Experts call for a state pact to boost Value-Based Health Care (VBHC)

• The paradigm shift means that the value of healthcare is measured in terms of the health outcome that ‘matters’ to the patient. 
• Technological changes, digitalisation, data availability and societal changes make the urgent transformation of healthcare both necessary and possible. 
• The Think & Act for Value platform aims to boost the VBHC, identify best practices, connect innovators across Spain and support initiatives already underway with specific programmes. 
• A call for projects will be open from 28 May until 9 September to build the landscape of innovation in VBHC in Spain. 

Barcelona, 28 May 2024 A State Pact is needed to transform the Spanish healthcare system towards Value-Based Health Care (VBHC). This is the main conclusion reached by the experts of Think & Act for Value, the public-private platform that brings together representatives of the different key players in the healthcare ecosystem who are leaders in the field of VBHC, coordinated and co-led by EIT Health Spain, a Co-Location Centre (regional hub) of EIT Health, which is part of the European Institute of Innovation and Technology (EIT), a body of the European Union.  

The World Health Organisation and the OECD state that 30% of the resources used in healthcare are wasted on avoidable complications, unnecessary treatments or administrative inefficiencies (1 and 2). 

In 2006, Porter and Teisberg introduced the VBHC concept as a framework for restructuring healthcare systems around the world, with the primary goal of delivering value to patients. “The paradigm shift proposed by the VBHC is a milestone comparable to that represented at the time by the General Health Act of 1986, which marked the consolidation of the universality, equity and decentralisation of the Spanish health system and shaped the health transfers to the autonomous communities,” says Francesc Iglesias, head of the Office of Support for Innovation and Research at the Catalan Health Institute. “This is a necessary evolution to avoid being stuck in the 20th century and to bring the National Health Service (NHS) into the 21st century”. 

“The international movement of the VBHC has an important potential to transform our healthcare system,” says Izabel Alfany, Managing Director of this foundation. “At EIT Health Spain we have put the strength of our structure, in which all the actors in the health system already coexist, at the service of Think & Act for Value, with the idea of being able to act as a driving force for change towards the VBHC”, Alfany is confident. 

The State Pact called for as a necessary condition for change involves promoting cohesion at the Interterritorial Council level in terms of the evaluation of innovation and technologies by the evaluation agencies. In the experts’ opinion, all agencies should agree that they should be guided by the value for the patient, and that such evaluation should be imperative, so that value guides decision-making in the purchase and adoption of technologies at regional and healthcare organisation level. Such a Pact would also aim to foster the exchange and implementation of best practice both intra- and inter-community, facilitating collaboration and joint learning to progress towards value-based healthcare in all regions.  

“The levers driving the VBHC are technological changes, digitalisation, data availability and social changes, with an increasingly ageing population with multipathology and chronicity. It is the very need to maintain the success of the NHS that is driving this transformation,” explains Francesc Iglesias. 

What is Value-Based Health Care? 

The Value-Vased Health Care model has been proposed as an innovative approach to improve patient experience and health outcomes with the limited resources available in healthcare. There is a growing trend to consider Value-Based Health Care initiatives as a strategic model of healthcare management, as they allow for the adaptation and design of the care and reimbursement process, with the aim of generating value for the patient while maintaining the economic sustainability of the healthcare system.  

Pioneers in Spain applying Value-Based Health Care 

“In recent years, very positive experiences have been accumulated in this regard both in Spain and in Europe, although mostly partial or sectoral,” explains Pep Pomar, president of the Signo Foundation and former manager of the Son Espases Hospital (Palma de Mallorca). In the same vein, Artur Palet, director of the Access & Development Area at Roche Diagnostics, stresses that “we have been running pilots for years with very good results, but they cannot be absorbed by the system. We need to build bridges and involve the different stakeholders in the healthcare ecosystem in order to cross them.  

In Spain, initiatives such as the H2O project, promoted by the Hospital Universitari Vall d’Hebron (Barcelona) together with more than 20 partners from 12 countries, which seeks to empower patients to provide better care outcomes, stand out, among others. Or the Value Strategy of Osakidetza, Health Service of the Basque Country, launched in 2023 as the first strategic plan in this field developed by an Autonomous Community. Its implementation is considered at different levels: on the one hand, on the system, professionals and citizen culture, and on the other, on what impacts on each individual and their own health.  

