Healthcare can't stop evolving: innovation as the catalyst for unleashing the managerial potential of value-based healthcare by stimulating intangible assets and enhancing organizational resilience.

Background: With increasing healthcare service utilization and the introduction of costly therapies, healthcare organizations are pressured to deliver cost-effective services within constrained budgets. Rising costs and the need for efficient healthcare delivery are major concerns for governments, insurers, and health plans. Objectives: It aims to understand the impact of these intangible assets on creating value and organizational resilience in healthcare, informing better practices and strategies for VBHC implementation. Methods: An applied research approach using the Work Breakdown Structure (WBS) methodology was adopted. The research was divided into seven interconnected Work Packages (WPs), each designed to investigate different aspects of the integration between VBHC and intangible assets, with a focus on enhancing organizational resilience through innovative health processes. Key methodologies included literature reviews and qualitative analyses, employing Open Innovation and Design Thinking. Results: The study revealed a dynamic interplay between VBHC, organizational resilience, and intangible assets. It showed that managerial effectiveness is influenced by direct patient outcomes and elements like intellectual capital and organizational reputation. Data integration from various Work Packages provided new insights into how intangible assets underpin VBHC strategies, proposing novel management approaches. Findings highlight the essential role of intangible assets in enhancing service delivery and fostering sustainable healthcare practices. Discussion: The study highlights a significant oversight in the integration of intangible assets within healthcare organizations, despite their crucial role in optimizing VBHC. It supports literature emphasizing the importance of intellectual capital and organizational culture in enhancing healthcare management efficiency and resilience. A paradigm shift in VBHC to include these assets is needed for building a more adaptable and sustainable healthcare system. This integration can lead to better clinical outcomes, patient satisfaction, and overall healthcare efficiency, aligning more closely with VBHC goals. Conclusion: Recognizing and effectively managing intangible assets are paramount for the successful implementation of VBHC and enhanced organizational resilience. Strategic integration of these assets into healthcare management practices can significantly improve patient outcomes and create a more sustainable, patient-centered, and resilient healthcare system. Future studies should develop methodologies for robust measurement and integration of these assets to fully realize the potential of VBHC.

Expert Consensus for the Use of Outpatient Rehabilitation Visits After Total Knee Arthroplasty: A Delphi Study.

OBJECTIVE: There is no consensus for how to use rehabilitation visits after total knee arthroplasty (TKA). We sought to develop expert recommendations for outpatient rehabilitation visit usage after TKA. DESIGN: Delphi study. METHODS: First, we developed a broad list of preliminary visit usage recommendations, which were specific to patients' recovery status (ie, slow, typical, or fast recovery) and time since surgery. We then invited 49 TKA experts to participate on a Delphi panel. During round 1, we surveyed panelists regarding their level of agreement with each preliminary recommendation. We conducted additional Delphi rounds as needed to build consensus, which we defined using the RAND/UCLA method. We updated the survey each round based on panelist feedback and responses from the previous round. RESULTS: Thirty panelists agreed to participate, and 29 panelists completed 2 Delphi rounds. The panel reached consensus on recommendations related to visit frequency, visit timing, and the use of telerehabilitation. The panel recommended that outpatient rehabilitation should begin within 1 week after surgery at a frequency of 2 times per week for the first postoperative month regardless of recovery status. The panel recommended different visit frequencies depending on the patient's recovery status for postoperative months 2 to 3. The panel agreed that telerehabilitation can be recommended for most patients after TKA, but not for patients recovering slowly. CONCLUSION: We used the Delphi process to develop expert recommendations for the use of outpatient rehabilitation visits after TKA. We envision these recommendations could help patients decide how to use visits based on their own preferences. J Orthop Sports Phys Ther 2023;53(9):1-9. Epub: 10 July 2023. doi:10.2519/jospt.2023.11840.

