In this section :
Value Based Healthcare Organizational Assessment
Twelve minimum criteria help determine promising value-based initiatives. The first four criteria below consistently rank as highest priority by health leaders
Organizations can use the definitions to discuss and assess the strengths and opportunities of potential initiatives or an initiative that is already underway. Consider the initiative(s) in light of each of the following criteria – in which areas is it strong, sufficient but has room to improve, or must improve in order to move forward successfully?
Definitions
Metrics that Matter to Patients:
Clearly defined metrics that reflect outcomes that are important to patients/care partners and show the value of a change or improvement, both in terms of its costs and its outcomes. It’s ideal to use previously validated metrics when possible. (The metrics don’t have to be perfect but must be capable of showing change or improvement.)
Outcomes and Cost Data:
Data that show the impact of the change or improvement on patient outcomes, and the costs related to various services or deliverables across the patient journey. Where possible it is best to leverage existing data and financial systems to align with broader quality improvement initiatives and to reduce survey burden on patients.
Clear Scope:
An understanding of the target population as well as the care pathway. This includes defining the members of the population who will move in and out of the target group over time – which will be important in order to understand the impact of changes on outcomes and value.
Material Impact:
The level of effort required to make the change or improvement needs to correspond with the extent of value that is likely to result – making the effort worth it in the end. Also, the people undertaking the change or improvement will want to see the benefits of the increased value.
Capacity/Skills:
VBHC requires leadership, change capacity, and skills beyond traditional performance measurement and reporting, with expertise in many of the categories outlined here. While some of these skills may be developed over time and through the implementation of value-based work, it is important to consider whether those involved are ready and have the capacity to proceed.
Dedicated Resources:
Resources needed to make sure the healthcare change or improvement provides value. Consider whether there is appropriate funding for the initiative and dedicated staff time and leadership resources.
Clinical Leadership:
It is critical that clinical leaders are engaged and effective along the care pathway.
Coordination across Silos:
Health sectors or organizations involved share responsibility for costs and outcomes. Consider whether there are care pathways, if systems are integrated or if they can be integrated to allow this to happen, e.g. if appropriate information and resource sharing mechanisms are in place.
Supportive Policy and Structures:
Governance, accountability structures and policy/regulations need to support implementation.
Aligned Payment Models:
It is important that payment models allow the flexibility to pursue value, and that they enable higher value behaviours and decisions.
Proven Solutions:
Solutions that have been tried and tested and have worked effectively in a similar context. Consider whether there are solutions that have already been developed which are proven to be more effective than the status quo. Note, open-innovation models may specify a problem to draw out possible solutions.
Time to achieve value:
Achieving value takes effort and time. Are the time horizons aligned with funding and planning cycles? Do the stakeholders have realistic expectations of the time required? Different initiatives will require different amounts of time. For example, a procurement initiative may take less time, and a social impact bond may take more time.
