How AbbVie’s ‘Decisions with Value’ initiative brought healthcare experts together to tackle the challenge of improving health outcomes while making savings.
Over recent years the NHS has faced complex challenges to remain sustainable – adapting to deal with an ageing patient population and tightening financial controls, whilst also making productivity and efficiency savings. AbbVie recognised the challenge that this presented having seen frequent examples of how pressure to realise efficiencies had led to a concept of ‘value’ in NHS services commonly being approached in terms of cutting costs, instead of securing the greatest improvement in outcomes within the NHS budget available.
The Decisions with Value initiative began in 2017 with the aim of helping those working within the NHS to achieve the greatest improvement in health outcomes possible, within the fixed budget or resources available. The work remains highly relevant as the NHS Long Term Plan sharpens the value imperative further, containing as it does a number of interdependent aims to ultimately secure more efficient services, enhancing impact on patient and clinical care, whilst maintaining financial discipline.
Making value-based decisions
AbbVie brought together experts from across academia, healthcare policy and the NHS, all with front-line knowledge on the concept of value, to firstly investigate how it is understood and perceived within the NHS. The resulting report, ‘Kick-starting Value in the NHS’, focused on the implementation of value-based decision-making in a healthcare setting, which considers a broader set of metrics than simply cost of acquisition alone to deliver valuable health outcomes.
The experts sought to facilitate an understanding of ‘whole system value’ and support a more holistic view of healthcare that avoids the pitfalls of silo thinking – in particular, how different roles within the NHS can fit with others to make more sustainable value-based decisions. Three practical guides for providers, commissioners and clinicians identified the barriers and challenges that often hinder the achievement of value (such as a single-minded focus on cost of acquisition); highlighted successful case studies of innovative local initiatives, and signposted NHS validated tools to support implementation of value-based decisions locally and at scale across regions.
One of the greatest challenges is uniform adoption of approaches across the NHS. Speaking to front-line staff in the NHS I was struck by how difficult it can be, for a doctor or nurse trying to make positive change in the way they care for patients, to get visibility on how that change fits into the wider needs of the healthcare system or get buy-in from other parts of the NHS.
Integration continues to be a key driver to reform healthcare delivery but people needed help in articulating their plans to commissioners and providers, or vice versa, to deliver an improved, sustainable system-wide service. That’s where the guides come in, giving examples of how it has been done elsewhere to try and remove unwarranted regional variation so that next time healthcare staff want to improve out of hospital care in a long-term condition, for example, they have a resource at their fingertips to make that happen.
In addition to materials, facilitating face-to-face interactions was key to further embed the value concept across the NHS, fostering networking and the sharing of best practice.
• Decisions with Value Roundtable meetings discussed how to ensure that the principles of whole-system value are taken into account with pathway design and optimisation and reducing variation (as per NHS Right Care principles) in gastroenterology, helping to bring to life the concept in a specific therapy area. This led to a special report ‘Taking the Value-Based Agenda Forward: The Five Essential Components of Value-Based Approaches to Health and Care’.
• Commissioner and Provider Roundtable meetings at Clinical Pharmacy Congress and the Commissioning Show tasked participants with sharing and delivering their own case studies about value-based decision-making locally. Those attendees are now networked and sharing progress.
AbbVie formally partnered with NHS Confederation (NHSC) and the Healthcare Financial Management Association (HFMA), to reach NHS commissioners, providers and finance leaders. In each of the devolved nations, Decisions with Value was exhibited at NHS conferences in Scotland, Wales and Northern Ireland.
The Decisions with Value initiative has delivered tangible outcomes. Whether discussing whole system value at an exhibition in Belfast and Cardiff, or a roundtable discussion in London it was clear how much interest there is in the concept. Getting these things right is more complicated than it seems, but we know that healthcare teams have taken the insights back into their regional and local service discussions.
We’ve also seen pathways being redesigned to reduce hospital demand across inflammatory bowel disease services in different parts of England. And we have discussions ongoing about how to embed these principles in long term condition management in other areas to trial the approaches in a practical setting.
Value, when properly implemented across organisations and whole systems, can deliver improved clinical and financial outcomes, alongside achieving better patient experience – all critical if the NHS is to remain sustainable for years to come.
Decisions with value
The NHS is facing complex challenges every day; with only finite resource available it must rethink its approach to value.
Value is securing the greatest improvement in health outcomes possible within the fixed budget of the NHS
It is NOT…
minimising costs by cutting resource or budget, often at the expense of health outcomes.
Achieving real value in the NHS requires a whole system approach
Everyday healthcare decision-making should consider:
- Personal value1 for the individual
- Delivering outcomes of most importance to a patient
- Allocative value1 for the population
- Delivering outcomes across a group of people
- Technical value1 for the system
- Delivering quantity, safety, quality and outcomes from allocated resource
Maximising value can be difficult and there are many barriers
However, embedding it in everyday practice will help lay the groundwork for the longer-term change required within the NHS.
Decisions with Value guides provide practical advice and tools to support adoption
of value-based decision-making for:
• Managing conflicting priorities between departments and organisations
• Overcoming perceived lack of information on outcomes or costs data
• Aligning contracts to the achievement of health outcomes over activities
• Collaborating with clinical colleagues
• Securing investment in value
• Designing effective patient pathways
• Identifying patient challenges
• Securing the clinical voice in leadership decisions
• Developing a business case template to implement value change
Antonis Papasolomontos is Corporate Affairs and Policy Lead at AbbVie UK.
References: 1. NHS Confederation (2015) The ’triple value agenda’ must be our focus this century. Available at: https://www.nhsconfed.org/blog/2015/05/the-triple-value-agenda-should-be-our-focus-for-this-century [Accessed May 2017]. 2. Wagner et al. Med Care. 1995 Aug;33(8):765-70. Available at www.ncbi.nlm.nih.gov/pubmed/7543638 3. Williams, S. et al. (2012) IMPRESS Guide to the relative value of COPD interventions, British Thoracic Society Reports, 4(2). Available at: http://www.academia.edu/26043328/ISSN_2040-2023_British_Thoracic_Society_Reports_Vol_4_Issue_2_2012_IMPRESS_Guide_to_the_relative_value_of_COPD_interventions [Accessed May 2017]. 4. NHS Institute for Innovation and Improvement (2012) Quality and Service Improvement Tools. Available at: https://webarchive.nationalarchives.gov.uk/20121201160701/http://www.institute.nhs.uk/quality_and_service_improvement_tools/quality_and_service_improvement_tools/ [Accessed May 2017].