Rewarding quality: Value-based care
PharmAccess is striving for…
- Optimizing value-based care models to empower patients and improve quality of care
- Support and inspire other stakeholders to adopt value-based care models, especially in lower-income countries
- Harnessing data for better decision-making on available healthcare funds.
With the 2030 goal of universal health coverage (UHC) fast approaching, health financing remains limited, and health outcomes for patients are not improving fast enough. The traditional approach to healthcare finance is ineffective and inefficient, and it does not empower patients. Notably, it does not reward the quality of care delivered. Instead, financial rewards for facilities are given on the basis of the number of services provided, with no incentive to ensure that these services are impactful. The smarter use of funds is needed — and it is possible. Transforming the healthcare system with a digitized, value-based care approach can allocate funds efficiently and support health facilities to set the right priorities. Moreover, patients can be empowered and placed at the center of the healthcare systems.
‘’Women in Tanzania, when they attend the clinics for maternal healthcare services are told that the services are free. However, on reaching the facilities, they usually end up being told ‘the supplies and drugs are out of stock’. Those who can afford can go to a nearby dispensary or drug store while others leave quietly back home, hoping to get the services during the next visit. There are the people we are more likely to leave behind in the road to Universal Health Coverage, if we don’t have carefully planned strategies. Free healthcare is not available in systems like ours with very limited financial resources. However, through models like MomCare mothers know at the embark of their health journey, what they are entitled for. The funds available can be directed to the most impactful interventions and can reach those that need it most. The services that the women should receive are clearly communicated in each step, empowering the women to access care they can trust’’. - Dr. Heri Marwa, Country Director PharmAccess Tanzania
3.1 Value-based care: an alternative financing mechanism for healthcare
Healthcare facilities, insurance providers, and others in the sector have traditionally taken a pay-per-service approach to care. This means governments and other funders pay for the services provided. If a person visits their general practitioner, there will be a cost associated with the appointment and any tests and treatments provided. Value-based care turns this approach on its head. Rather than paying for the service, funders and governments pay for the outcomes and the quality of the care people receive. By supporting people throughout their healthcare journey – including improving their adherence to treatment – this approach saves costs for governments, facilities and patients. This is particularly important in sub-Saharan Africa, where 2% of the world’s health expenditure must cover 20% of the world’s disease burden. A system focused on outcomes rather than delivery also means higher quality care and better outcomes for patients – in short, their physical and financial health will improve. The benefits extend far beyond patients. Health insurers, both public and private, reduce risks because their payouts fall as people become healthier. The first step to achieving this is to collect data and see where improvements can be made. Although there may be initial time and investment in developing new services and approaches, healthcare facilities can ultimately save costs by considering treatments in terms of outcome rather than process. And more broadly, the health of the general population improves, accelerating progress towards Sustainable Development Goal 3: Ensure healthy lives and promote well-being for all at all ages.
3.2 Adopting value-based care models in low-income settings
Value-based care is especially impactful in low-income settings, including in sub-Saharan Africa, where more must be done with less. At PharmAccess, our ambition is to build and lead a learning hub that inspires others to create scalable value-based healthcare solutions. We will test and implement models to match supply and demand more cost-effectively efficiently through a digitally enabled, patient-centric approach. Our goal is to empower patients with instant access to the care they need. With a digitally enabled contract, patients can access and follow instructions from their healthcare provider on their cellphone, helping them stay committed to their healthcare journey. The iterative process, in which data provides feedback on the journey’s progression, also allows for continuous improvement on the side of the provider. We have developed these care bundles for non-communicable diseases (NCDs), hepatitis C and malaria in addition to our main care bundle, MomCare. MomCare is a care bundle for expectant mothers that covers antenatal care, delivery, and postnatal care at a health facility. MomCare has helped make pregnancy and birth safer for 50,000 patients in sub-Saharan Africa, making it the world’s second-biggest example of value-based care [40]. It has been recognized by the World Economic Forum as a ‘mature early adopter of value-based care models’ [41]. The MomCare model also offers incentives for providers, as well as a step-wise quality improvement method through SafeCare. Patients receive a health wallet with the maternity services they can access, and they can track their progress with data and technology. This data also serves the community more widely: with information from more than 50,000 patients and 69 healthcare providers supported so far, data can help shape more effective and efficient maternal (value-based) care in the future. The data transparency also means providers can better determine the costs of safe deliveries and other types of care. These care bundles are proving the effectiveness of value-based care. In Tanzania, where H.M. Queen Máxima visited the MomCare project in October 2022, MomCare has increased the uptake of antenatal care visits from 3.3 to 5.1 per patient on average within its network. And in Cameroon, PharmAccess worked with the Joep Lange Institute (JLI) to deliver care bundles for hepatitis C, achieving a cure rate of 96% for the 253 patients who completed treatment. The program was financed through a trial version of a performance-based financing structure. JLI provided pre-payment, and as the outcome payer, Achmea Foundation repaid Joep Lange Institute based on ‘cured’ defining good performance. To date, outcome validations have been received for all 244 of the patients who were cured, and JLI was fully repaid. The results will soon be submitted for publication in a peer-reviewed academic journal.