This article marks part three in a four-part monthly series by Shelley Thomson, which focuses on the nuances that drive patient-centred care, why it matters more than ever, how to better understand these dynamics, and how to measure its effectiveness.
In the last two articles in this series, we explored the concept of patient-centred care, which is essentially an approach to health care that is personalised, respectful and responsive to each patient’s preferences, needs, and values.
In this article, we will focus on value-based health care, the new healthcare operating model being adopted in Australia and internationally to support healthcare professionals in their delivery of patient-centred care.
What is value-based health care?
Whilst becoming patient-centred is a cultural and behavioural shift in how care is delivered, value-based health care (often referred to as outcomes-based care), represents the overarching operating model of care adopted by healthcare entities whose purpose is to deliver patient value and outcomes.
In a value-based health care model, everyone involved in a patient’s care – healthcare professionals across multiple disciplines, family, carers and the patient themselves are engaged and agree on an approach to achieve the desired health outcomes (or ‘value’) that matter to each patient.
In this model, success is defined by creating ‘value’; defined as the change in health outcomes that matter most to patients for the cost of delivering those outcomes.
Shifting from volume to value
This reflects a complete shift from the current Australian healthcare approach which is focused on volume and the concept that the more patients you see, the more successful you are at providing care.
To evolve to a value-based health care model, our focus must shift from paying for activity (volume) and profitability of services provided (i.e. consultations, hospitalisations, procedures and tests) to rewarding and remunerating providers based on health outcomes achieved.
At its heart, adopting this model re-aligns us to the purpose of health care – which is to help and heal. It reminds us that what one patient defines as the outcome of their healthcare journey may be very different to another patient’s perspective and needs.
How do you measure the value in value-based health care?
When measuring value-based health care outcomes, three common measures are used: Patient Reported Outcome Measures (PROMs), Patient Reported Experience Measures (PREMs) and Patient Activation Measure (PAM).
1. Patient Reported Outcome Measures (PROMs)
PROMs focus on measuring the patient’s view of their own health as a result of the treatment or care received. These perceptions include the quality of life experienced following a treatment, the types of symptoms experienced, their daily physical capability or the level of pain or distress they might suffer. PROMs have a common purpose, in that they all measure health-related quality of life, and are usually gathered via specific survey tools gathered at different points across the patient journey. PROMs can be divided into three broad categories: general wellbeing, disease-specific (such as diabetes, osteoarthritis) and anatomical (such as foot and ankle).
2. Patient Reported Experience Measures (PREMs)
PREMs focus on the patients’ perspective about their experience of healthcare services, and the outcomes of health services. They also consider the interactions and people they come in contact with across their care journey. PREMs might include the level of involvement the patient had in decision making, the communication and coordination of care across multiple healthcare practitioners, the physical environment and experience of the practice or service they visited.
3. Patient Activation Measure (PAM)
PAM is a short survey designed to measure how willing and able each patient is to take independent actions to manage their health and care. By determining each patients’ activation level, healthcare professionals predict the types of resources or risks a patient may have throughout their care and use the score to tailor support journeys, coaching, frequency of appointments, and measure their impact over time.
Whilst these are the three most common measures found in a value-based care model, there are a variety of additional measures that might be considered, including but not limited to, Net Promoter Scores (NPS) and hospital admissions.
Putting PREMs into practice
A practical way to get started is to implement PREMs into your podiatry practice. It can help you see where you may be creating friction points across each patient’s journey, and can identify where patients fall through the cracks, key interaction points and opportunities to improve.
The great news is that you don’t need to develop them yourself. For example, the NSW Agency for Clinical Innovation has developed a series of resources for both health professionals and consumers to use.
Go to this link to download a PREM survey, scroll down to the ‘For Clinicians’ section, and click ‘PREMs surveys’.
Review the list and view the one that best suits your clinical environment. For example: