Principles for the effective implementation of value-based healthcare: a scoping review and proposed process model for successful implementation

Abstract

Background Porter's value-based healthcare (VBHC) idea has gained immense popularity in literature and practice in the past decade. While the value agenda clearly articulates the goal and content of VBHC, it provides no advice on an implementation strategy. This is problematic as, without an appropriate implementation strategy, even the most significant improvement initiatives are bound to fail. In this research, we adopt a change management perspective to understand better the critical principles that determine an effective implementation of VBHC. Furthermore, we provide guidelines to increase the likelihood of implementation success. Methods We performed a scoping review of the literature published in English on the topic of VBHC initiatives using Scopus and Web of Science. The studies were included if they offered empirical evidence on care providers' implementation of VBHC. Results The findings from the scoping review are based on 24 studies and underline that VBHC implementation is a complex concept. Implementing all ideas related to VBHC in practice appears to be challenging, and frequently, projects fail to measure or make progress in reducing costs and improving patient-centric outcomes. The findings also indicate that specific change management elements increased the likelihood of the VBHC implementation's success. The findings show the importance of 1) establishing the need and vision for change throughout the organization, 2) managing stakeholders' responses to change, 3) combining a supportive top-down and participative approach to change, and 4) using data on patient-centric outcomes and costs. Conclusion: The implementation of VBHC is a complex endeavor, demanding that the reason (why), content (what), and process (how) of the change to VBHC is well-developed. With no approach to VBHC implementation, there is little knowledge about the shift to VBHC from a change management perspective. By conducting a scoping study, this research aimed to systematically investigate the concept of VBHC implementation in the literature from a change management perspective by identifying and mapping the available empirical evidence on care providers' implementation of VBHC.

Leadership, regulatory approaches and policy to re-orientate health services towards health promotion

“…Globally, the adoption of value-based health care for the oral health context has been limited but shows promise and could support progress to achieve universal health coverage that includes oral health ( Nguyen et al ., 2023a ). Successful implementation of value-based health care requires strong leadership, significant organizational commitment and effort and priority alignment ( Renting et al ., 2022 ). From a population oral health perspective, effective health promotion is pivotal but remains absent from the value-based health care literature.…”

Health outcomes measurement for value-based healthcare

“…Our study in Chapter 3 of this dissertation also acknowledged the limitations in the models of outcome measurement in other countries (Renting et al, 2022;Heijsters et al, 2022;Cossio-Gil et al, 2022;Noel, 2022;van Staalduinen et al, Varela-Rodríguez et al, 2022;Arora et al, 2016). For instance, the authors of an outcome measurement model that was implemented and piloted in a tertiary hospital in Spain reported that the implementation phase might last 18-24 months per medical condition with a cost of 90,000-250,000 Euros (Varela-Rodríguez et al, 2022).…”

“…For instance, health outcomes for heart failure patients would differ from those for cancer or diabetic patients. Therefore, improving value necessitates thorough planning and management to ensure the accurate measurement of the effectiveness of the healthcare services in achieving the desired health outcomes aligned with the goals in the healthcare setting (Renting et al, 2022).…”

“…As a result, these sets have the capacity to address the needs and concerns expressed by hospital administrators in Chapter 5 regarding their uncertainty about which measures to include and which measurement procedures to follow. In line with this, using standardized sets of outcomes was highlighted by several international initiatives as a key element in the transition to VBHC(Cossio-Gil et al, 2022;Renting et al, 2022;Heijsters et al, 2022; Economist Intelligence Unit, 2016;Stamm et al, 2021).…”

“…As a result, various independent initiatives worldwide have developed unique implementation models that are tailored to their specific needs and objectives (van Staalduinen et al, 2022). Undoubtedly, one of the most important steps included in these initiatives is health outcome measurement (Renting et al, 2022;Noel, 2022;Nilsson et al, 2018;Varela-Rodríguez et al, 2022). Although the existing literature advocates for measuring disease-specific health outcomes, there is no consensus on the effective approaches to implement these outcomes in the current health system without jeopardizing the healthcare operations (Heijsters et al, 2022;Cossio-Gil et al, 2022;van Staalduinen et al, 2022;Arora et al, 2016;Varela-Rodríguez et al, 2022).…”