Transforming Health Care Delivery towards Value-Based Health Care in Germany: A Delphi Survey among Stakeholders

Abstract

Value-based healthcare (VBC) represents one strategy to meet growing challenges in healthcare systems. To date, VBC is not implemented broadly in the German healthcare system. A Delphi survey was conducted to explore stakeholders’ perspectives on the relevance and feasibility of actions and practices related to the implementation of VBC in the German healthcare system. Panellists were selected using purposive sampling. Two iterative online survey rounds were conducted which were preceded by a literature search and semi-structured interviews. After two survey rounds, a consensus was reached on 95% of the items in terms of relevance and on 89% of the items regarding feasibility. The expert panels’ responses were in favor of the presented actions and practices of VBC in 98% of items for which consensus was found (n = 101). Opposition was present regarding the relevance of health care being provided preferably in one location for each indication. Additionally, the panel considered inter-sectoral joint budgets contingent on treatment outcomes achieved as not feasible. When planning the next steps in moving towards a value-based healthcare system, policymakers should take into account this study’s results on stakeholders’ perceptions of the relative importance and feasibility of VBC components. This ensures that regulatory changes are aligned with stakeholder values, facilitating greater acceptance and more successful implementation.

Value-Based Healthcare Delivery: A Scoping Review

“…More briefly, other studies conclude that the use of patient-reported outcome measures has itself been a stimulating factor for the implementation of VBHC [44]. Furthermore, the transparent display of health outcome information, so that it is available to both care providers and the general public, has also been shown to facilitate improvements in the health outcomes achieved [51]. In the same vein, other studies confirm that having a coding system to measure health outcomes in a subgroup of patients allows the team to critically examine processes and decisions in relation to different treatment regimens [42].…”

“…---Krebs et al [51] Quantitative and qualitative -Involving patients or patient representatives; the accessibility of data; upto-date IT systems; multidisciplinary VBHC implementation teams.…”

“…Studies also agree on the importance of involving the patients' perspective, although they differ in their manner. Some of the studies emphasised that the patient is at the core or centre of VBHC [43,47,51]. In the same line, other studies highlighted the importance of involving patients or patient representatives during the implementation process [41,45].…”

“…Other studies also mentioned involving patients in the shared decision-making process as one of the most important elements of VBHC [32,50,51].…”

“…Several examples that confirm that IT support is an important factor for a successful delivery of VBHC are presented in the reviewed literature. These include the following: the creation of information platforms that enable communication and inform both clinical teams about PROMs and patients about their health status [32], the development of a coding system to measure outcomes across a whole group of patients [42], the installation of supporting IT tools that allow for the searching of data in different IT systems of a hospital [42,51] or that allow, in a given hospital, the systematic recording of information from the primary source, the existence of an up-to-date IT system containing the data, the opportunity to search for statistics for outcome measurement mapping [41], or even the presence of national data registers [44].…”