What is Value-Based Healthcare and How Can We Support Our Clients?

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At NHG, we employ VBHC approach in solving real-life questions and challenges that our customers encounter. NHG is experienced in implementing VBHC principles and methods in multiple settings, ranging from creating VBHC strategy to implementing ICHOM Standard Sets in individual hospitals and building national level benchmarking. 

“At NHG, we have been passionately working on value-based healthcare (VBHC) projects for a long time and learned that there is plenty of outcome data already available which is simply not used. A great starting point on path towards value-based healthcare is to start using this already available outcomes data to improve patient outcomes.” Vesa Komssi, Executive Vice President at NHG. 

To employ VBHC in practice, we often need to collect outcome and cost data, supported by the key process metrics, to provide meaningful information at all levels from patients to clinicians, hospital management, payers and health care systems.

Our offering includes for example:

  • VBHC strategy
  • Integrated patient pathways
  • Outcome metrics definition
  • Data collection
  • Data visualization and BI dashboards
  • Continuous improvement

NHG is a certified implementation partner for ICHOM (International Consortium for Health Outcomes Measurement) and, hence, works in close collaboration with ICHOM to enable international and standardized comparison of outcomes while learning from the global best practices in VBHC. To learn more, please see the ICHOM & NHG blog.

Contact:

Vesa Komssi

Executive Vice President
Nordic Healthcare Group
vesa.komssi@nhg.fi / +358 5033 179 78

Pauliina Vähäviita

ICHOM partnership manager
Nordic Healthcare Group
pauliina.vahaviita@nhg.fi / +358 4076 520 92

Research and expert insights

NHG is experienced in conducting research on VBHC-related topics and its researchers are widely acknowledged experts in the field of VBHC – both nationally and internationally. As Dr. Paulus Torkki, partner at NHG and associate professor at the University of Helsinki, states:

”At NHG, we are currently active in studying the applicability of VBHC in different levels of the health care system and naturally have our findings published. Our research includes for example studying the experiences from implementing and using patient-reported measures and how outcomes and cost information can be utilized in management decisions and in the national steering of the system.”

To learn more about research at NHG, please see our research services

NHG has been an active speaker in international forums on VBHC

The patient pathway in stroke was fragmented in Estonia and hence there was also great potential to improve patient outcomes. Therefore, the Estonian Health Insurance Fund (EHIF) decided to develop a two-year patient pathway pilot for ischemic stroke to include patient-reported outcome measures, clinical outcome measures and costs and to employ the ICHOM Standard Set for stroke in 2020. This program includes now 4 out of 6 hospitals in Estonia providing acute stroke care. The pilot is conducted together with Philips, local partner Meditsiinigrupp and NHG.

NHG’s role has been to support the overall management of the project and provide an IT solution together with its partners: the software from Philips is to enable the collection of patient-reported outcomes data whereas financial data is provided by EHIF. NHG has combined these data with clinical outcomes into a visual BI dashboard which for example displays the relationship between costs and outcomes for ischemic stroke care and analyses the deviation from the average between the respective hospitals to show need for an improvement.

 

The solution takes into account patients’ baseline situation, thus making the indicators comparable (such as patients’ ability to function, success of returning to employment and flow of the care process). Outcome index on the dashboard summarizes different dimensions of the ICHOM standard set.

As a result, benchmarking has enabled hospitals and clinicians to detect and learn from the best practices in stroke care: the dashboard built by NHG enables the comparison of outcomes and costs between separate hospitals, patient groups and care paths as well as a deep dive into specific dimensions of stroke standard set and costs in each care pathway stage. The dashboard is also highly valuable in evaluating what impact each piloted intervention has on outcomes and costs and enables improvements in patient processes to support patient needs. As Triin Naudi, project manager at the North Estonia Medical Centre states: “With the help of the dashboard, we at the hospitals already see potential to improve the patient pathway by finding new effective intervention methods, for example extending rehabilitation could be a possibility.”

