What is Value-Based Health Care?
NHS Wales aims to get the very best outcomes for patients with the resources we have. To achieve this, we are working with patients and clinicians to gain a deeper understanding of the value we get. We view value from a patient perspective, striving to deliver what matters to the people who use our services.
In practice, this means defining the results we want – according to what matters to patients – and collecting Patient-Reported Outcomes Measures (PROMs). To achieve this, NHS Wales is focused on data-driven decision-making: we are collecting PROMs data and using it to make services better and more efficient.
At the beginning of the COVID 19 pandemic, we recognised that heart failure patients were at high risk if hospitalized and exposed to the virus. We established a Heart Failure Hub, aiming to offer a responsive service for patients at greatest risk of acute hospital admission.
The Heart Failure Hub had three main aspects:
PROM data, collected before and after the Heart Failure Hub was established, has shown improvements in patients’ health and well-being with care delivered by the Hub model; providing rich evidence to continue this service.
Dr Carey Edwards
Consultant Cardiologist, Morriston Hospital
Swansea Bay University Health Board
By deepening our understanding of how we use resources, NHS Wales aims to:
Value-Based Health Care (VBHC) encourages us to focus on meeting the goals and preferences of our patients by involving them in decision making, supported by the best evidence to hand. To improve patient outcomes and their experience of healthcare, we are working to improve our communication systems and to embrace digital technology.
Why is VBHC right for Wales?
Our population is changing. People in Wales are growing older and living longer, and some are developing complex health needs. Our services must adapt to the needs of the population to ensure the sustainability and health and social care.
Wales is committed to investing in meeting these needs as efficiently as possible. This requires changing how we work and being smart with the resources we have. It means developing new, personalised approaches to delivering care at the right time, to the right people, in the right places.
‘We want to know what matters to patients. We’re asking which treatments and care keep people well; what interventions affect their quality of life in ways that they value.
By completing questionnaires about their health and wellbeing, patients are helping us to learn how best to deliver care that improves their lives in meaningful ways
Dr Sally Lewis, National Clinical Director for Value-Based Healthcare
Building on the principles of Prudent Healthcare, NHS Wales is embracing Value-Based healthcare. This fits with the ambition of A Healthier Wales – the government’s long-term plan for our health and social services. Our National Action Plan for VBHC, published in the autumn of 2019, sets out a roadmap for delivering on our vision of data-driven care.
We are working with international organisations, including the OECD and ICHOM, to apply the latest technologies and knowledge as we reimagine our health system together. In the process, Wales is becoming recognised as a global leader in VBHC and building the knowhow and information tools best suited to our population.
How will VBHC help Wales to get better value?
We do not know enough about how the services we deliver contribute to the best outcomes for patients. To find out more, questionnaires have been carefully designed to learn about patient-reported outcome measures (PROMs).
The assessments draw on international expertise and surveys developed with patients and clinicians in each therapeutic area. Patients in Wales are asked to complete questions that were selected by our clinical teams. This will guide their immediate care while also revealing what works best for people with their condition. As we learn more about the kinds of care that offer the best value, we can do less of the things that do not help and reinvest that money to do more of what works. Our goal is to enhance our capacity to meet the needs of patients now and into the future.
How is it improving patient outcomes and experiences?
Access to data on what works best empowers patients and clinicians to make informed decisions. In building systems to collect and analyse this information, NHS Wales has invested in technologies that radically improve communication with patients. Using smartphones and tablets, patients can communicate with clinical teams remotely about their health. This presents opportunities to access care quickly if needed. It also saves patients the time, inconvenience, and expense associated with traveling to unnecessary clinic appointments.
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What does it mean for clinicians?
Our clinical teams can review PROMs before a patient visits the clinic, helping to make appointments more efficient and to identify areas in need of attention. Our data specialists are working with clinical leaders to build data dashboards that help our busy frontline staff to visualise key PROMs data for individual patients.
PROMs data can be used as a triage tool and can help to prioritise patients with the greatest need, helping to make the best use of clinic time. This allows urgent cases to be identified and fast-tracked, while easing pressure on services by reducing unnecessary in-person follow-up appointments.
Equipped with data about service needs and the value of available interventions, clinicians can refine how they deliver care and make the business case for investment where needed.
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What are PROMs?
Patient-Reported Outcome Measures (PROMs) are a form of digital health assessments that have been designed and tested with patients and clinicians for either specific diseases or for your general health and quality of life. They look for changes in people’s health before and after treatment and/or overtime to understand changes in people’s quality of life. They have validated questionnaires, usually condition-specific, developed by research academics following extensive research.
An example of the EQ5D 5L general health/quality of life questionnaire.
PROMs questions are usually multiple-choice, with most questionnaires having a scoring system which converts answers into a single score. Each PROM may have a different number of questions, and scoring system, with answers to different questions being weighted according to their importance.
VBHC in NHS Wales: Key milestones