Ten clinician-driven strategies for maximising value of Australian health care

Abstract

Objective. To articulate the concept of high-value care (i.e. clinically relevant, patient-important benefit at lowest possible cost) and suggest strategies by which clinicians can promote such care in rendering the Australian healthcare system more affordable and sustainable.Methods. Strategies were developed by the author based on personal experience in clinical practice, evidence-based medicine and quality improvement. Relevant literature was reviewed in retrieving studies supporting each strategy.Results. Ten strategies were developed: (1) minimise errors in diagnosis; (2) discontinue low-or no-value practices that provide little benefit or cause harm; (3) defer the use of unproven interventions; (4) select care options according to comparative cost-effectiveness; (5) target clinical interventions to those who derive greatest benefit; (6) adopt a more conservative approach nearing the end of life; (7) actively involve patients in shared decision making and self-management; (8) minimise day-to-day operational waste; (9) convert healthcare institutions into rapidly learning organisations; and (10) advocate for integrated patient care across all clinical settings.Conclusions. Clinicians and their professional organisations, in partnership with managers, can implement strategies capable of maximising value and sustainability of health care in Australia.What is known about this topic? Value-based care has emerged as a unitary concept that integrates quality and cost, and is being increasingly used to inform healthcare policy making and reform. What does this paper add? There is scant literature that translates the concept of high value care into actionable enhancement strategies for clinicians in everyday practice settings. This article provides 10 strategies with supporting studies in an attempt to fill this gap. What are the implications for practitioners? If all practitioners, in partnership with healthcare managers, attempted to enact all 10 strategies in their workplaces, a significant quantum of healthcare resources could be redirected from low-to highvalue care, culminating in much greater health benefit from the healthcare dollars currently being spent. However, such reforms will require a shift in clinician thinking and practice away from volume-based care to value-based care.

Pharmacist health coaching in Australian community pharmacies: What do pharmacy professionals think?

“…Furthermore, health coaching could reduce the costs to the Australian healthcare infrastructure, improving clinic wait times well, and unnecessary costs to public health insurance schemes, such as Medicare (Scott, ). Pharmacist health coaching would thus be most practical if it were to target patients with chronic health conditions that have the greatest cost to the Australian health system and increasing burden on individuals (McMillan et al, ).…”

Sustainability in Health care by Allocating Resources Effectively (SHARE) 9: conceptualising disinvestment in the local healthcare setting

“…An optimisation approach has also been proposed to address the difficulties related to finding the unequivocal evidence of harm or lack of effect required for disinvestment decisions. ‘Optimal targeting’ has emerged as an alternative strategy where the focus is on identifying the subgroups for which a TCP is most clinically or cost-effective [ 1 , 10 , 38 , 55 , 56 , 59 ]. Rather than disinvestment, this is referred to as “ refining the indications for service provision ”, targeting TCPs to those who will benefit rather than removing them from those who will not [ 45 ].…”

“…There are many challenges to the sustainability of healthcare services. Ageing populations and the rising prevalence of chronic diseases, increasing use of new and existing health technologies, duplication and gaps in service delivery from poorly coordinated care, ineffective practices, systemic waste and external economic pressures all threaten the ability to maintain health services at optimal standards [ 1 – 8 ].…”

Sustainability in Health care by allocating resources effectively (SHARE) 1: introducing a series of papers reporting an investigation of disinvestment in a local healthcare setting

“…There are many challenges to the sustainability of healthcare services. Ageing populations and the increasing prevalence of chronic diseases, the proliferation and high costs of new health technologies, duplication and gaps in service delivery from poorly coordinated care, ineffective practices, systemic waste and external economic pressures all threaten the ability to maintain health services at acceptable standards [3–10]. …”