or patient experience metrics.5.Warranty:Specify the warranty and terms of risk/value sharing.6.Price setting:Determine the price and how the payout occurs with risk stratificati

149、on and cohort selection.Key success factors:Experienced organizations shared success factors in the design stage.1.Ensure there are tools in place for compliant data sharing across organizations.2.Establish capabilities internally regarding:a.Collaboration skills:it takes time and headspace to work

150、through the design elements with partner organizations,which may require negotiation and coalition-building skills.b.Outcomes measurement:collecting,measuring,and uploading patient outcomes data will be necessary.c.Complex data analytics:to arrive at the payment,the organization will need skills in

151、cleaning data,risk adjustment,translation of outcomes and compliant data sharing.i.Providers often discuss their lack of capabilities to complete the analytics required for new payment models.The Hospital for Special Surgery(HSS),headquartered in New York City with multiple care points on the US Eas

152、t Coast,is a leading medical system focused on musculoskeletal health.While participating in the Bundles Payment for Care Improvement(BPCI)model 2 and subsequently the Comprehensive Care for Joint Replacement(CJR)model,HSS successfully implemented a bundled payment programme for lower extremity tota

153、l joint replacement that demonstrated net savings for CMS in the US of an estimated$23.9 million,with impacts to quality of care.As voluntary participants,HSS had access to the 90-day CMS claims data from patients who had undergone a lower extremity joint replacement to track outcomes and use.Withou

154、t the transparency to claims data,HSS had little visibility into the patient experience post-discharge but now recognize that 40%of the costs were incurred post-discharge.Within the bundled payment programme,HSS developed an episode of care that mapped the patient pathway programme with a multidisci

155、plinary team and included new pathway components like a new role for physical therapists to track the patients post-discharge.The programme created direct savings and decreased the intensity of post-acute care services.CASE STUDY 7How data transparency enabled robust patient pathway design for the H

156、ospital for Special Surgerys value-based payment modelThe Moment of Truth for Healthcare Spending19Between 2018 and 2022,Novartis sought to market three of the first ex-and in-vivo gene therapies.The treatments are unique in that they bring value over a patients lifetime,but payers globally manage y

157、early budgets.Novartis sought to establish the value of the treatments with multiple methodologies to ascribe appropriate value,then held early value discussions with stakeholders.These early connections were key given the unique value situation of the products.For one of these therapies,for example

158、,Novartis had early collaborations with the Institute for Clinical and Economic Review(ICER)in the US and Health Technology Assessment(HTA)bodies elsewhere,like the National Institute for Health and Care Excellence(NICE)in the UK,to help develop the right value assessment approach.They held value co

159、nversations that enabled a strong understanding of payer needs related to the specifics of evidence generation and payment models.Internally,close connections with financial teams to run payment model risk evaluations proved beneficial.CASE STUDY 8How Novartis used early engagement in the design pro

160、cess Stage 4:ImplementObjective:Implement a value-based payment model that incentivizes behaviours that drive value for patients through improved outcomes at the lowest appropriate resource use while recognizing the need for investment in people,communication and capabilities during the transition s

161、tage.Challenges:Challenges during the implementation stage across case examples included legal and regulatory variability across countries.The legal and regulatory landscape must be well-understood,and the processes,in some cases,must be tailored for each country.From the outcomes standpoint,a key c

162、hallenge is motivating providers(clinicians and organizations)to change behaviours,measuring and analysing outcomes,adapting care delivery to what works best,and focusing on value over volume.Often,incentives arent seen as strong enough to drive change.Remaining with the status quo would need to be

163、made less attractive.The most robust designs include strong incentivizes to encourage behaviour changes.Key considerations:Multiple key considerations were discussed for the implement stage to ensure successful model launch and execution:1.Change management:Changing systems,processes and,above all,c

164、are practices is hard and specific attention needs to be given to keep all stakeholders engaged on the rationale for change.It is also important to create an understanding across partners that the agreement could change over time depending on the assessment of its impact and effects.Additionally,emp

165、loyee turnover is likely across organizations implementing value-based payment models,so it is key to establish strong change management practices to ensure continuity.2.External expertise:External third-party organizations can provide great encouragement in areas of implementation where out sourcin

166、g their expertise and experience is easier than building it in-house.These skills,capabilities and resources from third parties can help accelerate adoption.For example,expert digital companies and consultants specialize in facilitating the contracting life cycle and collecting claims data to run an

167、alytic modelling and reconciliation for value-based payment models.3.Impact assessment and follow-up:During the implementation phase,unintended consequences for the health systems and patients are detected early.Unintended consequences can include risk adjustment issues,such as overly wide risk stra

168、tification that can lead to avoiding higher-risk patients within a strata(“cherry picking”)or claiming a patient is at higher risk for larger payments(“upcoding”).These consequences often speak to the importance of the design stage and creating a payment model that is built around the needs of the p

169、atient segment that it is serving and incorporates key considerations of risk for that population.4.Auditing model:It is important to incorporate an auditing model into the implementation stage to remove any desire to use inappropriate coding or risk score growth.The penalty for falsification of ris

170、k adjustment should discourage the behaviour,for example,financial penalties or public disclosures.Key success factors:Experienced organizations shared three key success factors for the implement stage.1.Provide visibility of outcomes data to stakeholders involved in the payment models to facilitate

171、 the payment reconciliation and to providers to self-monitor and inform their decisions.The Moment of Truth for Healthcare Spending202.Spend time educating clinical staff to optimize interventions for better outcomes and ensure change to care delivery approach.See the example from Philips and Holsto