The PaRIS study (“Patient-Reported Indicators Surveys”) is the first international survey, promoted by the OECD, which measures health outcomes (PROM, Patient-Reported Outcome Measures) and experience (PREM, Patient-Reported Experience Measures) in Primary Care (PC) referred by the adult population, with special interest in those patients with one or more chronic conditions. In Spain, it is coordinated by the Ministry of Health and all autonomous communities participate. 

Manifesto for the pursuit of Value in Health Care

The experts of Think & Act for Value, with the aim of identifying, connecting, promoting and scaling up all the experience available in Spain and Europe in the field of VBHC, based on national and international experiences, have drawn up a manifesto with 54 recommendations for decision-makers at national and regional level, healthcare centres, healthcare professionals, patients and industry.

“This is an initiative that has been maturing over time, but now the time has come to take action with the alliance of EIT Health and developing a line of work around different concrete actions,” says Pablo Serrano, Director of Planning at the Hospital 12 de Octubre (Madrid).

The proposals are based on five pillars, which are essential for promoting change: evaluation based on the availability and funding of suitable tools and value indicators; the adoption and purchase of technologies based on this new form of evaluation and these indicators; the training of professionals in tools that enable care based on indicators and data; the culture of value in organisations, with the integrated management of care processes around the patient, incentives for professionals and connections and sharing of learning between centres; and the real participation of patients, as well as the integration of their perspective in the policies themselves.

Ensuring the active participation of the patient in the definition of Value-Based Health Care policies and practices is one of the critical points highlighted in the manifesto, promoting the development of the figure of the expert patient and the greater adoption of digital tools that help in the collection of information and data-based care management.

With regard to healthcare organisations, the experts propose the development of an outcome measurement model that integrates the patient’s perspective with the clinical outcome and provide healthcare systems with prospective financing models based on indicators that consider costs adjusted by care processes, not by intervention. It is also recommended that a transversal and multidisciplinary vision of care for the different health processes be strengthened through the creation of functional clinical units.

To this end, the involvement of professionals is key, as well as identifying the training needs that will enable them to carry out clinical practice with value, encouraging them to develop value-based multicentre projects, and fostering the creation of multidisciplinary and integrated teams. This makes it possible to manage patients around processes: offering them what they need, when they need it, where they need it and by the professional who provides the most value.

As for companies, it is recommended that collaboration with health administrations be strengthened, and that progress be made in socio-technological models in the search for common objectives and innovative value-based purchasing models. This implies the creation of a system of payment for health results.

Value Radar

Another of the Think & Act for Value actions presented this morning was Value Radar: a detector of good practices in VBHC, which will act as a knowledge generator and facilitator of innovation with impact throughout Spain.

Through a non-competitive call for projects, Think & Act will build a dynamic landscape of value-based innovation for healthcare: projects and innovations identified through this call will be visible on the Think & Act website and in a marketplace tool, where innovators will be able to generate virtual connections.

In addition, Think & Act will initiate events to enable face-to-face connections, the first of which, Value Radar Cantabria, will take place in Santander (Palacio de la Magdalena), on 10 / 11 October, with the support of the Regional Ministry of Health of Cantabria.

The aim of all the platform’s activities, as Izabel Alfany points out, is “on the one hand, to generalise projects and best practices in value-based healthcare; and, on the other, to incubate value-based healthcare projects, so that they become a tangible reality in the NHS”. Think & Act for Value, Alfany adds, “is a platform open to all those agents, organisations and professionals who are willing to commit to making progress in the transformation of our healthcare system”.

About Think & Act for Value

Think&Act for Value is a public-private collaborative platform for knowledge and innovation, coordinated by the EIT Health Spain Foundation and made up of experts and leading organisations in the field of Value-Based Health Care. It brings together all the experience available in Spain and Europe and serves as a catalyst for change and innovation.

Its objective is to promote the implementation of the Value-Based Health Care model focused on improving patient outcomes and contributing to the economic sustainability of our National Health System.

Think&Act for value has the non-exclusive patronage of Roche Diagnostics.