The interview partners
Prof. Dr. Patrick Da-Cruz is Professor of Business Administration and Healthcare Management at the Faculty of Healthcare Management at Neu-Ulm University of Applied Sciences (HNU) and Academic Director of the MBA program Leadership and Management in Healthcare.
Before joining the HNU, Mr. Da-Cruz worked for renowned strategy consultancies in the pharmaceutical/healthcare sector and in management positions in companies in the healthcare industry in Germany and abroad.
As Health Innovation Manager at IKK Südwest, Dr. Florian Brandt deals with the development, implementation and evaluation of new approaches to improving healthcare. This also includes promoting the introduction and dissemination of digital technologies in the German healthcare market. In addition to his professional activities, he researches and publishes on current health science topics. He previously completed a degree in economics and a doctorate in theoretical medicine at Saarland University.
What do you mean by value-based healthcare?
Dr. Florian Brandt: Value-based healthcare describes a way of designing healthcare systems that is consistently geared towards increasing patient well-being. The concept goes back to the Harvard economist Michael Porter, according to whom healthcare systems around the world are currently organized around medical specialties rather than patients. The aim of any further development measures should therefore be a stronger focus on patient benefit, without losing sight of sustainable financial viability. Michael Porter summarizes this connection in the relationship between “health outcomes” and “costs”, from which the patient-related “value” is derived. In terms of SHI, this is reflected in the sometimes ambivalent relationship between “patients” and “insured persons” - two sides of the same coin. Anyone who looks at their payslip at the beginning of the month and is annoyed about excessively high health insurance contributions or “costs” is in the role of the insured person, while the person in hospital hoping for a complication-free operation or the best possible “outcome” is in the role of the patient. In SGB V, the central regulatory framework of the SHI system, these two perspectives are manifested in the quality and efficiency requirements.
What role does the topic currently play in the healthcare sector?
Dr. Florian Brandt: In view of the still uncoordinated coexistence of specialists in private practice, the inadequate linking of outpatient and inpatient care units and a remuneration logic that creates an incentive for more “volume” instead of “value” through non-performance-related service fees, Porter's assessment is unfortunately confirmed. In addition, developments such as the ageing of society, the shortage of specialists and advances in medical technology pose fundamental challenges for the healthcare system in terms of quality and financial viability. However, it is also becoming increasingly clear that the established structures of the healthcare system organized by associations are too sluggish to adequately counter such dynamic developments through continuous innovation. This is where the individual players, e.g. individual practitioners, technology providers or health insurance companies, increasingly come into play, who can react comparatively quickly and unbureaucratically with innovative care solutions to specific care problems by concluding individual special agreements, so-called selective contracts. Value-based healthcare plays a central role in such selective contracts, as participation in selective contracts is voluntary for all parties, including patients. If no perceptible “value” were created here for all parties in comparison to regular care, the selective contract would simply not work.
To what extent can VBHC improve patient orientation?
Dr. Florian Brandt: If we understand Value Based Healthcare, as already described, as an interplay to be optimized between “health outcomes” and “costs” or, to put it in SHI terminology, “quality” and “cost-effectiveness”, the improvement in patient orientation is probably obvious: if the VBHC yardstick is applied in the decision-making process regarding potential further development measures, patients, or insured persons, will receive either higher quality or more cost-effective care - ideally both. This is basically also the perspective that we health insurance funds take when evaluating care innovations offered by us that are eligible for selective contract cooperation. In this respect, we are two-dimensional beings, so to speak. The providers in question should always explain to us as plausibly as possible how the healthcare innovation on offer can provide a health benefit for the patient while at the same time reducing costs in the respective area of care. These two aspects often go hand in hand: if, for example, better treatment results are achieved through an innovative treatment method and secondary diseases or complications are avoided, this also leads to cost savings in the medium to long term. After all, the secondary diseases or complications do not have to be treated later at great expense.
What dimensions can be used to measure “patient value”?
Dr. Florian Brandt: The systematic measurement of the actual patient benefit achieved is indeed an essential component of the VBHC concept. Michael Porter also repeatedly emphasizes this. Various objective outcomes such as complication rates, comorbidities, hospitalizations, days off work, certain vital signs, changes in organs or mortality rates, but also subjective measures such as Patient Reported Outcome Measures, PROMs for short, or Patient Reported Experience Measures, PREMs for short, come into consideration here. PROMs and PREMs are measurement instruments based on self-assessment by patients. With the help of standardized individual questions, health-related parameters are recorded for patients, which enables systematic patient orientation. Well-known examples that are used to measure health-related quality of life are the SF-12 or the EQ-5D. Added to this is the “insurant value”, which corresponds to the cost savings achieved. After all, we in the healthcare sector essentially spend the money that our policyholders entrust to us health insurers and that we try to allocate as efficiently as possible.
What lighthouse projects/initiatives can be found in German-speaking countries?
Dr. Florian Brandt: In a broader sense, these are all selective contracts that aim to improve the quality and cost-effectiveness of healthcare and are sustainable following an evaluation in this regard. Together with BIG direkt gesund, mhplus Krankenkasse and SBK Siemens-Betriebskrankenkasse, we have been running the Healthy Hub since 2018, the equivalent of the VOX show “Die Höhle der Löwen” (The Lion's Den), to find healthcare innovations that are eligible for selective contracts in this context. In the first round, IKK Südwest chose the technology provider Preventicus, with whom we have been cooperating on a selective contract basis for several years now. Preventicus offers a two-stage smartphone-based screening for atrial fibrillation - a cardiac arrhythmia that is considered the main risk factor for strokes. First, our policyholders can use the Preventicus app, which can be used to measure the heart rhythm easily and without accessories. In the event of abnormal measurements, technical verification is carried out by a connected telemedicine center and patients are then referred to a cardiologist for medical diagnostics using a long-term ECG. If the suspicion is confirmed, treatment can be started at an early stage, usually with the prescription of blood-thinning medication. The contract contains a pay-for-performance provision according to which the remuneration for Preventicus is reduced in line with the number of app-based suspected cases that are not confirmed during medical diagnostics - a provision that we have never actually had to apply due to the app's high measurement accuracy. The aim is to prevent strokes. In this way, those affected are spared the drastic consequences and the insured community is spared cost-intensive stroke care. However, VBHC elements are also increasingly found in standard care: For example, the proportion of performance-based price components in the provision of digital health applications (DiGA) must soon be at least 20 percent of the remuneration amount, PROMs are already widely used in hospital care and, in accordance with the much-discussed hospital reform, compliance with certain quality standards is also to be given greater weight in remuneration in future.
Thank you very much for the interview!
The content and statements presented in the interviews reflect the perspective of the interviewees and do not necessarily reflect the position of the editorial team.
