Value-Based Care: Balancing Outcomes, Efficiency, and Sustainability

Measuring health outcomes is crucial for evaluating healthcare delivery beyond services, focusing on efficacy, effectiveness, and efficiency. Efficacy ensures treatments meet patient needs, effectiveness assesses overall system performance, and efficiency maximises resource use. The cost-opportunity principle balances innovation with sustainability. Strategic procurement and continuous evaluation ensure quality care and financial stability.

Key Points

• Health outcomes are measured through efficacy (individual treatment effectiveness), effectiveness (overall system performance), and efficiency (cost-effectiveness of healthcare processes).
• Decision-making in healthcare must balance resource allocation with potential health outcomes, ensuring sustainability alongside innovation.
• Transparency and long-term strategic procurement, aligned with European directives, bring better health outcomes and sustainable healthcare.
• Integrating value-based care into healthcare systems ensures improved patient outcomes and financial sustainability through continuous evaluation and resource optimisation. 

Perspectives on Measuring Health Outcomes

In recent years, there has been an increasing emphasis on the importance of measuring health outcomes. This shift reflects a growing recognition that healthcare delivery must be evaluated not just on the services provided but also on the tangible benefits to patients. Health outcomes can be examined from three distinct perspectives: efficacy, effectiveness, and efficiency.

- From the efficacy perspective, health outcomes are measured by assessing specific, relevant processes based on criteria such as the severity of a condition or the consumption of resources by a particular patient. This approach ensures that individual treatments deliver the desired results and are aligned with the patient’s needs.

- Effectiveness, on the other hand, is considered from a broader viewpoint. It involves evaluating the overall performance of healthcare processes and examining key indicators such as the average length of stay, readmission rates, and care delays. This perspective emphasises how well healthcare systems function as a whole and whether they consistently deliver quality care to all patients.

- Lastly, efficiency in health outcomes focuses on the costs associated with the entire care process. It looks at whether resources are being utilised in a way that maximises value while minimising waste. This perspective is crucial in ensuring that healthcare systems remain financially sustainable and can continue to provide care to all who need it.

In the public healthcare sphere, the principles of good governance must guide all actions. These principles include financial sustainability, transparency, budgetary stability, and, importantly, efficiency in the allocation and use of resources. Focusing on efficiency affects everyone involved in healthcare, from managers to frontline healthcare professionals. It is not enough to allocate resources appropriately; they must also be used wisely. The responsibility falls primarily on healthcare providers, who must make critical decisions about what care is needed, when it should be provided, and how best to deliver it. By focusing on efficiency, healthcare systems can ensure they provide the best possible care while maintaining the sustainability needed to serve future generations.

The Cost-opportunity principle

In a healthcare system with limited resources and an ever-growing list of needs, the cost-opportunity principle becomes crucial. This principle involves making decisions by evaluating the potential repercussions, particularly regarding health outcomes. To apply this principle effectively, we can consider two critical perspectives.

First, health outcomes can be measured from an individual perspective through tools like PatientReported Outcome Measures (PROMs) and PatientReported Experience Measures (PREMs). These tools assess the patient’s perspective on their health and treatment outcomes. Additionally, clinical improvements can be tracked through specific indicators, such as the reduction or improvement of a clinical parameter that signals a change in the health status of an individual patient or a broader population.

Second, from an economic perspective, decisionmakers must assess the consumption of resources associated with various treatment options. This involves evaluating the costs and benefits of different healthcare interventions to ensure that resources are used efficiently.

Like many other developed countries, the Spanish National Health System (SNS) faces significant demographic and health challenges. These include an ageing population, the chronic nature of many previously fatal diseases, and the constant influx of new healthcare interventions, such as innovative drugs and technologies. While these advancements often bring significant benefits, they also come with high costs. Therefore, applying the cost-opportunity principle is essential to balance innovation with sustainability, ensuring that the healthcare system can continue to meet the needs of all patients.

Maximising Value in Healthcare Interventions

In the current healthcare landscape, a key strategy to implement swiftly is maximising the use of health interventions that offer true added value. This value must be assessed from multiple angles: clinical value, efficiency, patient efficacy, and societal effectiveness. By focusing on interventions that deliver significant benefits, both to individual patients and to society as a whole, healthcare systems can achieve better outcomes while maintaining sustainability.

To achieve this, measuring and evaluating the health outcomes generated by new technologies and their application in everyday clinical practice is increasingly important. This data-driven approach allows healthcare professionals, patients, funders, and managers to make informed decisions, prioritising high-quality care at the lowest possible cost. Ultimately, this would enable the implementation of truly patient-centred medicine that not only benefits individuals but also serves society’s broader needs.

Health outcomes studies play a crucial role in this process. These studies focus on quantifying, analysing, and interpreting treatments’ real-world therapeutic benefits. By assessing clinical effectiveness and safety, healthcare providers can better understand the impact of their interventions.

From an economic perspective, health outcomes evaluation also considers the resources different treatment options consume. This includes analysing the costs generated by various alternatives and evaluating their efficiency by comparing costs to the health outcomes they produce, such as years of life gained or Quality-Adjusted Life Years (QALYs). This comprehensive evaluation helps ensure that healthcare interventions provide the best possible value, balancing costs with improved patient outcomes.

Strategic Change and Procurement in Healthcare Systems

Understanding how health interventions impact the cost of disease management has become increasingly important. It involves analysing the care process in terms of analytical accounting to assess whether resources are being used efficiently. Studies focused on health management outcomes play a vital role in evaluating the effectiveness of National Health Service (NHS) health services. These studies develop and calculate indicators that reflect outcomes in terms of population health, such as annual rates of myocardial infarction or stroke in a given region. By understanding these metrics, healthcare providers can determine if the interventions being used are the most appropriate and cost-effective.

One of the significant challenges in this area is the gap between the wealth of therapeutic information generated over the years and its continuous evaluation. Often, data is only analysed at specific points when required rather than being routinely reviewed. This approach limits the ability to make timely adjustments and improvements in healthcare delivery. To address this, a cultural shift is needed within the NHS, involving all stakeholders.

Continuous evaluation of therapeutic information should become a standard practice to ensure that health interventions consistently deliver the best outcomes.

Another critical factor in this evolving landscape is Spain’s new law on public sector contracts. Law 9/2017 on Public Sector Contracts mandates that all parties involved—administrations, public entities, and supplier companies—make maximum efforts towards transparency. One of the key objectives of this law is to enhance transparency in public procurement, ensuring that public funds are spent wisely and effectively. This law sets the foundation for a future in which public procurement evolves towards a more strategic approach, with a medium to long-term vision prioritising quality, innovation, and improved health outcomes.

Leveraging European Law and Directives

The law also emphasises the importance of obtaining the best value for money, which aligns with the broader goal of ensuring the sustainability of the healthcare system. Achieving this requires a shift towards value-based care, where the focus is on optimising the cost of care through the effective use of resources. Significantly, this shift should not be constrained by short-term budgetary considerations. Instead, it requires a longer-term perspective that measures health outcomes in terms of their impact on the overall cost of care over time.

In this context, value-based care emphasises doing well what needs to be done—providing the proper care at the right time and in the right way. This approach not only improves patient outcomes but also contributes to the financial sustainability of the healthcare system by reducing the overall cost of care in the long run. Strategic value-based public procurement is a critical component of this approach. By aligning procurement practices with the award criteria outlined in Law 9/2017 and the Directives of the European Parliament and of the Council 2014/23/EU and 2014/24/EU, healthcare providers can ensure that they are acquiring goods and services that contribute to improved health outcomes and better value for money.

Conclusion

Ultimately, the goal is to create an effective and sustainable healthcare system. This requires a balanced approach that considers both the short-term budgetary impact and the long-term benefits of improved health outcomes and reduced costs. The healthcare system can achieve this balance by focusing on value-based care and strategic public procurement, ensuring highquality care while maintaining financial sustainability.

In conclusion, integrating value-based care into healthcare delivery and procurement practices is essential for addressing the challenges faced by the NHS and other healthcare systems. This approach requires a cultural shift towards continuous evaluation of health outcomes, strategic procurement practices, and a long-term perspective on cost management. By doing so, we can ensure that healthcare systems remain both effective and financially sustainable, providing the best possible care for patients and society as a whole.

Conflict of Interest

None.