Changing demands for healthcare among Asian populations and raising healthcare costs will push healthcare organizations to a value-based approach to bring better patient care.
Based on a report by the United Nations ESCAP (Economic and Social Commission for Asia and the Pacific), almost 12.4 percent of the population in the Asia Pacific region was 60 years and older in 2016. This number is predicted to increase to more than a quarter of the population – or 1.3 billion people – by 2050.1 With this rapidly ageing population, a number of healthcare challenges can arise from an increasing prevalence of age-related diseases. This will thus prompt healthcare institutions to look into developments on current models of care delivery so as to meet the demands of the ever-changing and growing ageing population.
A survey conducted by Willis Towers Watson found that there is a steady increase in healthcare costs in Asia Pacific. Countries such as China, India, and Malaysia are expected to show more than 10 percent increase by 2019.2 Another report also showed Singapore ranking highest in projected rising medical costs.3
With these pressing challenges that countries and their healthcare organizations will face, there needs to be a shift in the focus of healthcare delivery to provide cost-effective and also quality patient care. This has caused a shift in focus and increasing trend to move to a value-based approach in healthcare institutions. To provide us with his thought leadership on the topic is Tim Morris, Commercial Portfolio and Partnership Director at Elsevier. He has nearly 30 years of healthcare experience, from delivering care as a trained nurse in a London A&E department, research and management within the National Health Service (NHS) in the United Kingdom, to direct sales and product development with a range of private and public health institutions.
1. In what ways are healthcare models shifting from volume-based to value-based?
I’m seeing differences in every region, however there is a lot of discussion in the Asia-Pacific region about value-based healthcare moving away from the traditional volume-based which everyone is quite used to. Having said that, we are still seeing volume-based healthcare in some countries such as China as the way forward.But Singapore, for example, is looking at value-based healthcare and there have been discussions about how we can transform quality healthcare into value.
When looking into quality, we are not just referring to the improvements in the hospital infrastructure, but also the value given to patients. In the United States, they are trying to move away from the volume-based structure into ways that can increase the value of care to the patients. Whereas in Asia Pacific, there is a focus on improvement in hospital standards. Some of the challenges I believe in the region would be to provide value and stay cost effective.
2. How do healthcare organizations in Asian countries prepare for value-based healthcare?
It is really about how you measure quality. Many hospitals have adopted the JCI (Joint Commission International) standards to look into clinical safety, and there is an introduction to quality as part of that safety process. But if you’re going to measure costs, data needs to be collected and outputs need to be analysed. One way is the introduction of electronic medical records. However, some countries, such as Myanmar, are in early stages of healthcare development and use of electronic medical records. Hence, it will be premature to implement value-based healthcare.Starting with a foundation of getting the healthcare professionals trained in a standard of care that they are able to follow the best guidelines and structures. I believe that preparation is about training people to the right level of skill set and implementing electronic medical records. These will then drive forward a technological solution that incorporates the healthcare processes that can directly attribute to the outcome of the patient. This will allow healthcare institutions to start keeping an eye on patient reported outcomes, and patients' experience within hospitals as well because it is not just about the cost of the physical outcome, it’s actually the patient experience.
3. Would that mean a lot of digitization is required to achieve this?
Digitization is essential and moving away from scanning the documents to actually documenting the information electronically is key. Some private hospitals that have invested in products by health information technology companies are doing full documentation from beginning to end.
Within our Care Plan product, we are able to document every individual item of care provided. We can also guide nurses on what they should be doing, where even the most junior nurse is able to enter the system and identify what the goals are for the patients and any signs to look out for in a patient. Digitization can provide insights from the patient data in managing infections or disease in the hospital.
We have Order Sets available for doctors as well, where they are able to look at the orders that they placed based on a diagnosis or a problem. So that when a patient comes in with a suspected disease the doctor is able to see what the most appropriate tests to carry out.
Therefore, digitization is absolutely essential and we have to lay the groundwork for what we want to do for healthcare in future. We need to start with evidence-based medicine where the information that are input to the systems are validated through evidence at the clinical level. After creating the system, spending time to adopt, learn and use the systems is also needed to move to a value-based system.
We also need to ensure interoperability and break down silos to ensure data sharing happens beyond the individual hospitals. This would be applicable for areas looking to adopt a universal healthcare model so that patients are treated appropriately.
4. With rapidly ageing Asian populations and the paradigm shift in the demands for healthcare facilities, how do you see value-based model benefitting the ageing population?
It is important to work with these patient groups to find out what is qualityfor them. Quality isn't sitting in a hospital bed, it’s probably being at home and being cared for in a community. Keeping them in hospitals unnecessarily might put patients at risk of infections, as such we need to look at providing a cost effective treatment for their lengthy stay. Many are now living more than 30 years after their retirement, we've got to find a way to manage this care over a long period of time.This means there should be efficient delivery of healthcare and looking into what they want to achieve in terms of the quality of their life over the cost of care that they receive. Another would also be providing pre-emptive or preventive care for elderly patients by intervening earlier so that we can increase the value in terms of quality of life. Which means we have to look at other levels of care including primary care, community care, and social care.
5. What technologies are required to achieve value-based healthcare?
First, in terms of achieving value-based healthcare, we need to look at training the nurses through learning management systems. We need to train healthcare professionals to have a mindset that is continuously learning and provide facilities for them to learn while working on the job. We have a skills program catered for nurses who are now in practice and would like to learn to manage patients in different environments.
Another would be how we can interact with our clinical decision support and implement decision protocol modules to help doctors make clinical decisions based on the evidence available. This will assist in identifying an appropriate treatment plan and increase quality of care for patients, reducing the overall cost.
Technologies in terms of big data to identify how we manage patients is also emerging.
6. What do you hope to see in future for value-based healthcare in terms of patient care and the working environment of healthcare professionals?
Value-based care cannot just be about the hospital environment, the patient is the multiplier effect. 95 percent of care happens outside the hospital, patients may not comply even with the right drugs and treatment plans. Therefore, patient engagement in what they are going to expect is very important. Taking the patient through the processes of care after they leave the hospital will help them manage their diseases or conditions. Also, training the doctors to be able to explain the conditions to the patients in a way that they are able to understand.
7. Would having value-based care mean creating a healthcare network?
Yes, a doctor cannot deliver value-based care alone, everyone within that network has to contribute. The first line of care will be from the community. They can intervene early and better manage patients with chronic conditions to prevent further escalation of the disease. Even if they require hospital care, patients should be discharged with the most knowledge on how to manage their conditions. Also, introducing a healthcare community of continuous learning to ensure a complete network which means inter-disciplinary deployment, with no silos and everyone working together.
This interview was conducted by Deborah Seah
- 1.United Nations ESCAP (n.d), Ageing in Asia and The Pacific: Overview, Retrieved from: https://mipaa.unescapsdd.org/files/documents/SDD%20Ageing%20Fact%20Sheet%20Overview.pdf
- 2.Willis Towers Watson, (2018, Nov 13) Asia Pacific health care benefit costs expected to increase by 7.8% in 2019, Willis Towers Watson survey finds, Retrieved from: https://www.willistowerswatson.com/en-SG/News/2018/11/asia-pacific-health-care-benefit-costs-expected-to-increase-by-7-8-percent-in-2019
- 3.Baker, J.A. (2018, April 07) Singapore ranks high in report on medical inflation in Asia, Retrieved from: https://www.channelnewsasia.com/news/singapore/medical-hospital-costs-singapore-inflation-aon-10112896