A decade ago value health was flying high. Launched by Harvard guru Michael Porter in 2006 the idea was enthusiastically espoused by Barak Obama and central to Obamacare. Then along came Trump. Meanwhile, the fiendish complexity of health care has stymied efforts. So where is it now? ICHOM 2019 in Rotterdam with 1,250 delegates was a great place to find out.
The answer was alive and well, but still mainly at the hospital department stage. It is here that you typically find a bunch of surgeons who want to do better by patients. Patient outcome measures combined with meticulous comparisons to others via patient registeries can and does lead to startling improvements in outcome.
And value health properly implemented can cut procedures and painkillers. That is what the prize winner this year did.
The prize was won by GLA:D. Using physiotherapy and exercise, it is a Danish method of treating osteoarthritis using exercise and physio which reduces surgical procedures and removes the need for painkillers. It has now been exported to China, Canada and Australia and shows a remarkable 27% reduction in progression of symptoms.
There is a striking correlation between the happiness index and value health. It is now at home in the world’s happiest countries: the Netherlands, the Nordics, Canada, Australia and New Zealand.
But even there progress has been limited. Value health works well for improving prostate cancer and hip replacement outcomes. Applying it to more complex conditions like breast cancer, or deploying it across primary and secondary care is far harder. It is largely absent in Emerging Markets where health care providers are paid on activity (as they are in Germany and much of the USA) – hence the emergence of a business model in which the primary aim is to max out insurance policies, rather than cure the patient.
Sadly, it has also not changed the dire political discourse on health care. Whether you are for-profit or publicly owned remains far more important than your outcomes. People would rather have a dangerous local hospital than superb outcomes which involve travel.
But AI and the surge in big data means its time will still come. What is now needed are champions – consultancies and big software outfits – who can build platforms that can achieve this. Sadly Optim, Cerner and the like were absent from ICHOM 2019. Shame on them. And honour for-profit hospital groups like Mediclinic, Luz Saude and Jose de Mello who were there.
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