Value-based health care in heart failure: Quality of life and cost analysis

Abstract Objectives: To measure Quality of Life (QoL) and costs of Heart Failure (HF) outpatients in Brazil as an introduction to the Value-Based Health Care (VBHC) concept. Materials and methods: Cross-sectional study, patients with HF, with ejection fraction <50%, were recruited from three hospitals in Brazil. Two QoL (36-Item Short Form Survey [SF-36] and Minnesota Living with Heart Failure Questionnaire [MLHFQ]) and two anxiety/depression questionnaires were applied. SF-36 scores were stratified by domains. Treatment costs were calculated using the Time-Driven Activity-Based Costing (TDABC) method. Results were stratified by NYHA functional class and sex. Results: From October 2018 to January 2021, 198 patients were recruited, and the median MLHFQ (49.5 [IQR 21.0, 69.0]) and SF-36 scores demonstrated poor QoL, worse at higher NYHA classes. A third of patients had moderate/severe depression and anxiety symptoms, and women had higher anxiety scores. Mean costs of outpatient follow-up were US$ 215 ± 238 for NYHA I patients, US$ 296 ± 399 for NYHA II and US$ 667 ± 1012 for NYHA III/IV. Lab/exam costs represented 30% of the costs in NYHA I, and 74% in NYHA III/IV (US $ 63.26 vs. US$ 491.05). Conclusion: Patients with HF in Brazil have poor QoL and high treatment costs; both worsen as the NYHA classification increases. It seems that HF has a greater impact on the mental health of women. Costs increase mostly related to lab/exams. Accurate and crossed information about QoL and costs is essential to drive care and reimbursement strategies based on value.

Cost standard set program: moving forward to standardization of cost assessment based on clinical condition.

This communication piece is reporting the launching of the International Cost Standard set program, aiming to introduce standardized frameworks to measure costs for specific clinical conditions worldwide. A scientific committee including 16 international healthcare cost assessment experts from several countries, and International Consortium for Health Outcomes Measurement was formed to introduce the program. The committee got together in Lisbon for a first scientific meeting, followed by an international conference where time-driven activity-based costing applied studies were shared with the community. The cost standard set program start to offer instruments for people to measure with real-world data, the financial impact of having access to health technologies, improving the ability to evaluate inequity. Those advances might represent a paradigm shift in our ability to generate cost information on an individual level.

Escore de Valor em Saúde (EVS): Uma proposta para mensuração de valor dentro de um sistema de saúde / Value-based Health Care Score (EVS): A proposal for measuring value within a health system

Um sistema de saúde baseado em valor deverá entregar os melhores desfechos possíveis ao paciente, desfechos que realmente importam para ele, ao menor custo possível. O conceito é relativamente fácil de entender, mas a métrica para a sua demonstração tem sido um grande desafio dos sistemas de saúde. O presente artigo demostra a criação de um Escore de Valor em Saúde (EVS) utilizando Análise de Decisão por Multicritério, o qual pode ser aplicado em qualquer sistema de saúde para avaliar profissionais, serviços de saúde e linhas de cuidado de pacientes com condições clínicas específicas.

A value-based healthcare system must deliver the best possible patient outcomes, outcomes that really matter to the patient, at the lowest possible cost. The concept is relatively easy to understand, but the metric to demonstrate it has been a major challenge for healthcare systems. This article demonstrates the creation of a Health-Based Health Care Score (EVS) using Multi-Criteria Decision Analysis which can be applied in any health system to evaluate professionals, healthcare providers and care pathways for patients with a specific disease.

Success and failure after surgery of degenerative disease of the lumbar spine: an operational definition based on satisfaction, pain, and disability from a prospective cohort.

BACKGROUND: To describe success and failure (S&F) after lumbar spine surgery in terms equally understandable across the entire health ecosystem. METHODS: Back and leg pain and disability were prospectively recorded before and up to 12 months after the procedure. Satisfaction was recorded using a Likert scale. Initially, patients were classified as satisfied or unsatisfied. Optimal satisfaction/unsatisfaction cutoff values for disability and pain were estimated with ROC curves. Satisfied and unsatisfied groups underwent a second subdivision into four subcategories: success (satisfied AND pain and disability concordant with cutoff values), incomplete success (satisfied AND pain and disability nonconformant with cutoff values), incomplete failure (unsatisfied AND pain and disability nonconformant with cutoff values), and failure (unsatisfied AND pain and disability concordant with cutoff values). RESULTS: A total of 486 consecutive patients were recruited from 2019-2021. The mean values of preoperative PROMs were ODI 42.2 (+ 16.4), NPRS back 6.6 (+ 2.6) and NPRS leg 6.2 points (+ 2.9). Of the total, 80.7% were classified as satisfied, and 19.3% were classified as unsatisfactory. The optimal disability and pain cutoff values for satisfaction/unsatisfaction (NPRS = 6, AND ODI = 27) defined a subdivision: 59.6% were classified as success, 20.4% as incomplete success, 7.1% as incomplete failure and 12.4% as failure. The descriptions of each group were translated to the following: success-all patients were satisfied and presented no or only mild to tolerable pain and no or borderline disability; incomplete success - all patients were satisfied despite levels of pain and/or disability worse than ideal for success; incomplete failure - all patients were not satisfied despite levels of pain and/or disability better than expected for failure; failure - all patients were unsatisfied and presented moderate to severe pain and disability. CONCLUSION: It is possible to report S&F after surgery for DDL with precise and meaningful operational definitions focused on the experience of the patient.