172、n Valley Medical Center in case study 9.3.Establish capabilities internally regarding:a.Payment reconciliation:to execute and reconcile the payment model,the organization must quickly collect and analyse data and organize financials.b.Change management:it is important to have capabilities to manage

173、internal and external stakeholder fears to combat the tendency to remain with the status quo.c.Audit capabilities:during the implement phase,it is critical to have the capability to manage financial flow between stakeholders for the payment model accurately and audit risk indications.Philips IGT sou

174、ght to partner with a forward-thinking,data-driven organization that implemented technology and medical devices but might be underusing them.Philips manufactures an optical imaging intravascular ultrasound(IVUS)and the diagnostic instant wave-free ratio(iFR),both of which have clinical evidence enab

175、ling better outcomes but are underused.Philips engaged with Holston Valley Medical Center in Tennessee to pilot a risk-sharing programme that assessed the clinical and quality outcomes of real-world use of these two products.By partnering,Philips was looking to extend device performance to impact ke

176、y outcome metrics through value-based risk sharing.Philips created buy-in to enable optimized use of their devices and provided data insights on the provider outcomes.The partnership created an environment to effectively implement the devices into relevant procedures and extend their performance.The

177、 healthcare delivery organization improved outcomes,including a reduction in revascularizations(zero with iFR/IVUS patients),reduced procedure supply costs by$99,393,increased same-day discharge by 12.5%and lowered acute kidney injury rate.Discovery Health is a South African-founded financial servic

178、es organization.Their mission is to make people healthier and enhance and protect their lives.Discovery is committed to funding differently in healthcare,resulting in years of investment into alternative value-driven contracts.While Discovery Health has value-based payments across conditions,includi

179、ng arthroplasty and diabetes,they have also implemented a primary care value-based multiplier to improve quality outcomes and cost efficiency.They set up and implemented a multiple payment system for their general practitioners(GPs)in primary care.When providers met certain criteria,including digita

180、l engagement,cost-efficiency and value-based score expectations,they received a percentage increase in remuneration.While the return on investments were high,the shift in quality was less tangible,perhaps due to the only 8.2%of GP practices receiving enhanced payments or outcomes selection.Discovery

181、 Health has updated and incorporated additional tools and funding to support efforts by GPs to enhance quality outcomes in the primary care setting.CASE STUDY 9How Philips and Ballad-CVA Heart Institute used change management and clinical education to drive successCASE STUDY 10How Discovery Health u

182、ses continuous learning and iterationThe Moment of Truth for Healthcare Spending21PharmAccess launched MomCare in 2017 to address the 200,000 deaths that resulted from pregnancy-related complications in sub-Saharan Africa.MomCare is a value-based healthcare initiative that incorporates three dimensi

183、ons of care:mobile health wallets that entitle women to care,support for improving quality according to SafeCare standards and transparency on the value of care.MomCare uses the mobile technology already in place in Kenya and Tanzania to communicate with patients,combining claims data,SMS surveys an

184、d data from calls.Through the surveys and data collection,MomCare can track user behaviour,well-being,care experience and outcomes during the journey,as well as risk mitigation by providers.The clinics enrol women,who then get a digital wallet(M-TIBA in Kenya)that they use for each visit.The digital

185、 wallet entitles them to a care bundle encompassing the entire pregnancy journey,including postnatal and neonatal care.This helps empower mothers and support continuous improvement.MomCare has been implemented in over 70 clinics across Tanzania and Kenya,supporting over 55,000 mothers.Providers them

186、selves actively engaged with data-based insights for quality improvements,actionable feedback and the pay-for-performance system.MomCare identified unmet needs like mental health support for(teenage)mothers or breastfeeding support and designed care activities accordingly.CASE STUDY 11How PharmAcces

187、s used existing technology to support implementationTakeda prepared in advance at a global level,a scalable framework for the launch of a new innovative treatment for Hereditary Angioedema(HAE)called Takhzyro.To do so,Takeda mapped the patient journey with global feedback from cross-functional teams

188、 such as finance,patient advocacy,legal,access,health economics,etc.Takeda then developed a detailed playbook for the affiliates that supported the design,implementation and addressed the individual countrys healthcare systems uncertainties.Designing the framework up front for multiple health system

189、s empowered the country teams to engage earlier with the proper tools and data required to address their potential uncertainties around the value of Takhzyro.Takedas framework brought rigour to the payment model,allowing Takhzyro to achieve broad access in 27 countries three years post-launch.CASE S

190、TUDY 12How Takeda prepared to scale value-based payment models implementationStage 5:ScaleThis stage aims to scale value-based payments across larger geographies,patient segments and conditions.While there havent yet been many examples of significant national scaling-up of value-based payment models

191、 around the world,some providers have scaled models within their practice setting,and some pharma and medtech companies have scaled models across countries.The learnings and sentiments are quite positive for those with experience.Having worked under a condition-based payment model for the past four

192、years,I really believe it is the way of the future for musculoskeletal care.A prospective annual payment for the full breadth of care for a given condition allows the patient and provider to work together towards better health rather than primarily anchoring reimbursement to sick care and procedures

193、.It puts the treatment decision into a more appropriate context and allows financial incentives to be much more aligned with overall patient health.Karl Koenig,Orthopaedic Surgeon and Clinical Director,Lower Extremity Integrated Practice Unit,UT Health AustinThe Moment of Truth for Healthcare Spendi

194、ng22Medtronics Integrated Health Solutions(IHS),a business unit offering innovative services and solutions to healthcare providers,partnered with Maastricht University Medical Centre+(MUMC+)to implement patient-centric care delivery model.This example illustrates an improvement in the care pathway t

