Paying for health: reward results not activity

There is general recognition healthcare systems need to shift from paying for volume to paying for outcomes, but this is a difficult change to make. A new incentive system in France for funding remote monitoring of chronic diseases, points the way

Laurent Vandebrouck of Qualcomm Life, speaking at the Healthy Measures roundtable in Lyon

Experts from academia, industry and the public sector attending a Healthy Measures roundtable at the BioVision conference in Lyon earlier this month agreed health systems need to move from paying healthcare providers for the volume of service to paying for patient outcomes.

The pace of this transition depends on how swiftly the established systems can be reformed said Laurent Vandebrouck of Qualcomm Life, a company specialising in connected healthcare. “The technologies are available but we need to look at the reimbursement mechanism,” he said. “What is missing is a signal from health providers that there is a business model to support the use of these products.”

Breaking budget silos

A big part of the problem is that spending by one part of the healthcare system often delivers benefits for another. For example, investing in community care may curb hospital costs, but shifting money from one budget to the other is rarely easy.

As one case in point, although remote monitoring of patients with chronic diseases has been shown to reduce complication rates and hospital admissions, it is yet to be implemented at scale.

Now France is taking a lead in adoption, embracing remote monitoring for three chronic diseases and providing financial incentives to promote uptake.

“This is the first time a health authority has shown how remote monitoring of chronic disease patients can be financed,” Vandebrouck said. “They have assigned a value to this technology, set out how general practitioners will be paid, and added bonus payments where hospital readmissions are reduced. All of these efforts are a step in the right direction.”

The new French reimbursement system comes into effect this month, covering heart failure, chronic obstructive pulmonary disease and kidney disease. GPs will receive €300 per patient every six months, along with a €300 bonus if readmissions are reduced by 20 per cent.

More than 600,000 patients in France could be covered by the scheme. Details of a separate system for diabetes patients are expected to be published shortly.

Spreading the word

Several participants said the rapid pace of technological progress is a severe challenge for watchdogs and authorities responsible for oversight, regulation and funding of healthcare. 

Douglas Gregory of Amgen said some administrators and regulators are more advanced than others in grasping the potential technology holds to reshape healthcare. “We need to create a wider understanding of the basic technology in this area and the possibilities that it brings.”

Access to expertise from across the healthcare continuum will be essential to policymakers, according to number of speakers, with one suggesting that an ‘ecosystem of stakeholders’ should be established at European level.

Representatives from EU institutions pointed to a number of existing forums where experts and health professionals can engage with policymakers, administrators and regulators. For example, the EU has an e-Health stakeholder group which includes two doctors’ organisations and several technical experts.

European expert groups have also been set up to study the performance of health systems in EU member states and may highlight examples of how best to adapt health bureaucracies to incentivise results. Putting a price on these outcomes is at the heart of this shift towards value-based healthcare.



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