Danish regions are experimenting with new approaches to financing healthcare services, in which rather than paying for individual surgical procedures such as the implantation of an artificial hip or a pacemaker, the goal is to buy patient-centric outcomes like improved mobility or reduced cardiac risk.
At the heart of each of the pilot projects is the use of patient-reported outcome measures (PROMs) to move towards value-based healthcare, says Adam Wolf, CEO of Danish Regions. “Five Danish regions have embraced PROMs to varying degrees,” he told Healthy Measures. “This approach may ultimately inform funding decisions.”
The pilots are carefully structured to ensure each takes a unique approach to incorporating patient outcomes into account. Based on the results of the pilots, officials hope to identify best practices that can be applied nationwide. Areas of interest vary widely and include surgery, psychiatry and palliative care.
“We are trying to move away from process and activity-based funding towards value-based healthcare,” said Wolf. “It can be very complicated but ICHOM has shown what is possible.” ICHOM, the International Consortium for Outcome Measurement, has devised a standard method for measuring health outcomes that matter to patients.
This is not simply a matter of whether a patient is satisfied with their healthcare experience, it includes hard targets such as clinical results.
Central to making this approach work is accessing the large volume of available patient data and translating it into meaningful outcomes to which a monetary value can be assigned.
“We are working on developing infrastructure to standardise how we organise data and how to incorporate PROMs data in our databases,” Wolf said. “We are also trying to standardise [patient] questionnaires so that, in the long run, we can move towards a more generic approach to collecting PROMs.”
So long, silos
As the number of people living with chronic diseases continues to grow, Denmark plans to restructure how health services are paid for, notably by ending silo budgeting which currently separates budgets for hospitals and community care.
“To cope with managing chronic diseases in future, we need to change our incentive structure,” Wolf said. “Today’s health systems have separate sectors. We can reward outcomes and create incentives for hospital doctors to work together with GPs and municipalities.”
In practice, this could mean that instead of paying hospitals a set rate for a hip replacement, a value is attached to successful rehabilitation. This would give hospitals a financial interest in what happens to patients in the weeks after they are discharged. Rather than rewarding hip replacement surgery, per se, the goal could be to restore a patient’s mobility over a certain time period.
However, Wolf noted that shifting away from the traditional financing model in hospitals are paid for activity – a would be a slow process.
“There is a lot of enthusiasm about including PROMs in general but there is some hesitation or fear that it will all get very complicated to benchmark for financing purposes,” he said. “We need to make sure that it will not be more complicated than current systems.”