195、o treat patients with cardiac resynchronization therapy(CRT).The novel multi-disciplinary nurse-led pathway was implemented for CRT and resulted in a significant reduction of the combination of all-cause mortality and heart failure hospitalizations at reduced costs.The key to scaling was creating an

196、d using a value-based healthcare dashboard that enables patient stratification combined with real-time measurement of outcomes,processes and costs to allow for continuous improvement,better decision-making and facilitate potential novel payment models with payers.This framework was developed in the

197、Heart and Vascular Center and is currently being deployed and scaled across numerous medical conditions at MUMC+.This public-private collaboration illustrated how a supplier can take an active role in long-term partnerships that hinge on risk and value-sharing schemes.CASE STUDY 13How Medtronic and

198、Maastricht University Medical Centre+deploy a data-driven approach to improve patient outcomes further We have designed a model to actually translate the value-based healthcare theory into practice.Michael Jacobs,Professor of Surgery,Department of Vascular Surgery and Chief and Executive Director,He

199、art and Vascular Center,Maastricht University Medical Centre+The Moment of Truth for Healthcare Spending23Barriers to adoption and scaling of value-based payments4The barriers that prevent system-wide adoption and scale-up include investment hurdles and current ways of working in our healthcare syst

200、ems.The Moment of Truth for Healthcare Spending24Several barriers constitute the constraints of implementation and scale-up of value-based payment models across countries and healthcare systems,which remain largely chained to the current framework.Thus,it is important to identify them to raise aware

201、ness of the challenges organizations committed to value-based payments will likely face so that they can be better prepared to invest time,attention and capital to overcome them.Additionally,identifying current system-level barriers helps policy-makers,governments and educators work on developing so

202、lutions for them.This is because payments are one of many enablers that should be addressed concurrently to pave the way for value-based healthcare.As in any pervasive structural transformation,the investment hurdle is considerable,requiring organizations to devote significant resources,including ti

203、me and monetary resources.Most benefits of value-based healthcare likely realize only in the medium-long term.There hasnt yet been enough dissemination of value-creation data to make appropriate predictions for organizations to assess the impact of the payment model.Thus,their willingness to engage

204、in transformational initiatives and experiments can be limited.These barriers contribute to further resistance to change by creating a sense of hesitancy across healthcare systems and stakeholders when progressing towards a value-based payment system.Chapter 5 suggests system-level recommendations t

205、o address these barriers.Summary of barriers to systemwide adoption and scaleFIGURE 4Barriers to investmentBarriers across key levers1.Near-term financial hurdles Investment hurdlesAny sizeable change requires money,time,management,attention and a high-level commitment to the long-term vision.Resour

206、ce-constrained environments limit the bandwidth and willingness to engage in deep transformation initiatives,especially for smaller and underfunded institutions.Challenging hybrid stageThe transition between two equilibria often involves transitioning through a hybrid period.During the transition ph

207、ase of change,provider organizations need to continue to deliver care while at the same time changing their delivery model and related payments.These additional demands on the system introduce affordability issues and complicate the prioritization of activities competing for the same constrained set

208、 of resources.The coexistence of multiple payment models can raise unusual administrative issues in billing and collection activities.1.Near-term financial constraintsFinancial investment hurdleChallenging hybrid stageThe current system is lucrative4.PolicyRigid reimbursement systemsLimited politica

209、l willpowerStakeholders creating complexity5.Delivery organizationFragmented care delivery Mistrust between stakeholdersHidden financial interdependencies Inconsistent outcomes measures Variation across payment models6.ToolsMisunderstanding of the term“value”Limited awareness of shared evidence and

210、impactClinician training7.Informatics Inconsistent data collectionLimited data exchange and transparencyLack of funding Difficulty aligning on prioritiesEvolving regulation2.Short-term focusShort-term cost focus rather than patient outcomesInconsistent time horizons3.Resistance to changeRisk and per

211、ceived risk Unclear rationale As in any pervasive structural transformation,the investment hurdle is considerable,requiring organizations to devote significant resources,including time and monetary resources.The Moment of Truth for Healthcare Spending25The current system is lucrativeOrganizations ha

212、ve learned to work with the current system in a way that provides sufficient aggregate revenue to cover aggregate costs.Thus,despite the best intentions,making a change that could impact financial sustainability,albeit only in the short term,may appear to be an irrational organizational decision.2.S

213、hort-term focusShort-term cost-focus rather than patient outcomesThe widespread pressure to contain the growth in healthcare delivery costs has led to the implementation of short-term cost-controlling measures in attempts to regain control over healthcare spend.Governments,procurers,payers and purch

214、asers prioritize curbing the cost curve over planning the transition to a more sustainable healthcare system.Value-based delivery models often require sizeable upfront investments,which could appear as cost-increasing initiatives,but will provide the longer-term benefits of improved costs and patien

215、t outcomes.To motivate upfront investments,payers,purchasers and providers must be focused on the long-term and require standardized outcome measurement to be included in value-based payment models.Inconsistent time horizonsThe time horizon to capture the benefits of value-based healthcare is incons

216、istent across stakeholders.Payers often manage yearly budgets,but patient outcomes could take longer than one year to improve,depending on the patients condition.Care delivery is fragmented,so provider time horizons vary depending on the portion of the care cycle in which they participate.This disco

217、nnect leads to misalignment between the investment made by each stakeholder and the benefits they receive from that investment(for example,the stakeholder providing an upfront investment may not be the same stakeholder that receives the benefit from that investment).This is often a concern for the U