Telemedicine Versus Face-to-Face Care in Ophthalmology: Costs and Utility Measures in a Real-World Setting.

OBJECTIVES: Advances in telemedicine offer a unique opportunity to expand access to the health system. Nevertheless, few studies have described the impact of telediagnosis implementation on health and economic outcomes. METHODS: An ophthalmology telediagnosis service (TeleOftalmo) was compared with traditional face-to-face care provided by the Brazilian public health system. For both groups, utility data were collected at 2 time points using the Visual Function Questionnaire-Utility Index instrument from interviews with 536 patients. The cost per patient encounter was analyzed according to the time-driven activity-based costing. Value analyses were conducted to ascertain whether and how telemedicine service has the potential to generate cost savings for the health system. RESULTS: Visual function-related quality of life did not differ significantly between TeleOftalmo and face-to-face care groups. Using the current model, the telemedicine service assisted an average of 1159 patients per month at a median cost per telediagnosis of Int$97 (interquartile range, Int$82-Int$119) versus Int$77 (interquartile range, Int$75-Int$80) for face-to-face care. If the telemedicine service was redesigned, considering the opportunities for improvement identified, it could operate at a cost of Int$53 per telediagnosis (a 31% cost savings) and could serve 3882 patients per month. CONCLUSIONS: This study demonstrates the potential value of a telemedicine service. There was no difference in patient-perceived utility between a telediagnostic ophthalmology service and face-to-face care by an eye specialist. TeleOftalmo has the potential to be a cost-saving strategy for the Brazilian health system and could be a template for implementation of telediagnostic services in other regions.

Indicadores de calidad en la atención de salud en cirugía oncológica de cabeza y cuello / Quality indicators in health care in head and neck cancer surgery

Resumen La mayoría de los servicios de salud han experimentado un aumento de los costos asociados a la atención de salud lo que ha llevado a adoptar medidas para optimizar la costo-efectividad de los servicios otorgados. Desde esa perspectiva surge la atención de salud basada en el valor. El concepto de "calidad en la atención de salud" se ha definido como el grado en el cual los servicios de salud aumentan la posibilidad de generar ciertos desenlaces en salud a los que se aspira. Los indicadores de calidad de clasifican en indicadores de estructura, de proceso, y de desenlace. Los indicadores de estructura se refieren a las características del sistema de salud o de la institución hospitalaria. Los indicadores de proceso se refieren a los que el proveedor de servicios de salud realiza para el proceso de atención en salud, mientras que los indicadores de desenlace se refieren a los resultados del proceso en el paciente. El objetivo de la presente revisión es proveer un marco conceptual para dar un contexto al concepto de indicadores de calidad en salud y el rol que estos juegan en cirugía oncológica de cabeza y cuello. Se debe aspirar a lograr un mayor cumplimiento de los indicadores de calidad en cirugía oncológica de cabeza y cuello, especialmente en instituciones terciarias de referencia. Aplicar indicadores de calidad en el manejo oncológico en cabeza y cuello permitiría mejorar tanto la percepción y satisfacción del usuario, como también mejorar resultados oncológicos en estos pacientes.

Abstract Most health services have experienced an increase in the costs associated with health care, which has led to the adoption of measures to optimize the cost-effectiveness of the services provided. From this perspective, the concept of value-based health care emerged. The concept of "quality in health care" has been defined as the degree to which health services increase the possibility of generating certain desired health outcomes. Quality indicators are classified into structure, process, and outcome indicators. The structure indicators refer to the characteristics of the health system or the hospital institution. Process indicators refer to those that the health service provider performs for the health care process, while outcome indicators refer to the results of the process in the patient. The objective of this review is to provide a conceptual framework to give a context to the concept of health quality indicators and the role they play in head and neck surgical oncology. The system should aspire to achieve greater compliance with quality indicators in head and neck cancer surgery, especially in referral tertiary institutions. Applying quality indicators in head and neck cancer management would improve both user perception and satisfaction, as well as improve oncological results in these patients.

