Delivering value-based healthcare: start with one pathway, then scale

By Meena Sebastian, Healthcare Lead, NEC Software Solutions

As we all know, the NHS is caring for an ageing population with increasingly complex needs, against a backdrop of constrained resources and a productivity challenge the current model is struggling to meet.

Value-based healthcare (VBH) – organising services around what care actually delivers for patients rather than how much of it gets delivered – is widely understood to be a more sustainable path. The harder question is how we actually achieve it.

The NHS still largely measures and rewards activity; appointments attended, procedures completed, waiting times reduced.

Yes, these matter, but they only tell us part of the story. And the gap between activity and outcomes has real consequences in terms of how money is spent and decisions get made.

Moving the conversation on

How we overcome this tension has been a key focus for us at NEC Health.

We hosted an executive roundtable earlier this year with data experts and clinical leaders, including Professor Sally Lewis and Hassan Chaudhury, to have a real conversation about what was actually getting in the way of us achieving VBH at scale.

Two themes kept coming up. The measurement challenge between activity and outcomes, and the fact that relevant data to inform value-based decisions too often sits outside of discussions about service delivery and care. We came to call the latter the ‘knowing-doing’ gap.

As a result of these discussions, we published a white paper: Value-Based Healthcare: Time to Deliver. And in September, I had the opportunity to present it at the Data Observatory’s inaugural summit.

There was plenty of agreement around the principle. The question, as ever, was how to make it practical. The suggestion that stayed with me was to focus on a defined area of care and see what becomes possible when you connect the information that already exists.

Orthopaedics use case

Orthopaedics is a good example of this, because some solid foundations are already in place. The National Joint Registry (NJR) has recorded more than five million joint replacement procedures, providing a long-term view of procedures, devices and patient outcomes. At NEC Health, we are starting to connect parts of that picture through a proof of concept developed with the NJR, bringing clinical outcomes together with procurement and spend insight through NEC Advise Inc.

Looking at revision rates and longer-term performance alongside implant usage, patient demographics and organisational spend means NHS providers and commissioners can ask more useful questions. Is a higher-cost implant associated with a better long-term outcome? Are organisations paying different amounts for the same thing? Where could a different decision improve value? It is about giving people a clearer picture of what those decisions are achieving.

And this thinking can apply elsewhere. Take diabetic eye screening –  it’s another good example because its value lies partly in a poor outcome that never happens.

Detecting diabetic retinopathy before symptoms develop can help prevent irreversible sight loss and reduce future demand on health and social care. Our white paper estimates that reducing type 2 diabetes-related diabetic retinopathy prevalence by just 1% each year could save the UK economy more than £150 million by 2050.

And similar opportunities exist in cardiology and other screening programmes.

From ‘pilotitis’ to usability at scale

I have written before about the NHS suffering from ‘pilotitis’ – proving something can work in one place, learning from it and then moving on to another pilot instead of turning those lessons into something others can use.

The aim should be to take a defined pathway, bring the right data together, build a working model and evaluate it properly, while documenting what worked so another service does not have to start again from scratch.

Hassan shared a useful analogy for this – if you want a burger, you don’t want to source the bun, patty and lettuce separately and work out how to assemble it yourself. You want a recipe that already works. And the same logic can apply here – rather than asking every NHS organisation to build the data infrastructure, outcome measures and accountability arrangements from scratch, we can create a working model that others can pick up, adapt and improve.

A great deal of what we need already exists. If we can connect it, use it in real decisions and leave behind a model others can follow, we can start to close that knowing-doing gap and move from defining value to delivering it.

Read the full Value-Based Healthcare: Time to Deliver white paper here