Value-Based Healthcare in Residency Training: a Perspective from Singapore

Abstract

Value-based health care aims to achieve the best outcomes at the lowest cost. Many leading health systems worldwide have already begun to restructure care delivery guided by value-based concepts. Residency training programs will play a key role in the transition to value-based healthcare. However, incorporating value-based healthcare into residency programs has received little attention. This commentary introduces an approach developed in Singapore which encompasses structured teaching, clinical teaching, and evaluations. We elaborate on how educators can use avenues such as quality improvement initiatives and journal clubs to introduce concepts of valuebased healthcare to residents. The curriculum is then reinforced by allowing residents to apply value-based concepts in their clinical rounds and multidisciplinary meetings. Lastly, we give examples of how residents can be assessed with a value-based healthcare component in their in-training examinations and posting evaluations. This approach contributes to a wellplanned and smoothly executed educational program in valuebased healthcare for residents, which will be a keystone in the long-term success of the value-based healthcare model. Keywords Value . Value-based . Healthcare . Residency . International . SingaporeAs the leading nation in medical innovation, the United States (US) continues to influence healthcare delivery in developed nations worldwide. In recent years, debates on US healthcare spending and reform give pause for thought. Prior to introduction of the Affordable Care Act, the US spent $9086 per capita on healthcare in 2013, expending 17.1% of its gross domestic product (GDP). This far exceeded the next highest spender, France, by 50% [1]. Yet despite this expenditure, the US reported poorer health outcomes comparatively, with shorter life expectancy and a greater prevalence of chronic conditions [2]. This raised several questions about the successes and failures of the healthcare system, and whether the various players in the system were getting the bang for their buck.Leading US healthcare providers are now uniting under a new shared goal: value. What is value in healthcare? In our opinion, Michael E. Porter and Elisabeth Teisberg conceptualized value most clearly. In their framework, value is defined as the health outcomes achieved that matter to the patient relative to the cost of achieving those outcomes. Improving value requires either improving one or more outcomes without raising costs or lowering costs without compromising outcomes, or both [3]. Value-based health care delivery makes achieving high value its central tenet and aims to achieve the best outcomes for each specific medical condition at the lowest cost [4]. This is a paradigm shift from a traditional fee-forservice model which incentivizes higher patient volumes and looks at process measures which tend to reflect compliance to guidelines rather than health outcomes. A value-based model focuses on creating value for patients by increasing transparency of health outcome...

Analysis of Business Intelligence Applications in Healthcare Organizations

“…This strategy in the HC domain has been created to confront many highlighted challenges and gap in this study. This system aims to align patients, providers, and funders toward the shared goal of improving quality and outcome with lower costs [46].…”