The Economic Impact of COVID-19 Treatment at a Hospital-level: Investment and Financial Registers of Brazilian Hospitals.

Background: The economic impact associated with the treatment strategies of coronavirus disease-2019 (COVID-19) patients by hospitals and health-care systems in Brazil is unknown and difficult to estimate. This research describes the investments made to absorb the demand for treatment and the changes in occupation rates and billing in Brazilian hospitals. Methods: This research covers the initial findings of "COVID-19 hospital costs and the proposition of a bundled reimbursement strategy for the health-care system," which includes 10 hospitals. The chief financial officer, the chief medical officer, and hospital executives of each participating hospital provided information regarding investments attributed to COVID-19 patient treatment. The analysis included variations in occupation rates and billing from 2019 to 2020 observed in each institution, and the investments for medical equipment, individual protection materials and building construction per patient treated. Results: The majority of hospitals registered a decrease in hospitalization rates and revenue from 2019 to 2020. For intensive care units (ICUs), the mean occupancy rate ranged from 88% to 83%, and for wards, it ranged from 85% to 73%. Monthly average revenue decreased by 10%. The mean hospital investment per COVID-19 inpatient was I$6800 (standard deviation 7664), with the purchase of ventilators as the most common investment. For this item, the mean, highest and lowest acquisition cost per ventilator were, respectively, I$31 468, I$48 881 and I$17 777. Conclusion: There was significant variability in acquisition costs and investments by institution for responding to the COVID-19 pandemic. These findings highlight the importance of continuing microeconomic studies for a comprehensive assessment of hospital costs. Only with more detailed analyses, will it be possible to define and drive sustainable strategies to manage and reimburse COVID-19 treatment in health-care systems.

Atención en salud basada en el valor: retos y oportunidades / Value-based health care: challenges and opportunities / Assistência médica baseada em valor: desafios e oportunidades

La atención en Salud Basada en el Valor es un modelo de atención re-ciente, innovador, dirigido a garantizar mejores resultados en salud para la población atendida, paralelo a un uso óptimo de los recursos. Para su implementación, dicho modelo propone una serie de principios, los cua-les son analizados dentro del presente documento. Para esto, se tiene en cuenta no sólo sus características fundamentales, sino también, su facti-bilidad, posibles barreras y oportunidades. Los principios revisados son: unidades integradas de atención, medición de resultados en salud y cos-tos, plataformas tecnológicas, modelos de pago centrados en la atención, sistemas integrados de atención y expansión geográfica. Adicionalmente, se incluyen la atención centrado en el paciente y el trabajo en equipo co-mo componentes fundamentales de este modelo también

Value-based Health Care is a recent, innovative delivering healthcare model which has emerged as a cost-effective alter-native to provide superior health outcomes for patients while decreasing inefficiencies in the system. For its successful im-plementation this model provides a set of principles which are revised in the present article, providing insights on their feasibility, challenges and opportunities. The principles revised here are: Integrated Practice Units, Health Outcomes and Cost Measurement, Value-based Payments, enabling health systems platforms, and efficient allocation of resources. Along with the-se, a person-centered approach and stakeholders' participation and engagement have been also revised as key components of the model.

A assistência médica baseada em valor é um modelo de assis-tência inovador que visa garantir melhores resultados de saúde para a população atendida e o uso ideal dos recursos. Para sua implementação, propõe-se uma série de princípios anali-sados neste documento, uma análise na qual são levadas em consideração as características fundamentais, viabilidade, pos-síveis barreiras e oportunidades que esse modelo pode gerar. Os princípios revisados são: unidades de atendimento integra-das, mensuração de resultados de saúde e custo, plataformas tecnológicas, modelos de pagamento focados na geração de valor, sistemas / redes de atendimento integrados e expansão geográfica. Além disso, o atendimento centrado no paciente e o trabalho em equipe são incluídos como componentes funda-mentais deste modelo.