Value Based Healthcare: Care innovation or care renovation?

Value-based healthcare is the buzzword in healthcare. Inspired by the ideas of Harvard professor Michael Porter, initiatives have also been launched in the Netherlands to achieve better healthcare outcomes per euro spent. A beautifuldevelopment. But is Value Based Healthcare (VBHC) the panacea for realising real healthcare efficiency? Or is it in its current form more of a pseudo-innovation, or renovation approach?

The hype of a pseudo-innovation

With the far-reaching economisation of health care, more attention has also been paid to management theories in recent years. But management concepts seem to be very trend-sensitive. Have we just mastered Lean Six Sigma, we already have to start working with VBHC. This is also referred to as pseudo-innovation:
Reinventing comparable ideas and methods every 3 to 5 years.
similar ideas and methods
using new words.
The consequence of ‘pseudo-innovation’ is that improvement initiatives are given insufficient time and opportunity to become truly embedded in practice. It either remains a managerial toy or worse: it leads to projecteritis on the work floor. Not the umpteenth improvement project… Research shows that an improvement method such as ‘Lean’ is often incompletely implemented. Often only a few principles are applied and afterwards people are disappointed that the desired goal has not been achieved. The embrace of a new management guru then ‘luckily’ offers a solution.

When the solution is the problem

VBHC and Triple Aim (better perceived quality of care, better health and lower per capita costs) are often mentioned in the same breath, yet they are two different views of how value can be created. VBHC is based on a disease-specific approach aimed at value-based competition, where value is defined as the health outcome achieved per euro spent. Compare this with the Triple Aim, which pursues a much broader people- and population-oriented approach. VBHC is mainly in vogue in secondary care, Triple Aim mainly in primary care.

No value creation without integration

In the discussion on VBHC and the Triple Aim, one thing is crystal clear: better care outcomes per euro spent can only be achieved through constructive collaboration across the entire chain of prevention, care and welfare. In other words, value-driven care! Our research shows that we need both functional (linear thinkers) and normative (system thinkers) preconditions to make our healthcare system future-proof. Or to put it in more popular terms: spreadsheet management and the outcome costing method, supplemented by a thorough change management approach, are needed to make a difference.

The main problem in the Netherlands is that parties remain stuck in their own domain and the tribal conflicts that go with it. Both VBHC and Triple Aim adherents point to the need for integration of care across the entire chain of zero, first, second and third line necessary. And this requires an innovative approach from all stakeholders involved! Unfortunately, care remains compartmentalized and that does not help to achieve the desired outcomes together. Feel free to use a model like VBHC or Triple Aim, but if we don’t change the basics and our attitude, we’ll be stuck in renovation projects.

Without friction no shine

Because it is difficult to make the interests of all parties involved transparent, we keep going round in circles. And we call it a complex problem within a complex system, because we find it difficult to put our real (organizational) interests on the table. But it is precisely this transparency that is needed to make the integration of care a success. And… there are no simple solutions to a complex problem.

Walk the talk!

So what’s up? In the words of the Rotterdams: don’t talk the talk, but walk the walk! Parties must work together constructively. Not looking at the problems, but looking for the solutions. Look at best practices in, for example, Germany, the United States, England, Sweden and Australia. Learn how these initiatives are achieving better outcomes at lower costs through deep integration of care. Try to apply these principles in your own context. And don’t go reinventing the wheel. Building an integrated business case together instead of pointing at each other and saying there is no money. It really is high time to explore new routes, and establish constructive collaborative relationships across the chain. And yes, this must involve the patient, care provider, administrator and health insurer! Only then can we make the step to innovation.

Want to know more?

I hope the above insights inspire you to make VBHC an innovation approach. We are happy to share our knowledge to put this into practice. Take a look at our website to see how we can help you with this.

Pim Valentijn

Do you have any questions?
Please contact us.