Four steps towards a value-based care model for Singapore
Mar 04, 2019 - reading time 6-7 mins
By Diederik Zeven General Manager, Health Systems, Philips ASEAN Pacific Diederik Zeven is the General Manager, Health Systems for Philips in ASEAN Pacific. He oversees the diverse portfolio of products, services and solutions across the region, including diagnostic imaging, image-guided therapy, patient monitoring and health informatics.
While Singapore’s healthcare system topped Philips’ Future Health Index (FHI) survey in efficiency and satisfaction, a future-proof approach is needed to cope with rising healthcare costs and a rapidly aging population. Moving towards a value-based care model could be the answer.
Singapore’s healthcare system came top of our recent Future Health Index (FHI) study[1] for both efficiency and satisfaction, with most of its healthcare professionals (HCPs) agreeing that the care available meets patient needs. However, maintaining such a well-performing system comes at a price. Singapore’s Finance Minister Heng Swee Keat recently announced that the government expects to spend an additional 0.8% of gross domestic profit on healthcare – an increase of about SGD$3.6 billion)[2] – over the next decade. In addition, costs are expected to rise as a result of the country’s aging population and rising rates of chronic diseases like diabetes. The financial implications of maintaining standards of care for a bigger, and more demanding, population is a pressing challenge across the developed world, but just pumping in more money might not be the answer. Instead, forward-thinking governments are starting to look at new models of care in order to future-proof quality – in particular, the ‘value-based care’ model. Value-based care is a care delivery model where providers are paid based on patient health outcomes rather than the amount of healthcare services that they provide. This is a fundamental shift from most countries’ current models – placing more emphasis on helping patients to live healthier lives and to prioritize illness prevention, rather than just on treating the sick. According to the World Economic Forum there are four key enablers[3] that countries need to invest in to truly make the shift to a value-based approach:
Data and health informatics
The first step towards value-based care is having an infrastructure in place for collecting, sharing and analyzing data that can be used not only for early diagnosis, but also in informing health policy around population management and disease prevention. The holy grail is to make it possible for data to be easily and safely shared between different organizations and databases, providing a single patient view regardless of which department or institution a patient is seeing. According to our FHI study, this integration to enable easy sharing of patient data is something that would be welcomed by the vast majority of Singapore’s healthcare professionals – with 90% agreeing that it’s important for healthcare systems to be integrated. To achieve this, Singapore will need to introduce a singular standard and architecture so that there is a common framework across all healthcare organizations. As well as government backing, this will require healthcare organizations – both public and private – to be willing and open to collaboration. Data security and trust are also key; Singapore’s government will need to reassure healthcare professionals and patients alike that their medical data is protected, in order to encourage widespread adoption.
The holy grail is to make it possible for data to be easily and safely shared between different organizations and databases, providing a single patient view regardless of which department or institution a patient is seeing.
Diederik Zeven
General Manager, Health Systems, Philips ASEAN Pacific
Benchmarking, research and tools
All that said, data can only make a difference if healthcare professionals have the knowledge and tools to make sense of it – otherwise it’s just numbers. So, as well as putting in place a framework to gather and share data more easily, Singapore will also need to upskill its healthcare professionals to be able to benchmark and analyze it effectively. Again, having a common language and curriculum around this is important, to ensure a consistent experience for patients, and to make it easier for healthcare professionals in different faculties, or even different organizations, to collaborate.
Delivery organizations and change management
Another challenge to be overcome is the organization of care delivery and patient information. Most healthcare professionals are segmented by function at each stage of the care chain, which often makes it difficult to achieve transparency and coordination. In theory, this structure should allow patients to find the right treatment for their conditions – be it basic care and disease prevention, or more specialized care. However, in practice, because most functions are not currently in the habit of sharing information with each other, patients often find themselves repeating the same information to multiple HCPs. For better patient outcomes and satisfaction, health systems need to do a better job of collaborating. Guided by the principles of equal access and regional autonomy, Sweden’s healthcare system is a good example of what can be achieved through an integrated healthcare system. All patients have access to their electronic health record online and undergo a similar process when it comes to seeking treatment.
Incentives and payments
The final piece of the puzzle is how healthcare is remunerated. The reality is that more often than not, payment models in the private sector still tend to ‘reward’ providers for the amount of treatment they provide, not the outcomes that they achieve. In the public sector, the fragmentation of government agencies can lead to compartmentalized spending, rather than a holistic approach – meaning certain areas of care are sometimes prioritized over others. To truly move towards a value-based approach, more emphasis needs to be placed on rewarding outcomes – particularly preventative ones. The difficulty comes in setting short-term KPIs for this, given the success of an outcomes-based approach will be most visible over the longer term Clearly the road to value-based care won’t be an easy one, but as costs continue to rise it may be Singapore’s only chance of safe-guarding its high quality of care in the future. By focusing on these four pillars, and following examples of best practice from around the world, Singapore can place itself into a stronger position to address the challenges of the next decade, and beyond.
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