New Delhi: February 4, 2021
Every generation of Indians has overcome challenges to secure our nation’s role as the world’s economic leader. Solving the health care puzzle is this generation’s challenge. It will require change.
True healthcare reform requires both moving toward universal insurance coverage and restructuring the care delivery system. These two components are profoundly interrelated, and both are essential. Achieving universal coverage is crucial not only for fairness but also to enable a high-value delivery system. When many people lack access to primary and preventive care and cross-subsidies among patients create major inefficiencies, high-value care is difficult to achieve.
ICT enabled healthcare can enable value improvement, but only if they support integrated care and outcome measurement. Simply automating current delivery practices will be a hugely expensive exercise in futility. Among our highest near-term priorities is to finalize and then continuously update health information technology (HIT) standards that include precise data definitions (for diagnoses and treatments, for example), an architecture for aggregating data for each patient over time and across providers, and protocols for seamless communication among systems.
The value-based health care movement isn’t an organization with a membership card. It is a growing collection of people, organizations and governments that believe value-of-care should replace volume-of-care as the most important virtue in the way we pay for and consume health care in this country.
Value-Based healthcare requires Data Standards, IT
Value-based health care systems need certain data standards and IT infrastructure to operate effectively, according to a report by the Boston Consulting Group. For the report, BCG researchers examined how 12 countries are working toward implementing a value-based health care system. The 12 countries examined in the report are: Australia, Austria, Canada, Germany, Hungary, Japan, The Netherlands, New Zealand, Singapore, Sweden, The United Kingdom; and The U.S. After evaluating the 12 countries, researchers identified four factors that contribute to the successful implementation of value-based health care:
- Establishing a national health care infrastructure that includes certain shared IT platforms and unified standards for tracking diagnoses, outcomes, costs and treatments;
- Encouraging clinicians to collect and interpret clinical data as part of efforts to improve patient outcomes;
- Using disease registries to track patients’ health outcomes so physicians and insurers can identify and promote cost-effective care; and
- Providing clinicians with incentives based on outcomes data to spur changes in care delivery.
Indian Scenario
The transformational challenge facing India’s healthcare system is considerable but addressable. It should expand its primary focus on often poorly coordinated episodic care to encompass the life-long and coordinated management of preventive, acute and proactive chronic care across India’s burgeoning middle class, as well as for those who will not benefit from economic development.
India needs a healthcare system that can meet the demands of over 1.3 billion people, most of whom are unable to bear the burden of healthcare costs each year 39 million people are pushed into poverty because of their inability to meet healthcare costs. The challenges are gargantuan, as our cover stories point out: India leads the world in terms of maternal deaths, there is a dearth of qualified medical professionals in rural areas; health insurance covers only about a fifth of the population while unorganised private sector accounts for almost 80% of outpatient healthcare.
So, what should be the principles that will help to achieve the alignment of all the healthcare components:
- The focus should be on value for patients, not just lowering costs. Value is driven by provider experience, scale and learning at the medical condition level.
- Free flow of information that is, information on results and prices needed for value-based competition must be widely available.
- Innovation in healthcare such as enhancing the patients experience, redefining the business around medical conditions, growing by developing its delivery value chain etc. that increase the value must be strongly rewarded.
- There must be unrestricted competition based on results and should not be confined to the local realm instead should be regional and national.
