Regional and international healthcare leaders gathered at the opening plenary session of the HIMSS AsiaPac19 conference in Bangkok, Thailand, on Oct. 7 to discuss the topic of value creation in healthcare, moderated by Dr. Charles Alessi, chief clinical officer of HIMSS International. Historically, healthcare systems have been delivering care from a volume-based approach, typically from the number of visits to the clinician or doctor. 

However, with the rising costs of healthcare and the healthcare workforce crunch, it is untenable to keep increasing the number of hospital beds, and this is where value-based healthcare systems have something to offer – measuring value in terms of quality and health outcomes, with a focus on the patients’ needs.

Value creation in healthcare – whose perspective?

“When hospitals talk about outcomes, quality measurement and cost-effectiveness, it is often from their own perspective. From the patients’ perspective, it is about engagement, experience and accessibility. Since 2010, Seoul National University Bundang Hospital [SNUBH] started a healthcare interoperability project with 50 primary health centres and five years later, there was up to 15% savings on medical expenditure through the interoperability of systems. I think different stakeholders [in the healthcare system] need to consider the different axes of value,” said Dr. Hwang Hee, chief information officer at SNUBH. 

From a global perspective, Hal Wolf, CEO and president of HIMSS, summarised the challenges of healthcare systems in one line: How do you initiate large-scale change management in a system that has largely delivered care the same way in the last 250 years, a system that has been ingrained for hundreds of years yet only given a few years to change? It will be a nightmare for healthcare organisations that do not like change, but those who embrace change and innovation will find that it is going to be an exciting period for them.

Rethinking value

David Grauer, senior vice president at Health Catalyst, said that in the context of the U.S., it is not only about the rising costs of healthcare, it is also about the lack of value creation in healthcare – simply not providing enough for the money. There are high levels of healthcare wastage, and 20% of the GDP is spent on healthcare but the outcomes are no better than average. 

Grauer added that there are a number of ways to root out waste and there are several different levels. There is waste on the basic cost-supply efficiency level, there is waste within each clinical case and, most jarringly, there is waste on cases or procedures that are not even necessary. He feels that it is imperative to understand the underlying data and technology that can help root out wastage in the healthcare system and improve care that is being provided.

“As a doctor, we always aim for the best [for the patient]. We rarely stop to think about the value we bring to the patients,” said Dr. Poramaporn Prasarttong-Osot, Group Chief Executive Officer-Group 1 of Bangkok Dusit Medical Services, Thailand. “In Thailand, the healthcare system may differ from those in other countries. We may have a national healthcare system, but in a way it may stop people from looking after their health because they can say, “I can do and eat whatever I want – and walk to a government hospital and be expected to be taken care of,” she added.

“We cannot expect the payer or provider to be responsible for a person’s health, especially in the context of rising healthcare costs.” Dr. Prasarttong-Osot believes that individuals should be responsible for taking care of their health in a value-based healthcare system. 

Creating value through collaboration and innovation

Dr. Hwang explained that hospitals should be given opportunities to be exposed to new technologies and the value created by the new tools. For instance, SNUBH purchased a new building near its current hospital building to focus on innovation and work with industry and academia. 

“Currently, more than 40 startups are now working with our hospital to adopt new technologies, such as AI, data science and analytics. Whenever the startups want to work with our hospital clinicians, we are actively engaged with them. As clinicians are exposed to the challenges/problems faced by these startups, it adds new value to academics, as well as to themselves,” he said.

He also gave the example of returning to the fundamentals of EMR solutions. Despite his hospital achieving good EMRAM validations, he realised that looking into the details, there is a lot of lacking related to value creation for the patients. One such case is the introduction of an antibiotic stewardship CDSS function within the EMR that helps to reduce any unnecessary antibiotic usage, which not just reduces costs but is also safer for the patient. Such interventions from the IT systems can help with value creation not just for patients, but for physicians as well.