Value-based healthcare: PwC working paper calls for paradigm shift
The Swiss healthcare system is very good, but also very expensive. A paradigm shift is now required: away from costs and toward added value for patients. Value-based healthcare is supposed to provide the solution.
It is well known: The Swiss healthcare system is among the best in the world, but also one of the most expensive. This dilemma is being addressed from various sides. However, the current framework conditions often lead to pure volume competition. PwC Switzerland, with the support of a wide range of stakeholders from the healthcare sector itself, the insurance industry, politics, and the pharmaceutical and medical technology industries, has therefore drawn up a discussion paper that formulates the vision of "Value-based Healthcare".
Toward Value-based Healthcare: The Starting Point
With a high level of quality and a distinct range of services, the Swiss healthcare system is already excellently positioned today, it says. The high costs are not only the result of this, but also an expression of the potential to develop from a quantity-based to a value-based system. The players in the healthcare system - including service providers, insurers, producers and patients - act as they can: within the framework of legal requirements and the logic of system-related incentives. This has led to volume competition, limited interprofessionalism and interdisciplinarity, and silo thinking. These factors make it difficult for stakeholders to align their activities with patients and to consistently focus on increasing value and outcomes for patients.
Prelude to the transformation
This is precisely where the aforementioned publication by PwC Switzerland comes in. In it, PwC's healthcare experts have formulated a vision for a quality- and patient-centered healthcare system. For its implementation, they present PwC's Value-based Healthcare (VBHC) Framework. According to the authors, this approach serves to strengthen the quality and efficiency of the Swiss healthcare system. What's more, they say, it heralds a paradigm shift: toward maximum patient-centeredness, indication-specific quality and cost measurements, integrated and networked care unbounded by sector or specialty boundaries, and continuous quality improvement. VBHC not only offers the potential for higher quality in healthcare, but also for reducing cost growth.
Pulling together
"Only by joining forces can healthcare players realize the vision of quality and benefit-oriented care. To this end, the players should proactively set the strategic focus operationally in the direction of quality and orientation toward patient benefit, and regulatory reforms should support this development," says Philip Sommer, Healthcare Advisory Leader at PwC Switzerland. The basis for this quality orientation is a uniform understanding of quality and costs across entire treatment pathways. To make nationwide collaboration possible, legislators should remove obstacles and create framework conditions favorable to VBHC. Misaligned incentives must be abolished, care pathways are needed throughout the entire treatment cycle, and transparent, interoperable digital support is needed. In other words: analyzable data, transparency and networking. Substantial investments in digitization are a prerequisite for this. In the publication, you will find concrete recommendations for action for all players - from informed patients to regulatory framework conditions.
Where Value-based Healthcare is already a reality
Various practical examples show that this paradigm shift is already underway. The National Association for Quality Development (ANQ) has launched a pilot project to measure the quality of indication, intervention and anesthesia. Hirslanden is focusing on the digital and physical continuum of care and, in addition to partnerships, is consistently relying on uniform quality indicators and incentive systems across sectors. In a partnership, the University Hospital Basel (USB) and Roche measure and increase patient benefit and resource utilization in lung cancer patients. In the "Arc Jurassien", Swiss Medical Network is working to implement an integrated care landscape that follows the full capitation approach and uses innovative reimbursement mechanisms. IVF Hartmann has developed a digital platform for process and cost optimization in retirement and nursing homes. Spitalzentrum Biel and Johnson & Johnson (J&J) jointly increase patient benefits along the treatment pathway. CSS offers its customers a quality consultation hour. And the Patient Empowerment Initiative as a pilot project of USB and Kantonsspital Winterthur (KSW) in cooperation with CSS, SWICA and PwC Switzerland brings the patient benefit back to the center, corrects wrong incentives and reduces misuse and overuse.
These individual examples would show the great potential of value-based healthcare in Switzerland. The experts at PwC are convinced that the Swiss healthcare system will develop dynamically in this direction and welcome cooperation between all players to implement this approach across the country.
Source and further information: PwC Switzerland