For EHIF, this has also been an initiative to employ a bundled payment model for the entire stroke patient pathway in Estonia: price has been fixed for the stroke patients’ entire care pathway for 365 days. There are seven fixed prices dependent of the treatment group and age (these being the main cost drivers). Due to positive experiences with the stroke pilot, measuring will be next expanded to hip and knee replacements in Estonia.

This pilot has also been presented as one of the best practices VBHC cases at the ICHOM Conference in November 2020. To find out more about the pilot project in Estonia please see the ICHOM & NHG blog. The blog series follows up on the project and includes a recording of the conference presentation.

Coronary artery disease (CAD) poses a high disease burden in Finland and particular focus should be laid on patient-reported outcomes. Hence the Central Finland Healthcare District (KSSHP) decided to start measuring outcomes for their CAD patients according to the ICHOM Standard Set for CAD in 2019. The purpose was to use this patient outcomes in both patient work and in management. This pilot was conducted in collaboration between the healthcare district, Philips and NHG.

The approach was to build an ecosystem that could be expanded to other patient groups without depending on an individual supplier.

Philips VitalHealth was employed to collect patient-reported outcomes, which is a tool specialized in patient self-reporting of their symptoms and ability to function. NHG facilitated the launch of VitalHealth by choosing and translating the chosen measures, designing the ecosystem and deploying QuestLink for systematic PROM collection. In addition, NHG supported the hospital to develop its processes to enable the collection of PROMs. NHG collected patient-reported outcome and clinical outcome measures as well as costs and constructed metrics on this information on a value-based BI dashboard. These metrics were chosen together with KSSHP with the help of NHG’s experience.

This BI dashboard was constructed to cater for the information needs of the management to study outcomes and costs between patient subgroups. As Pirjo Mustonen, the chief development physician and specialist in internal medicine and cardiology in KSSHP states: “Listening to patient feedback systematically for a longer period gives us information not only on the long-term benefits of the treatment, but also on the functioning of the whole care chain.” With the systematic collection of PROMs, patients’ self-reported outcomes have been utilized in monitoring how patients’ wellbeing have developed over time and in discussing with patients how they experience their health status. 

This project was also presented at the ICHOM Conference in November 2020.

Read more on the pilot.

The City of Espoo, the 3rd largest city in Finland belonging to the capital region, has more than 90,000 dental care customers and more than 230,000 annual visits. Already in 2015, Espoo decided to start developing quality and effectiveness metrics together with NHG, since there was a limited amount of quality information available. With the help of metrics specifically developed for monitoring oral health it has been possible to identify challenges in oral health care, for example in prevention and early diagnosis. In the field of development and research, Espoo has long been one of the pioneers in oral health care in Finland.

NHG has long-standing experience in developing metrics for oral health since its benchmarking services in oral health were already launched in 2009.

Quality and effectiveness metrics have been utilized by almost 30 service providers including Espoo along with several other municipalities and also by the private sector. NHG both extracts this respective data as well as constructs ten key indicators on a BI dashboard, focusing on outcomes, quality of dental care and availability of services. To enable continuous improvement, NHG arranges regular meetings between the participating benchmarking actors to share best practices and to learn how metrics have been implemented in different units as well as how the units have improved.

In a five-year follow-up, Espoo’s results have improved in all quality and effectiveness indicators. “Using metrics and real-time data, we have been able to make rapid changes to our examination practices. For example, in the case of caries, the oral health of Espoo residents has improved with all indicators over the past five years.

In the field of periodontology, we have taken even bigger leaps: while at the beginning of 2019, 17% of customers were recorded being subject to a connective tissue examination in connection with oral examination, the corresponding figure in April 2020 was 63%. Based on data and analysis from the quality and effectiveness metrics, communicating our improvement goals and making change happen with our development-minded personnel is straightforward,” commented Annamari Nihtilä, Chief dentist, City of Espoo. For Nihtilä, the next steps would be communicating quality indicators also to the customers as well as measurement of PROMs and PREMs.

In 2018, Espoo’s Oral Health Care Quality and Effectiveness Metrics were awarded the Slush Quality Innovation Award. These quality and effectiveness indicators by NHG were also presented at the ICHOM Conference in Rotterdam 2019. Read more on the Espoo case.