218、S,where patients change payers as they change employers or age into Medicare.3.Resistance to changeRisk and perceived riskOrganizations fear the new business models because they are unknown.Some question their organizations relevance in the future state,the profitability of new payment models and th

219、e value they can provide across the care pathway.Unclear rationale Many organizations are also unsure how the change to value-based payment models will impact their needs and the needs of other stakeholders(regulators,policy stakeholders and providers).4.Policy Rigid reimbursement systemsCurrent rei

220、mbursement mechanisms offer limited flexibility for alternative payment models.Legacy systems have many interlinked processes.The rigidity of these systems can make even small-scale changes difficult.The variation in processes,tools and care cycle timelines across disease areas introduces additional

221、 complications in transitioning to value-based payments.This added burden can demotivate stakeholders from adopting even smaller changes.Thus,stepwise change could be more burdensome than a comprehensive value-based payment makeover.Limited political willpower In some countries,there is political re

222、sistance to introducing sweeping changes in the healthcare system given the potential to affect the constituents that political leaders serve.Additionally,priorities may vary across political terms,thus impacting movement and momentum,further supporting a short-term view and introducing uncertainty

223、among stakeholders.Policy is a key driver of payment model change,yet political leaders still need to enact and communicate its urgency.Though healthcare is frequently discussed in political conversations,policy leaders rarely provide clear direction on a way forward,especially when enabling a focus

224、 on value.Stakeholders creating complexityMost organizations across countries in the community indicated that challenges remain with the regulatory and policy landscape.Even where there is political willpower to address healthcare system issues,well-intentioned regulators and policy stakeholders oft

225、en have a limited understanding of ways to accelerate desired change.For example,in some countries,laws designed to prevent collusion in the current system hinder the ability of stakeholders to get financially rewarded for their contributions to shared processes that improve patient outcomes.Policy

226、is a key driver of payment model change,yet political leaders still need to enact and communicate its urgency.The Moment of Truth for Healthcare Spending265.Delivery organizationFragmented care deliveryBecause the current payment model does not incentivize care integration,payment model reform is re

227、quired.Without a push for integrated care,it is much easier to remain in current payment models where each clinician bills for individual care services.The current system lends itself to change paralysis.Mistrust between stakeholdersValue-based payments need to allow for the coordination and alignme

228、nt of different stakeholder perspectives.This contributes to the misalignment of goals and objectives.In the absence of a unifying principle across the care pathway,stakeholders might be less incentivized to collaborate and share information and data across organizations.Hidden financial interdepend

229、enciesThe current payment system embeds many financial interdependencies within and across stakeholders that hinder change.Most pointedly,as described in ongoing work by Susanna Gallani and Mary Witkowski at Harvard Business School,from the provider side,cross-subsidization across organizational uni

230、ts,payers,patients and processes within the care pathway causes concerns that lowering payments for some services could impact the ability to fund other services.These interdependencies make it hard to unwind from current payment models.Inconsistent outcomes measuresPatient outcomes data is vital fo

231、r measuring the value and impact of care for patients.Across value-based payment models already in practice today,organizations defining outcomes to measure may select multiple sets across payment models.Many factors impact the selection of outcome measures.One factor is that stakeholders tend to ch

232、oose metrics that show their performance in the best light,but these are not always the right measures to evaluate patient well-being.Variation across payment modelsScale-up of value-based payment models is possible.However,one of the biggest challenges in scaling is the need to customize each payme

233、nt model with each partner.This adds to the burden both in terms of design and implementation.For example,if a medtech company is looking to scale-up value-based payment models with providers in the US,they could have thousands of unique payment models to design,implement and maintain.This could pro

234、ve to be unsustainable for many organizations.6.ToolsMisunderstanding of the term“value”When discussing value in healthcare,many comment that each stakeholder could have a different definition of value.However,value should be universally defined as the health outcomes that matter to patients relativ

235、e to the resources or costs required to deliver those outcomes.A shared definition of value contributes to aligning different stakeholders in the industry by setting shared objectives.Limited awareness of shared evidence and impactThe lack of information and shared understanding of value-based healt

236、hcare creates a barrier to widespread adoption.Many organizations feel there needs to be more information exchange about successful models,their impact and their return on investment.Sharing evidence of successful implementations,best practices and lessons learned can encourage others to engage in s

237、imilar transformations.Clinician trainingEducational curricula for clinicians training rarely include information about value-based healthcare.Consequently,new physicians are more likely to follow traditional care delivery models rooted in the current norms,making it harder to change clinicians mind

238、sets and facilitate their adaptation to a new system.Sharing evidence of successful implementations,best practices and lessons learned can encourage others to engage in similar transformations.The Moment of Truth for Healthcare Spending277.InformaticsInconsistent data collectionOutcomes data is not

239、often collected,but when it is,it is frequently inconsistent over time,across countries,within countries and even across providers.Inconsistent data collection,processes,systems and data sharing make it difficult to assess outcomes meaningfully.The lack of comparability impedes the evaluation of suc

240、cessful initiatives and care models and the consequent sharing of best practices.Limited data exchange and transparencyWhile healthcare organizations collect data,this is done in isolation.Absent exchange and transparency make it hard to draw conclusions about where value is created or wasted along

241、the care delivery pathway.Difficulty aligning prioritiesWhen partner organizations work together to implement value-based payment models,a key obstacle is aligning stakeholders in building a singular data platform to meet all stakeholder needs.Evolving data management regulation Data sharing and int

