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Vol 22, No. 07, July 2018   |   Issue PDF view/purchase
How to make value-based care a reality?
Healthcare providers today face the challenge of delivering up-to-date, evidence-based care given the ever-burgeoning pool of medical evidence, coupled with the hassle of meeting advance electronic health record (EHR) platform integration requirements. Dr Ujjwal Rao proposes that buying knowledge-based CDSS is increasingly more favourable and the way forward.

Global healthcare needs to tackle an urgent and ongoing challenge – despite rising healthcare expenditures, health outcomes have begun to stagnate.1 The significant progress we have made in medical research, treatment and innovation have yet to fully translate into improved clinical outcomes. Instead, we continue to see a rise in patient safety incidents and even inadvertent deaths due to medical errors. In a developed country like Australia, almost 11 per cent of all deaths are the result of preventable medical errors.2

As populations continue to age, the demand for high volume and quality healthcare services is expected to rise. This places immense pressure on already stretched healthcare resources, which have often been inefficiently employed. In Asia Pacific, more than 25 per cent of the population will be above 60 years of age by 2050.3 Together with changes in lifestyle habits and choices (owing to higher income levels), the incidence of chronic conditions will continue to rise. Keeping people healthier for longer, therefore, will require more complex and expensive care.

To reverse this worrying trend and ensure that future healthcare systems remain sustainable, governments, healthcare providers and other key stakeholders in the healthcare ecosystem are shifting their focus from treatment to prevention, and from the current fee-for-service models towards value-based care. Unlike the incumbent fee-for-service model, which is driven by the volume and cost of services rendered, value-based healthcare looks at delivering the best quality care at the lowest possible cost. This means that all stakeholders in the health system are held accountable for delivering value to patients at every point of the care continuum. In short, the singular determinant in the new value-based care paradigm is outcomes.

While an overhaul of the current health system is likely to be a gradual process, with years or even decades in the making, there are ways we can accelerate this transition.

Evidence-based care processes as a driver of value

To guarantee the provision of the best possible care, it is imperative that medical professionals ground their practice in a reliable evidence base. However, with the explosion in the rate of biomedical literature, it is impossible for clinicians to manually keep pace with the latest medical research and information. This leads to knowledge variability – where physicians often ‘don’t know what they don’t know’ – which poses the greatest threat to the quality, cost efficiency and outcomes of care delivery.

Evidence-based care processes, supported by automated clinical information and decision support systems (CDSS) offer the greatest promise of achieving the best outcomes. The inclusion of CDSS in clinical workflows enables electronic health records (EHR) to guide clinicians in making the right decisions at all points of care by feeding current and credible clinical information, specific to the patient’s medical history and current clinical status, directly to the physician at the point of care. For example, Elsevier’s evidence-based Order Sets solution enables physicians, clinicians, and informaticists to author, review, and manage order sets in a collaborative environment. As a cloud-based solution that is easily integrated with EHR, the tool adapts to a hospital’s existing workflow and is shown to have a direct impact on clinical outcomes and resource efficiencies.

At present, evidence-adaptive platforms, which continually reflect current medical evidence gleaned from both the research literature and sources of practice expertise, still require human intervention. Yet, we are beginning to witness the inclusion of artificial neural networks, Bayesian networks, reinforcement learning, and other artificial intelligence methods for real-time synthesis of evidence relevant to patient data, delivering potentially unprecedented insights for clinicians. Ultimately, the goal here is to push the right information to the right healthcare professional in the right format through the right channel at the right time, thereby delivering the right care.

Empowering the patient

We are living in the era of the ‘e-Patient’, or the engaged patient. With improved access to information, patients today are empowered to make more informed decisions about their health like never before. The value-based healthcare model underscores the crucial role that patients play in their health: if patients are not engaged and invested in making decisions about the care they receive or following through the care plans their doctors have designed for them, the care outcomes will be undermined, and cost of care will increase.

For example, studies show that an estimated 50 per cent of all patients do not experience quality outcomes as they fail to follow their physicians’ instructions properly, mostly due to a lack of understanding.4 Consequently, such patients tend to incur significantly higher costs. Engaged patients on the other hand have better outcomes, quality of life and reduced costs.5

It is therefore in the interest of all stakeholders in the health ecosystem that we continue to find and develop better ways to engage and empower patients to take positive actions for their health. Innovations made possible by digital technology are opening new avenues for patients to drive better self-care. Shared Decision Making (SDM) as a clinical practice model is increasingly being acknowledged as a critical component of value-based care.

Engagement transforms patients and consumers into advocates and champions for their own health and the health of friends, family members and the community. When patients and consumers experience authentic education and empowerment, they become their own best providers.

In conclusion, given today’s healthcare challenges, the industry’s shift to value-based healthcare will ensure that the best care remains accessible and cost-efficient to all. While a successful transition to such a progressive model will take more effort, investment and research, there are practices today that put patients at the very center of all outcomes-focused care processes and continue to move the entire industry a step closer. These practices include decision support solutions that reflect the latest clinical evidence to help medical professionals avoid variability and deliver quality care, as well as tools that educate, engage and empower patients to make shared decisions and take charge of their health. Together, these offer us the greatest opportunity to provide the safest and highest quality care at the lowest possible cost today, and catalyze our transition to value-based care.


  1. Hance, D. (2018, Jan 23). Davos: The New Health Paradigm. Retrieved from http://fortune.com/video/2018/01/23/ davos-the-new-health-paradigm/
  2. Anon. (2009, Oct 15). Best Health (online). Drugs and Medical Errors Killing One of Every Five Australians. Retrieved from http://besthealth.com.au/drugs-and- medical-errors-killing-one-of-every-five-australians
  3. Kumar, N. (2017). United Nations ESCAP. Addressing the challenges of population ageing in Asia and the Pacific: implementation of the Madrid International Plan of Action on Ageing. Retrieved from http://www.unescap.org/sites/default/files/publications/Addressing%20the%20 Challenges%20of% 20Population%20Ageing%20in% 20Asia%20and%20the%20Pacific.pdf
  4. Elsevier Patient Engagement (online). Retrieved from https://vimeo.com/242094487
  5. Flemming, C. (2013, Feb 4). February Health Affairs Issue: New Era Of Patient Engagement. Retrieved from https://www.healthaffairs.org/do/10.1377/ hblog20130204.027879/full/


 Dr Ujjwal Rao is senior clinical specialist at Elsevier, India.







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