Your Value-Based Healthcare questions answered by Stefan Larsson

Stefan Larsson, MD, PhD

Board Member and Founder of ICHOM

Your Value-Based Healthcare questions answered by Stefan Larsson

23 June 2021 | 4min

Back in May, we invited you all to our Value-Based Healthcare (VBHC) Live Event, where we took a deep dive into what exactly is VBHC and how to best implement it. We invited our keynote speaker, Stefan Larsson, along with several other experts to share their experiences on implementation, adoption and utilization of VBHC and they gave us some real life examples on how this can make an impact on healthcare around the globe. 

In case you missed the live event and prefer to read all about it, take a look at our summary article: “Value-based healthcare: What is it and how best to implement it?

As expected, we received a huge volume of interesting questions during our Live Q&A session. While Stefan did his best to answer as many as possible, many were still left unanswered. 

So, in this special follow-up article, we went back to Stefan to get his answers to your insightful questions.

HT: How can institutions overcome the main barriers to adopt and implement VBHC? 

Stefan Larsson: The best way to overcome those barriers or challenges is by providing access to outcomes data and a consensus view among local clinicians on what the most important metrics are that should be used. We propose using the international standards from ICHOM as a starting point, as they have been developed by large groups of very experienced clinicians.

HT: Apart from public health officials, who do you identify as the most critical player(s) to achieve successful VBHC? 

Stefan Larsson: Patients – engagements in reporting outcomes and interest in learning from differences in results. But payers are also very important – we need to move away from fee-for-service and towards bundled payment or other payment models which promote a holistic perspective on the patient care pathway and that promote prevention, early treatment and good outcomes.

HT: There is often confusion between “patient outcomes” and “patient experience”. Do you consider them as two different concepts or do you see a connection between the two?

Stefan Larsson: I see them as absolutely different. Patient experience is typically the subjective view of a patient regarding the attitude and behaviour of staff, the condition of the facilities, etc. Patient outcomes are health metrics – concrete measures of whether the patient has reached a higher level of health following a care episode – whether it is quality of life that has improved, pain reduced or, for example, a better ability to walk.

Kind and caring staff are very important for good outcomes as patient trust is higher, for example, a patient’s likelihood of complying to a treatment prescribed is higher. Therefore a good experience will automatically contribute to better outcomes – but it is important to not mix them up. Nice facilities should never compensate for poor outcomes for the patient.

HT: How does VBHC benefit patients with respect to complications and negligence?

Stefan Larsson: Patients have the duty to know if a provider has many complications or if staff are perceived as negligent by other patients. If there is a choice of providers they may then choose to go elsewhere, or they can put pressure on insurers, governments or other payers to demand providers to improve. It is important that we facilitate the patient voice to be heard to drive improvement

HT: What would you suggest to put VBHC in the decision makers’ focus in developing countries where the healthcare system may be less mature?

Stefan Larsson: Primary in many developing countries is access to basic care, vaccinations, antibiotics, etc. As a country’s healthcare system matures, it is key to make sure changes and new methods used have the desired impact on patient health. Therefore, finding pragmatic (e.g. mobile phone-based, digital) methods to gather outcomes data for major patient groups should be a high priority. By doing so you make sure one does not replicate the inefficient systems of the rich world, but rather leapfrog to a more patient-centric system, where outcomes achieved have a central role.

HT: Some healthcare systems are not yet organized in a way that allows for a full VBHC approach (fragmented acute, community, primary care). In your opinion, can VBHC be implemented partially? What would be the key elements of success? 

Stefan Larsson: There may be specific patient areas where a partial implementation of VBHC could be piloted – e.g. in elective orthopedic surgery. There are outcomes registries across the world to learn from, or the ICHOM standard sets could be used. One could also start by integrating a bundled payment concept for those patients or for distinct patient groups, such as cataract patients.

Stefan Larsson, MD, PhD is an independent advisor and investor. During his 24 years with The Boston Consulting Group (BCG) Stefan led (2011-2017) the firm's global health provider and payer sector and (2017-2020) its healthcare systems sector. In addition, Stefan is a senior advisor to BCG and a fellow with BCG’s Bruce Henderson Institute where he lead the firm’s research on value-based health care.