242、eroperability regulation(e.g.data privacy legislation)is continuously evolving and not always in a direction that facilitates outcomes data sharing.This introduces uncertainty for stakeholders looking to implement and scale data-sharing solutions.The Moment of Truth for Healthcare Spending28Recommen

243、dations to drive payment change5Healthcare system transformation will enable investments to be spent on what works best for patients.The Moment of Truth for Healthcare Spending29The move to value-based payments is not an incremental one but rather disruptive in the ways healthcare delivery must be o

244、rganized,measured,rewarded and paid.In the old marketplace,the product was“treatment”and the measure was“volume”.In the new marketplace the product is“health”and the measure is“value”.12 Healthcare systems that engaged in the implementation of value-based healthcare and payment have begun to experie

245、nce the benefits of the transformation and are not turning back.The future marketplace must enable three overarching principles:1.The healthcare system must meet the needs of all patients.2.It must demand the measurement of patient outcomes.3.The system must organize around groups of patients with s

246、hared needs and drive integrated care delivery.To drive payment change,all stakeholders must come to the table committed to progress (see Figure 5).Recommendations to address barriersThe major barriers to system-wide adoption and scale-up of value-based payment models make clear that to catalyse cha

247、nge the recommended solutions would need to create:Transparency of outcomes and payments Policy direction Education Greater standardization of outcome measurement and value-based payment models.Summary of barriers and recommendationsFIGURE 5Transparency of outcomes and paymentsNear-term financial hu

248、rdlesShort-term focusResistance to changePolicyDelivery organizationToolsInformaticsNational-level scorecardsTools for connected data flow and transparencyPolicy reform ideasExample and case disseminationClinician education to empowerFunder influenceNational healthcare spend assessmentPolicy landsca

249、pe assessmentAwareness campaignCollaborative approach for standard rules on embedding value-based transformationStandardize outcomes measures across countriesStandard payment model elements nationallyAccreditation agency requirements for value-based healthcarePolicy directionEducationStandardization

250、 of outcomes and payments In the old marketplace,the product was“treatment”and the measure was“volume”.In the new marketplace the product is“health”and the measure is“value”.The Moment of Truth for Healthcare Spending30Transparency of outcomes and payments:1 National-level scorecards Objective:Creat

251、e shared learning,competition and motivation to continue the value-based healthcare journey with national transparency of patient outcomes and system metrics to shift the focus from cost as a percentage of gross domestic product(GDP)to outcomes and value delivered.Rationale:A national-level scorecar

252、d would provide macro-level outcomes and metrics and help countries identify their improvement areas for value and create comparisons across countries across these metrics.Recommendations:Modelled based on national disease registries,it is recommended to create national-level scorecards for collecti

253、ng summative data on value-based healthcare metrics,including patient outcomes and system metrics.The scorecard could include performance in outcomes that matter to patients for priority conditions.The metrics should come from a range of conditions often represented across countries.The scorecard sh

254、ould also include system-level metrics to evaluate the movement towards more patient-centred value-based care,like the percentage of value-based payments versus activity-based payments,mandatory reporting of outcomes,shared decision-making,tracking of social drivers of health,maturity of data connec

255、tivity,and others.These scorecards could be especially influential if owned by an organization like the World Health Organization,which has significant reach worldwide and already develops country-level health reports through the Global Health Observatory.Patient registries have been created around

256、the world to measure patient outcomes for specific diseases at the national level,e.g.the Cystic Fibrosis patient registry in the US or the Dutch Institute for Clinical Auditing in the Netherlands.Though these scorecards need to be built for measures that are most meaningful to patients and nations

257、holistically,they can be modelled on a few prominent registry examples.It is recommended to create national-level scorecards for collecting summative data on value-based healthcare metrics,including patient outcomes and system metrics.2 Tools for connected data flow and transparencyObjective:Enable

258、national-level development tools that create data interoperability and transparency.Rationale:Several national and regional e-Health strategies have been implemented globally over the past decade to enable connected data flow.However,fragmentation continues,given insufficient levels of investment in

259、 key infrastructure,proprietary standards,coordination between authorities and the weight of legacy systems.Recommendations:Two approaches are recommended:1.Public-private partnerships at the national level should meet to assess the landscape,requirements and drivers for a national informatics syste

260、m.This should include discussions around the objectives of a tool to enable data flow and transparency,operating guidelines,legal,regulatory and policy barriers,and the other organizations that need to be involved.2.The national government should hold full responsibility and leadership for establish

261、ing an integrated health information system across the country that adheres to the FAIR principles,which means that all relevant data including healthcare data as well as public health data and social care data are findable,accessible,interoperable and reusable.CASE STUDY 14Patient registries The Mo

262、ment of Truth for Healthcare Spending313 National healthcare spend assessmentObjective:Highlight how healthcare spend is being allocated today to identify areas of underinvestment in certain conditions and patient populations to better inform solutions and priorities.Rationale:If stakeholders had ac

263、cess to detailed spend metrics across national healthcare systems,this could motivate action when seeing where problems lie and where spend is inequitable.Recommendation:Create a national healthcare spend assessment that can be compared internationally with greater detail than healthcare spend as a

264、percentage of GDP,including a breakdown of the total spend on healthcare across two measures:the type of expense(labour,facilities,etc.)and the type of care(preventative,acute,etc.).Policy direction4 Policy landscape assessmentObjective:Arm policy stakeholders with policies across countries that hav

265、e enabled the spread of value-based payment models.Rationale:Value-based payments go beyond the healthcare sector.Healthy citizens impact the economy,workforce and healthcare payments,so there are financial sector impacts as well.The policy conversation is therefore crucial because healthcare and fi

