VALUE BASED HEALTHCARE

THE NEW WORLD OF MEDICINE

When the American economist Michael Porter stepped onto the stage at the World Economic Forum (WEF) in Davos, Switzerland, in 2017, "Value-based health care" (VBHC) was already a globally established concept that advocates restructuring of the health care sector. This will have pleased Porter, who laid the foundations for VBHC with the research work he undertook back in the 1990s. This scientist and Harvard professor focused on the cost-effectiveness of health care systems. His conclusion: they are too expensive and inefficient. How, he asked, can a high standard of medical care be combined with lower costs?

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Porter investigated the economic processes in the American health care system; based on an analysis of their weak points, he developed "Value-based health care". The model devised by Porter works in a fundamentally different way than existing models. This is because the focus is no longer on the doctor, his or her instructions, findings and decisions: instead, the value that the treatment gives the patient is now the central factor. Porter's book on this subject was published in 2006: "Redefining Health Care".

"Quality comes at a price" is the usual justification given for the costs of existing health care systems. Porter adopts a radically different approach: a health care system has to achieve the best possible result for the patient – and it must do so at low cost. His call to restore the patient's status as the central focus of health care is in line with economic principles. Porter's analysis: amid competition between health insurers, hospitals and doctors, the patient's wellbeing is relegated to the background.

A key issue in the entire process is the value of treatment – measured in the currency of the patient's long-term quality of life. This should be ascertained with the help of surveys before and after treatment, including questions such as: What is life like two years after a hip replacement implant? How quickly can the patient return to work? How many follow-up treatments were needed?

‍Consistent tracking of the entire patient pathway is the only way to arrive at a qualitative analysis. Digitalization makes it easier to collect, record and evaluate all the personal data for this purpose. Patients themselves move from being passive participants to active players – just as Hippocrates advocated – and they have to take on personal responsibility.

A Revolutionary Concept

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Health reformers have seized upon Porter's idea and continued to develop it; modern data processing systems make analysis easier. "Value-based health care works!" – that was the verdict of Gregory Katz at the annual congress of the European Institute of Innovation and Technology (EIT). Katz, who comes from France, is the Director of the EIT Health Trends Report. He is working on the publication of a report titled "Implementing Value-Based Health Care in Europe: Handbook for Pioneers".

The EIT is an EU body where researchers work together on an interdisciplinary and international basis. "We measure quality of life before and after treatment, with the help of calibrated instruments: we use questionnaires to do this," according to Katz, who holds a professorship at the University of Paris.

He advocates results-oriented medicine with a strong focus on benefits for the patient. According to Katz, it is crucial for all health care institutions to engage in interconnected data exchange so they can respond more precisely to patients' specific needs. Medicine ought to be measurable by its results. Johnson & Johnson sees VBHC as the health care of the future. For many years, the company has joined with other health care providers such as clinical centers to carry out practice-based projects on VBHC. "Through its programs for value-based health care, J&J aims to offer patients a better quality of treatment, and to combat negative financial trends in the health care sector," says Roman Iselin, Country Lead Medical Devices at J&J Switzerland.

Experience gained thus far is encouraging. For example, costs for patients undergoing hip and knee operations at a Neuchâtel clinic were cut by 40 percent thanks to faster recovery and mobilization. For bariatric surgeries such as a gastric bypass operation at a defined phase of severe overweight, there was a drastic reduction in the costs incurred due to diabetes and high blood pressure in connection with severe overweight. Scarring of the heart during catheter ablation makes antihypertensive drugs obsolete. Roman Iselin views these cooperative approaches as "urgently necessary so that VBHC can revolutionize the health care system".