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What does ‘value’ mean in Healthcare?
Jeff Elton, managing director of Accenture Life Sciences, discusses a new era of value-enhancing innovation that will directly affect the delivery of value to patients and providers
We are entering the era of value-enhancing innovation - the delivery of value to patients, providers and risk bearers. No longer is value the sole responsibility of health providers to deliver or health payers to assure. Value is defined by three principal components.
1) It is meaningful therapeutic value to the patient — where quantity of life, productivity, and fundamentals of the disease state are all positively affected.
2) It is a change in the cost, quality and predictability for the health provider. This may involve shifting the site of care to a less acute setting, being able to identify the non-responders in advance, or identifying and placing resources differentially to those with the highest risk of progression or re-hospitalization.
3) It is off-setting the risks borne by the payer — be this a government or private payer.
The value proposition debated
Value as a concept will be debated, but ultimately will be mutually measured and agreed to. The digitization of healthcare globally is a catalyst for this transformation to value as goal and basis for payments. Increasingly every aspect of health, health management, health status, and lifestyle are available electronically. Electronic Medical Records (EMRs) are becoming ubiquitous around the world. They are improving in the quality and the completeness of their data. They are increasingly being used by provider systems to measure and manage to quality goals. New tools are becoming available that allow sophisticated population health management, benchmarking clinical services in one system versus another, and identifying specific patients at the greatest risk of disease progression or greatest need for support to avoid a readmission. These are the foundations for value management and the basis for new collaborative care coordination and management models.
EMR companies are building far more sophisticated capabilities for providers. As reported, Cerner and Claritas Genomics have partnered to develop tools that allow the identification and precise diagnosis of rare, genetic childhood diseases. Further, Epic Systems and Apple have revealed a collaboration to integrate EMR data with person health data for the benefit of new patient engagement and emerging health management models. All of these are the foundations for new ways of working, ways to engage with patients “beyond the pill” and beyond the office encounter. They are also the foundations for new health ecosystems and new life sciences operating models.
Payers and governments too are advancing in their use of electronic medical record claims data and deploying patient engagement platforms that collect social data. Accenture industry analysis finds these are now enterprises of several hundred million dollars and growing — an industry that will become the equivalent of a block-buster therapeutic in scale and value creation.
In this context, value-delivery is an enormous task for life sciences companies. It requires a new understanding of the patient, the patient journey, and how providers actually diagnosis and treat patients. Value requires taking the insights on how patients are treated today, re-envisioning this through a new therapy, new therapeutic approaches, and new tools available to clinicians and patients. This can take many different forms. For instance, one could look at algorithms functioning within the EMR which can identify patients most responsive to a new therapeutic or device. In turn, this information can be realized into services – or delivery - that improve patient adherence to their medicines for long term health benefit and can integrate remote monitoring with other therapeutics or devices to enable the sickest patient to stay out of the hospital, lowering costs and improving outcomes. This is about translating ‘insight and understanding’ into precise ‘solutions’ which in turn allows manufacturers and others to co-assume risk with the provider and share in the benefits of improved quality and outcomes.
Value as transformational
Value is about transforming the ecosystem of partnerships and relationships that allow value to be optimized and increased over time. These are analytic-driven organizations that demand data before making decisions — the era of heuristics and past comparables is obsolete. It requires senior-to-senior interactions between life sciences companies and their largest provider partners. It reframes the responsibilities companies have to patients and is as about both insight and assuring value, as it is classic therapeutic R&D. It is about precision — using data, insight, services, and ecosystem partners to provide a patient or very specific strata of patients what is needed to receive benefit and optimize value.
In the coming months, we are going to be featuring what is changing in the current environment, how value management is evolving, key opportunities to advance the principles of precision and value today, and how to shape the broader life sciences environment to be one within which companies, health providers, and patients can find a new basis for a working and economic relationship.
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