266、nancial policies have meaningful impact on behaviour.Recommendation:Complete a policy assessment to identify policies that enable value-based payment models across geographies that will allow countries to understand how to create a meaningful impact on value-based payment model acceleration.The OECD

267、 is an international organization with a mission to create better policies for better lives.The OECD has published multiple reports referenced by the community specifically around payment systems in health.The OECD seeks to help countries measure health outcomes,use health resources and analyse poli

268、cies.CASE STUDY 16The OECDIn January 2021,the Ministry of Health,Welfare and Sport of the Netherlands commissioned the Organisation for Economic Co-operation and Development(OECD)to gather evidence and recommend legal,policy and organizational reforms to transform the existing arrangements into an i

269、ntegrated information system that supports the government in achieving their goals.To understand the strengths and weaknesses of the current health information system and to develop recommendations,the OECD,through a series of focus groups and interviews,consulted national experts from academia,busi

270、ness and government regarding the Netherlands health information system from January to March of 2021.The information gathered through consultations with experts was complemented with information on the Netherlands and other OECD countries through the OECDs regular programme of monitoring countries

271、health information systems.CASE STUDY 15The Organisation for Economic Co-operation and Developments integrated information system5 Policy reform ideasObjective:Engage policy-makers to motivate the simple act of collecting valuable health data,to help understand where value is being created and then

272、use it to enable better outcomes for their citizens and solve the rising healthcare costs.Rationale:Though a policy assessment is still needed,policy levers have been recommended by multiple organizations within the community.Additionally,there is an interesting overlap with existing policy imperati

273、ves,like environmental,social and governance(ESG),for which value-based healthcare and value-based payment policies could reinforce the responsible use of resources and equity.This makes for impactful,joint policy solutions,as seen in the NHS metrics and targets on carbon footprint,waste reduction a

274、nd recyclability.The Moment of Truth for Healthcare Spending32 There is a huge opportunity to create change by policy-makers requiring outcomes collection.The German government played a crucial role in incentivizing performance-based payments by introducing“quality contracts”in 2018,in which health

275、insurers and hospitals could agree on additional payments outside the rigid DRG system.In 2021,the German legislature went one step further and stipulated a minimum budget that health insurers had to spend on quality contracts.Health insurers were to allocate funds to quality-centred care and closel

276、y monitor individual treatment paths.To improve the value for patients and increase the incentives for healthcare providers to integrate PROs into clinical practice,German Heartbeat Medical,a Berlin-based tech company,developed a new value-based payment framework that combined PRO-monitoring with an

277、 outcome-based payment.CASE STUDY 17German Heartbeat MedicalRecommendations:Consider policy recommendations that could address barriers to system-wide adoption and scale-up,including:1.National mandates for collecting and processing outcomes measures:There is a huge opportunity to create change by p

278、olicy-makers requiring outcomes collection.The ability to review outcomes data and assess patient impact will help direct providers,payers,pharma and medtech to solutions that create value.2.Establish health credits to manage inconsistent time horizons:One way to combat the inconsistent time horizon

279、 barrier is to have policy-makers establish government-level health credits.Health credits could incentivize payer investment in value by ensuring a payer receives a return on investment.This could be particularly useful in a country like the US,where there is a multi-payer system,and the payer inve

280、sting in the treatment may not be the payer benefiting from avoided long-term costs.6 Funder influence Objective:Use the influence of funders(governments,private insurance companies,non-profits payers and other purchasers of care)to create progress against chains to the current system.Rationale:Fund

281、ers can impact transformation through legislation and policy reform.Policy and funders are often connected,and policy pieces often need to be in place for funders to create impact or vice versa.Recommendations:Funders should use their influence to enable value-based payment models.1.Create incentive

282、s to make the current activity-based payment models less attractive and value-based payment models less risky,potentially by introducing tax waivers or financial incentives to implement or participate in government value-based payment model programmes.2.Create incentives for providers with limited f

283、unding to invest in value-based healthcare infrastructure by offering funding for:a.Areas of healthcare that are often underinvested in by payers,like mental health.b.Collection of outcomes data,as well as race and ethnicity data,to help models address health equity.The Moment of Truth for Healthcar

284、e Spending33CMMI recently launched the ACO REACH model to advance equity through value-based payment.Using a“health equity benchmark”creates proportional funding for organizations to create upfront investments in infrastructure to help redesign care delivery models and services.The CMMI model is ess

285、entially helping to create funding for these typically underfunded providers to manage the upfront investment costs,which is especially important as they serve the more vulnerable communities.13The Health Outcomes Observatory Project(H2O)seeks to create a standardized data governance and infrastruct

286、ure system that incorporates patient experience and preferences data to inform care decisions,enhanced health research,promote the development of new treatments and sustain efficient healthcare systems.The observatories collect data across patients and analyse and share evidence in Europe for health

287、 decisions.They guard data on patients behalf,facilitate interoperability and promote the benefit of using patient outcomes.143.Set an example that motivates other payers/providers nationally:The funder and government initiatives create energy behind efforts and encourage others to attempt similar i

288、nitiatives by creating the“rules of the game”.Depending on the market situation,government payers or regulators could implement or encourage the following:a.Longer-term agreements with providers,pharma or medtech to manage the longer timeframes required to measure outcomes to tie to payment models,w

