Measuring what matters – how to achieve value-based healthcare reform

Introduction by Croakey: The COVID-19 pandemic has placed increasing pressure on an already stretched healthcare workforce.

During Australia’s ‘first wave’, one-third of frontline healthcare staff reported at least one symptom of burnout and depression, according to research by Edith Cowan University.

Reduced public health measures this year have caused additional burden on Australia’s health workforce due to furloughed staff.

In a recent statement, the Australian Healthcare and Hospitals Association (AHHA) called for “all parties to recognise the importance of our workforce in establishing a health system that can deliver the care Australians deserve”.

While acknowledging it is a complex situation, AHHA Acting Chief Executive Kylie Woolcock said “urgent action is needed to address workforce issues in Australia’s health system if it is to continue to provide vital services to the community.”

As services move from volume to value-based health care in Australia, it is important to determine what outcomes are important to patients and consumers and how to measure their value.

AHHA is hosting a series of virtual events in June to bring Australia’s health leaders together to explore how to ‘measure what matters’ in health care.

Below, Woolcock discusses the importance of creating a “health system that is delivering value and improving outcomes for all Australians”.

Kylie Woolcock writes:

Value-based health reform is critical for success in a system facing increasing pressures. All Health Ministers have signalled a commitment to value-based health reform by signing the 2020-25 National Health Reform Agreement.

The associated ‘Long term health reforms roadmap’  provides a flexible approach for jurisdictions as they shift in key areas of reform.

What ties many of these areas of reform together is a focus on improving and measuring the outcomes that matter to people and communities.

Yet, what does it mean practically to ‘measure what matters’? And how is it different to, or the same as, what we already do?

These are the questions that we continually hear from services and stakeholders across the health system pursuing the shift to value-based health care in Australia.

Why measurement matters

Health and health care information and reporting serves a number of purposes:

• For the public—patient-friendly and clinically-relevant statistical information can inform individuals and communities, promote transparency and support decision-making.
• At the point of care—it can inform shared decision-making and enable comparisons to drive service improvements.
• For regions— it can drive strategic directions, supports the allocation of funding and resources, and enable accountability for place-based solutions.
• For jurisdictions— it can inform policy and drives health system improvements.

Yet, despite the importance of information and reporting, and the substantial data currently being collected across the system, Australia has not implemented a long-term strategic plan to coordinate and direct national health information interests.

Linking outcomes to funding

Discussions around the use of outcomes data for sustainability in health system reform can quickly jump to how they can be linked to funding.

Linking outcomes with costs is not new in health care. Australia led the world in 1993 when a favourable cost-benefit analysis was introduced as a requirement for public funding of pharmaceuticals, in addition to the usual requirements of quality, safety and efficacy.

We now have a national framework for health technology assessments that encompasses medical services, pharmaceutical benefits and prostheses.

The hospital sector also uses pricing and funding as levers to improve patient outcomes across three key areas:

1. sentinel events
2. hospital acquired complications
3. avoidable hospital readmissions.

Attention is now moving to determining whether pricing and funding could be used as levers in reducing avoidable and preventable hospitalisations, and this requires consideration of preventive health interventions and early disease management delivered outside the hospital setting, within primary and community care settings.

The dominant funding model in Australian public hospitals is activity-based funding (ABF) which since its introduction in 2012 has effectively contributed to the creation of a more equitable and transparent system of hospital funding.

However, it has become evident that while ABF works well for predictable, one-off episodes of care, our system may benefit from the incorporation of alternate funding models (such as bundling and capitation) where health services are delivered across multiple care settings.

It has been estimated that around 30 percent of the patients currently funded by ABF could benefit from an alternate funding approach.

Realising the potential of these alternate funding models in the public hospital system will require an engaged and coordinated primary and community care system.

While much of primary care is also reliant on funding models that incentivise activity rather than outcomes, Primary Health Networks (PHNs) utilise commissioning to fund the delivery of services through a continual and iterative cycle involving needs assessment, co-design, procurement, monitoring and evaluation.

PHNs around Australia are adopting outcomes-based commissioning approaches to build local capacity and collaborative service arrangements that put people and communities at the centre of care, such as Sydney North Health Network (SNHN) and Murray PHN.

Data-driven improvements

Importantly, funding is only one lever in the shift to outcome-driven, value-based health care. Data can, and should be used, to drive improvements at all levels of the system.

Clinical registries are a prime example, providing a mechanism to monitor outcomes and report on quality of care.

Through collecting, aggregating, and reporting safety and quality data to institutions and clinicians, clinical registries provide a centralised mechanism for benchmarking, enable the identification of variation and incentivise improvements through comparison.

However, health data silos will continue to present a challenge to improving outcomes, throughout a person’s care pathway and over time.

When we measure what matters, this information should be accessible to individuals and available to share with their providers to support decisions about care. Our digital infrastructure must enable this.

Where to from here?

Across the Australian health system, but outside a national health information strategy, work is being done to adapt, develop and implement data collection and measurement approaches to better understand the impact of the care they provide.

Yet what is missing in the Australian context is a shared understanding of how we draw all these elements together to enable value-based reform.

The Measuring what matters event series seeks to address this.

In June, AHHA is exclusively bringing leading international experts Elizabeth Teisberg and colleagues from the Value Institute for Health & Care (virtually) to Australia.

They will work with health leaders from around the country to understand the ‘how to’ of outcomes measurement, including where to start, what measures to use, how to calculate associated costs and how to use the tools currently available.

It is a must-attend event for anyone involved in measuring outcomes to achieve high-value health care.

Following this, a roundtable will explore what this means in the Australian context. With decision-makers across the system, we will explore how systems and services can better support each other to create a health system that is delivering value and improving outcomes for all Australians.

More information about the ‘Measuring what matters’ event series is available here.

See Croakey’s archive of stories about healthcare and health reform.