Value-based healthcare: PwC working paper calls for paradigm shift

It is well known: The Swiss healthcare system is among the best in the world, but also one of the most expensive. This dilemma is being addressed from various sides. However, the current framework conditions often lead to pure volume competition. PwC Switzerland, with the support of a wide range of stakeholders from the healthcare sector itself, the insurance industry, politics, and the pharmaceutical and medical technology industries, has therefore drawn up a discussion paper that formulates the vision of "Value-based Healthcare".

Toward Value-based Healthcare: The Starting Point

With a high level of quality and a distinct range of services, the Swiss healthcare system is already excellently positioned today, it says. The high costs are not only the result of this, but also an expression of the potential to develop from a quantity-based to a value-based system. The players in the healthcare system - including service providers, insurers, producers and patients - act as they can: within the framework of legal requirements and the logic of system-related incentives. This has led to volume competition, limited interprofessionalism and interdisciplinarity, and silo thinking. These factors make it difficult for stakeholders to align their activities with patients and to consistently focus on increasing value and outcomes for patients.

Prelude to the transformation

This is precisely where the aforementioned publication by PwC Switzerland comes in. In it, PwC's healthcare experts have formulated a vision for a quality- and patient-centered healthcare system. For its implementation, they present PwC's Value-based Healthcare (VBHC) Framework. According to the authors, this approach serves to strengthen the quality and efficiency of the Swiss healthcare system. What's more, they say, it heralds a paradigm shift: toward maximum patient-centeredness, indication-specific quality and cost measurements, integrated and networked care unbounded by sector or specialty boundaries, and continuous quality improvement. VBHC not only offers the potential for higher quality in healthcare, but also for reducing cost growth.

Pulling together

"Only by joining forces can healthcare players realize the vision of quality and benefit-oriented care. To this end, the players should proactively set the strategic focus operationally in the direction of quality and orientation toward patient benefit, and regulatory reforms should support this development," says Philip Sommer, Healthcare Advisory Leader at PwC Switzerland. The basis for this quality orientation is a uniform understanding of quality and costs across entire treatment pathways. To make nationwide collaboration possible, legislators should remove obstacles and create framework conditions favorable to VBHC. Misaligned incentives must be abolished, care pathways are needed throughout the entire treatment cycle, and transparent, interoperable digital support is needed. In other words: analyzable data, transparency and networking. Substantial investments in digitization are a prerequisite for this. In the publication, you will find concrete recommendations for action for all players - from informed patients to regulatory framework conditions.

Where Value-based Healthcare is already a reality

Dass dieser Paradigmenwechsel bereits im Gang ist, zeigen diverse Beispiele aus der Praxis. Der Nationale Verein für Qualitätsentwicklung (ANQ) hat ein Pilotprojekt zur Qualitätsmessung von Indikation, Eingriff und Anästhesie gestartet. Hirslanden legt den Fokus auf das digitale und physische Continuum of Care und setzt dabei nebst Partnerschaften konsequent auf sektorenübergreifend einheitliche Qualitätsindikatoren und Anreizsysteme. Das Universitätsspital Basel (USB) und Roche messen und steigern in einer Partnerschaft den Patientennutzen und Ressourceneinsatz bei Lungenkrebserkrankten. Im «Arc Jurassien» arbeitet Swiss Medical Network an der Umsetzung einer integrierten Versorgungslandschaft, die den Full Capitation Ansatz verfolgt und innovative Vergütungsmechanismen einsetzt. IVF Hartmann hat eine digitale Plattform zur Prozess- und Kostenoptimierung in Alters- und Pflegeheimen entwickelt. Das Spitalzentrum Biel und Johnson & Johnson (J&J) erhöhen gemeinsam den Patientennutzen entlang des Behandlungspfades. Die CSS bietet ihren Kundinnen und Kunden eine Qualitätssprechstunde an. Und die Patient Empowerment Initiative als Pilotprojekt von USB und Kantonsspital Winterthur (KSW) in Kooperation mit CSS, SWICA und PwC Schweiz holt den Patientennutzen zurück ins Zentrum, korrigiert Fehlanreize und reduziert Fehl- und Überversorgung. Diese Einzelbeispiele würden das grosse Potenzial von Value-based Healthcare in der Schweiz aufzeigen. Die Experten von PwC sind überzeugt, dass sich das Schweizer Gesundheitswesen dynamisch in diese Richtung entwickeln wird und begrüssen eine Zusammenarbeit aller Akteure, um diesen Ansatz flächendeckend umzusetzen. Source and further information: PwC Switzerland

This article originally appeared on m-q.ch - https://www.m-q.ch/de/value-based-healthcare-arbeitspapier-von-pwc-fordert-paradigmawechsel/