289、ith governments informing the best way to set multi-year agreement terms.b.Scaled value-based payment model implementation at the national level.CASE STUDY 18CCMIs ACO REACH modelCASE STUDY 19Health Outcomes Observatory Project(H2O)Education7 Awareness campaign Objective:Create informed purchasers o

290、f healthcare,including the public,providers and funders.Rationale:A public awareness campaign could serve many purposes.First,the public is both the patient and the ultimate payer,who should be an informed purchaser of healthcare.Additionally,awareness of outcome variability can create better decisi

291、on-making between patients and their providers.Recommendation:Evaluate a public awareness campaign for value-based healthcare and its impacts and barriers.The campaign could focus on driving awareness around the variability of quality and patient outcomes,disparities in those outcomes,prices being s

292、et,failures of the existing payment model and the advantages and challenges of moving to a value-based system.8 Examples and case disseminationObjective:Motivate more implementation of value-based payment models by sharing examples that work and creating widespread awareness.Rationale:Value-based pa

293、yments have been widely piloted globally,yet the insights gained have been shared minimally.Organizations looking to launch a value-based payment programme or grow an existing programme need evidence and examples to help make good strategic and financial decisions.Recommendation:These examples shoul

294、d include the evidence of success,key learnings,identification of challenges,impact on patient outcomes,financial implications and opportunity costs of not changing.The Moment of Truth for Healthcare Spending34The World Economic Forums Global Coalition for Value in Healthcare established Global Inno

295、vation Hubs to bring together organizations with best-in-class examples of successful implementation of value-based healthcare and shared learnings and experiences.Some educational entities are already beginning to incorporate value-based healthcare in the medical school curriculum.Many medical scho

296、ols offer MD-MBAs for those clinicians wanting to focus on management issues in which a value-based healthcare curriculum should be a key part.Harvard Business School partners with Harvard Medical School to provide education in value-based healthcare as a part of the required curriculum for medical

297、students so that a broader portion of the class has exposure to teaching value-based healthcare.9 Clinician education to empower Objective:Ensure that the next generations of clinicians are not demotivated by the barriers to value-based payment models but rather energized by their potential through

298、their curriculum.Rationale:Physicians are rarely given any training in value-based healthcare.For physicians to take leadership roles in organizations and the clinical delivery system,they need education and skill development in this area.Recommendation:Ensure that any clinician education curriculum

299、 includes courses related to value-based healthcare delivery and payment models,their impact,implementation and the importance of measuring outcomes.This education could occur during medical training with a course curriculum or as a part of continuing education.CASE STUDY 21Harvard Business School a

300、nd Harvard Medical SchoolCASE STUDY 20Global Coalition for Value in Healthcares Global Innovation HubsThe Moment of Truth for Healthcare Spending35Standardization of outcomes and payments10 Collaborative approach for standard rules on embedding value-based transformationObjective:Bringing together a

301、 group dedicated to working towards transformational change in the value-based payment work,such as enabling the best price-to-value ratio methodology for healthcare procurement.Rationale:The association can seek to progress other recommendations within this report and connect people and organizatio

302、ns to share best practices and learnings.For example,in Europe and beyond,medical supplies,technologies and drugs used by publicly funded providers must go through formal,competitive tender processes.Procuring on standardized value considerations allows for the most economically advantageous purchas

303、ing and,therefore,spending of public money.Recommendation:Establish an international consortium of public and private bodies to continue progressing on value-based payment model change.This collaborative partnership can also encourage public procurement processes to embed standardized and measurable

304、 value criteria specifically on outcomes that matter to patients as well as the total cost of ownership considerations in public tenders.The Value-based Procurement Community of Practice(VBP CoP)in Europe brings together suppliers,providers,payers,procurement networks and policy-makers to encourage

305、value-based procurement.The community has developed a standardized value model,training materials and best practice examples,which are shared in regular meetings and conferences and have helped build significant momentum on value-based procurement implementation.The International Consortium for Heal

306、th Outcomes Measurement(ICHOM)publishes the most comprehensive standardized metrics and risk-adjustment variables for 40 major conditions and patient populations.The organizations standard aims to define a comprehensive but minimally sufficient set of metrics that all providers should track for a gi

307、ven condition.11 Standard outcomes measures across countries Objective:Create consistency of outcome measures sets used across countries.Rationale:Implementing standard measures will help ensure comparison and analysis of health interventions worldwide,while reducing the burden of selecting outcome

308、measures to use in payment models.Ensuring that outcome measures are available can help remove the conversation from price and costs and focus the conversation on value.Recommendation:Governments and organizations should use consistent,internationally recognized outcome measures.CASE STUDY 22The Val

309、ue-based Procurement Community of PracticeCASE STUDY 23The International Consortium for Health Outcomes MeasurementsThe Moment of Truth for Healthcare Spending3612 Standard payment model elements nationally Objective:Create consistency of payment model elements.Rationale:Payment model element consis

310、tency will reduce the burden of design,implementation and scale of multiple value-based payment models within an organization.Recommendation:Governments or national payers could develop and standardize payment model elements nationally at the pre-competitive level.This means they could create a set

311、of consistency elements of payment models to create less variability.Competitive dynamics would continue at the next level down for those providers to compete based on their ability to create better outcomes at the same or lower costs.13 Accreditation requirements for value-based healthcare Objectiv

312、e:Standardize outcomes measurement expectations at the provider level through accreditation or certification.Rationale:Accreditation bodies are a valuable lever to encourage behaviour change among providers.Societies and accreditors also benefit from outcomes measures as they inform their clinical p

313、ractice guidelines.Recommendation:Engage accreditation bodies to consider implementing requirements that providers progress towards value-based healthcare for certification.The German Cancer Societys certification programme for prostate cancer centres requires outcomes measures for recertification.C

