Value-Based Healthcare  

In this section :

What is Value-based Healthcare?

Value-based healthcare (VBHC) is about linking resources used for healthcare programs or services over a patient’s journey to the outcomes that matter most to patients and communities. Implicitly, patients’ preferred outcomes also reflect their values .
VBHC recognizes that what works best for whom in different contexts will vary. Our understanding of how to deliver value will also evolve over time. As a result, VBHC avoids over-specifying how outcomes will be achieved, e.g. the number of services delivered or specific activities or products.

Examples of VBHC in Canada

VBHC initiatives exist in many forms, some of which directly link payments and outcomes.

• For example, outcome-based procurement awards contracts to suppliers based on meeting pre-defined metrics.
• Social Impact Bonds are another pay-for-success model. Capital from private investors is used to pay for programs that enhance the social good. Investors’ return on investment depends on the extent to which pre-defined social outcomes are achieved.
• When an outcome is well-defined but how to get there isn’t as clear, open innovation challenges reward innovators who best meet the outcome sought. This approach can also uncover novel and promising practices.
• In other cases, VBHC may guide policy or program design. For instance, bundled funding provides pre-determined payments to a group of healthcare providers for all services within an episode of care.
• VBHC can also shape planning and evaluation, as in a multi-province collaborative to enable paramedics to provide palliative care, enabling patients to remain at home where most prefer to be.

What Value-based Healthcare is not

• VBHC focuses on the whole, not the parts. It does not aim to optimize individual components of an episode of care in isolation (e.g. focusing on just the surgical component without considering pre- and post-care, in addition to surgery). Rather, it seeks to understand and promote improvement in outcomes and costs that span an episode of care or population group, not just those delivered by a specific healthcare provider or at a particular time. Targeted improvements must contribute to the overall goal that cuts across organizational and/or budgetary boundaries.
• The focus of VBHC is not cost-containment, or to reward cost reductions in isolation. Both overuse and underuse of healthcare can affect value. The aim is to encourage services that deliver high value, and to scale back or drop those that do not. It is also to re-balance the mix of services to improve outcomes at the same or lower cost. In some cases, increased value may come from options outside the health sector that improve health outcomes, not just services offered by traditional health care providers. How we learn, live, work, and play can all affect our health. A broader focus that includes interventions addressing social determinants of health can contribute to value-based care.
• While evidence-informed practice can facilitate more appropriate care and improved outcomes, it is not the ultimate goal of VBHC. Providers can use evidence regarding the effectiveness of interventions in order to design and continuously adapt models of care to optimize value. However, VBHC is not the same as pay-for-performance models that reward delivery of specific care processes, e.g. prescribing of medications recommended in clinical guidelines, rather than outcomes.

Getting started with VBHC through HEC

Need help identifying where VBHC might be a fit for your context ? There are many ways you can get started or refine your approach, including guides and resources from HEC and other VBHC practitioners. You can view a sample of the resources available below:

• If you’re just beginning the VBHC conversation, try this prioritization exercise (PDF). It takes less than 30-minutes to generate and prioritize initiatives that deliver value within your context.
• Experienced VBHC practitioners identified twelve minimum criteria for a successful VBHC initiative . You can assess readiness or do a check-up on current VBHC initiatives using this VBHC Min Criteria discussion guide.
• Analyze your VBHC initiative from the different perspectives of key interest holders by using this Personas activity (PDF).
• Value can also be derived from reducing or eliminating low value initiatives. For a fun, collaborative way to identify potentially low value initiatives at your organization, consider hosting a DIGGING FOR DINOSAURS CONTEST (PDF).
• Any organization striving to deliver value-based healthcare must ask themselves how do we know what matters to the patients and communities we serve? Learn more about engagement capable environments here. Engagement-Capable Environments: Organizational Self-Assessment Tool (PDF).

Additional Resources

• Value-Based Healthcare in Canada: How the shifting paradigm will impact specialty medicine (PDF)
• Value-Based Healthcare Canada - The Conference Board of Canada
• From value for money to value-based health services: a twenty-first century shift (PDF)
• Value in Healthcare: Laying the Foundation for Health System Transformation (PDF)
• What is Value based Healthcare?
• Value-based Healthcare by Design Webinar: February 15, 2019