2. Value-based innovation


Value-based innovation

A value-based healthcare (VBH) system has the potential to provide a framework for innovation and improved access to new medical technologies for patients.
The focus in Value-based healthcare systems has shifted from short-term to medium- to long-term outcomes [1], and there is a growing consensus that the shift from outputs to outcomes forces healthcare delivery to fulfil four requirements: participation, personalisation, prevention and prediction [2]. To reach this ambition, patients need to be involved at each stage:  innovation, assessment, implementation and evaluation. The innovators who are aspiring to deliver new ‘solutions’ must demonstrate an understanding of the following aspects as a starting point of any product:

  • Patient needs.
  • What ‘value’ in innovation actually means to patients.
  • How to improve health outcomes for patients.

One of the most relevant aspects in VBH is the role that innovation should play in rethinking and improving health care delivery and outcomes. Evaluations and health technology assessments (HTA) of Medical Devices should be seen in the context of a value-based health care system, which needs a conceptual shift that makes HTA cooperation on Medical Devices a constructive component of a value-based model. 

According to one of six recommendations given by the EC Expert Panel, the focus should be on initiatives for shared decision-making. The full recommendation reads:
'Support initiatives for patients’ engagement in shared decision-making, recognising the importance of patients´ goals, values and preferences, informed by high quality information to implement empowering practices and goal oriented person-centred care.' [3] Patient involvement in the context of Value-based healthcare should be understood at the system level, as patient involvement affects involvement in planning, design and development, as well as which projects the health system initiates or enters into, and which solutions are implemented either directly or via procurement or reimbursement schemes.

Figure 3 below shows a model for value-based innovation as a closed loop where patients should have a role in defining unmet needs, value and measures, safety criteria, HTA and procurement processes. The way in which patients can contribute is described in further detail in the following sections. 

Figure 3: Value and innovation-driven access model. MedTech Europe 2020. 

Many VBH systems systematically measure patient satisfaction as an integral part of quality measures. However, 'value' and 'patient satisfaction' are commonly confused. While patients have brought a much-needed emphasis on treating people with dignity and respect, the essential purpose of health care is improving health. Value is about helping patients. Satisfaction surveys ask patients: “How were we?”. Value-based care providers ask: “How are you?” [4]. 

When discussing the purpose of innovation—either healthcare services or products—patients should pay attention to which 'benefits' are measured under the VBH approach in order to not be confused by 'satisfaction' vs. 'outcome'. Being able to distinguish between purposes and choosing the best methods for measuring will help focusing on what creates the most value for patients.  

Another way of including patient perspectives in value assessments is via a Health Technology Assessment (HTA). The HTA is a structured and evidence-based process that also includes patient aspects. Please refer to the HTA Module for more detailed information on principles, processes, methodologies and patient involvement in general. These general principles and methodologies are also relevant as inspiration for assessing patient aspects in any procurement decision or planning of innovation projects.

For specific considerations related to HTA of Medical Devices and in vitro diagnostics, please also refer to course 4 of this module (Medical Devices). 

[1] Burns LR (2020). The Business of Healthcare Innovation. Cambridge University Press, Cambridge. 
[2] Moriates C, Arora V,Shah N. (2015) Understanding Value-Based Healthcare. McGraw-Hill Education. 
[3] European Commission, Expert Panel (2019). Defining value in 'value-based healthcare'. https://ec.europa.eu/health/sites/default/files/expert_panel/docs/2019_defining-value-vbhc_factsheet_en.pdf

[4] Teisberg E, Wallace S and O’Hara S.: Defining and Implementing Value-Based Health Care: A Strategic Framework. 2020 May; 95(5): 682–685.