314、entres seeking to recertify must meet quality indicators reported to the public annually.Patient outcomes measurement in the recertification of speciality centres can help improve the capacity to collect and analyse outcomes data.CASE STUDY 24German Cancer SocietyThe Moment of Truth for Healthcare S

315、pending37ConclusionIt is the intention of this insight report to instill a sense of urgency across all stakeholders to change the way healthcare is delivered globally,to invest every healthcare dollar spent in what works best for the patient through the acceleration of the adoption of value-based pa

316、yment models.It is important to reemphasize the need for healthcare stakeholders to work together and find a common mission.As the Forum truly believes,change can only occur when everyone comes to the table together,as the many examples provided show how rewarding,motivating and above all impactful

317、such collaboration is.Many things need to transform concurrently for payment models to change,including the other four enablers of value-based care:tools,care delivery models,informatics and policies.While this report focused on ways to galvanize the adoption and scale-up of value-based payments to

318、progress the overall value-based healthcare agenda,it is hoped that it encourages efforts across all four enablers in the value in healthcare framework to truly catalyse a health transformation.The Forums Platform for Shaping the Future of Health and Healthcare has hosted the Global Coalition for Va

319、lue in Healthcare since its launch in 2019 under the auspices of the Forums Annual Meeting.For more information,visit the Global Coalition for Value in Healthcare website.For more information contact:Yasmin Dias Guichot,Lead,Healthcare Systems Transformation at:yasmin.diasguichotweforum.org.The Mome

320、nt of Truth for Healthcare Spending38AppendixCASE STUDY 25MomCare,Kenya The MomCare mobile health wallet facilitates journey tracking at each step through claims data,SMS surveys and phone calls,resulting in value-based and bundled payments as well as actionable insights and benchmarking information

321、 for providers.SMS reminders are sent to mothers for their appointments alongside birth planning calls.Outcomes focus:Percentage increase of adherence to timely care Percentage of risk mitigation expressed as journey score on a 1-5 scale Equitable care access(teenage and high-risk mothers)Percentage

322、 of maternal and neonatal morbidity and mortalityCost of care focus:The total cost of care per mother for the entire pregnancy journey stratified by risk and age Organization at a glance:PharmAccess is a foundation to make inclusive health markets work in Sub-Saharan Africa,addressing both supply an

323、d demand-side through public-private partnerships.Problem/challenge statement:In Sub-Saharan Africa,health outcomes for pregnancy remain poor,mostly from preventable causes.Despite rising care budgets,outcomes remain unacceptably poor.A root cause is the fragmentation of both funding streams and car

324、e provision.Mothers face a journey with many gaps and uncertainties both on the availability of care(e.g.stock-outs,ultrasound availability)and financial risks(e.g.it is often unclear if caesarean sections are fully covered).Consequently,they do not seek or receive sufficient care.Pathway scope:Preg

325、nancy journey including antenatal care(ANC)visits,delivery,postnatal care(PNC)visits and child immunizations.Product or service focus:Maternal and childcare.Population segment:Pregnant women and their newborns in Nairobi and Western Kenya.Background and starting pointContracting/solution life cycle

326、approachPregnancy journeyAntenatal care visitsPost-natal care visitsEnrolmentDeliveryImmunizationsMobile journey tracking(claims,SMS,calls)Value-based and bundled paymentsBonusThe Moment of Truth for Healthcare Spending39CASE STUDY 25 CONTINUEDMomCare,KenyaValue for organization:Quantitative(clinica

327、l and economic)16%increase in adherence to antenatal care visits for all mothers and a 25%increase for high-risk mothers.15%increase in antenatal care visits that have a full set of haemoglobin,syphilis,HIV,blood glucose,urine and tuberculosis tests.17%increase in completed pregnancy journeys (3 out

328、 of 5).37%decrease in journey costs for women who deliver through caesarean section.Qualitative(brand reputation)PharmAccess is recognized as a pioneer of value-based healthcare in Africa.Clinic reputation and collaboration(e.g.expanded local hospital and clinic network.Value for patients:Over 29,00

329、0 mothers in Kenya were given access to pregnancy care,including 10%of high-risk mothers.Mothers are empowered through increased awareness about delivery signs,perinatal danger signs,breastfeeding and appointment reminders.Early risk stratification improved care for high-risk mothers.Societal impact

330、:MomCare paved the way for a data-driven and patient-centred approach,using bundles and bonus payments combined with insights and clinical support to improve access to and quality of care.In addition to the direct impact listed above,MomCare serves as inspirational best practice of value-based healt

331、hcare in low-and middle-income countries.Goal:MomCare aims to improve maternal and neonatal health outcomes in Africa,by addressing the financing and quality of care over the full pregnancy journey.Involved stakeholders:Pregnant women,healthcare providers,social payers Funders:MSD for Mothers,the Ch

332、ildren Investment Fund Foundation,ELMA,National Postcode Lottery,St.Antonius Foundation,Health Connect Foundation Coverage:Entire pregnancy journey Payment type:Bundled per visit plus performance-based periodic value-conditional paymentsContextImpact generated and value createdThe Moment of Truth fo

333、r Healthcare Spending40CASE STUDY 26Takeda,Switzerland Model description:A framework tool has been designed to aid value-based contracting(VBC)selection and to support negotiations for Product X at launch.The framework model has been structured to allow countries a way to input data in order to simulate the comparison of different value-based contracts.Outcomes focus:Percentage of zero attacks in