Commitment to Change: Value-based Healthcare in Canada

In an article I posted late last year, I made the assertion that patients across the country were waiting for better care. I pointed to the importance of Canadians adopting new, value-based healthcare delivery models – as other jurisdictions around the world are doing – and the opportunities that exist, in this, our post-COVID reckoning phase, for bold thinking and innovation. While I fully recognize the examination and adoption of new practices is difficult, especially those which differ significantly from current standards, a commitment to change is needed, now more than ever.

How Did We Get Here?

Over decades, the evolution of healthcare delivery across Canada has led to different approaches in different provinces. Unintended outcomes have included a lack of standardized data collection and non-integrated care continuum (among many others). In some areas of care, where new modes of treatment or innovative technological advancements have become the norm, a lack of rigour in follow up means the true value of change either isn’t fully assessed or, is not assessed in ways that lead to widespread advantageous knowledge sharing. More recently, the COVID pandemic starkly illuminated flaws in our healthcare systems, exhausted the professionals who work in it, and impeded the delivery of services through the pandemic, and in its lingering wake. Clearly, from a standpoint of shared and collective need, we should be seeking ways to commit to changes that address these important issues.

How Will Canada Create Our Own Positive Path Forward?

There are a range of institutional voices in Canada not only actively speaking about, but also investing in value-based healthcare. Their narratives are compelling and increasingly consistent. Here are some of the key themes I see, in terms of what the research is telling us about the path towards effective VBHC adoption:

1. Establishing trust among partners and bringing the right people to the table is paramount to realizing value-based healthcare aspirations in Canada. The Resilient Healthcare coalition brought together diverse health and life sciences stakeholders to provide policymakers and system leaders with an ideal forum to pressure-test ideas and gather insights. Similarly, as the federal government voiced the need for a broad data infrastructure and national standards agreement, the pan-Canadian Health Data Strategy Expert Advisory Group gathered input from diverse institutional partners. I’ve had the opportunity to participate in several Public Policy Forum conversations, with Johnson & Johnson as a supporting partner and industry representative. The Public Policy Forum: The Future of Health Care in Canada report outlines the many and varied bodies which have come together to work toward VBHC ideals.
2. Ensuring cross-sectoral representation – with input from patients, academics, industry, and clinics – is key to healthcare decision-making. For example, in the Conference Board of Canada’s Value-Based Healthcare Overview, Patient Reported Outcomes (PROs) and data collection are being tracked by a multi-site collaborative initiative with hospitals and experts. The aim is to initiate and improve the collection and use of PROs across a variety of therapeutic and surgical areas. Meanwhile, The 20 Sense Report: Value-Based Healthcare in Canada confirms that measuring value should start with diagnostic testing to identify the right patients for complex treatments. Then, they advocate sharing patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) with healthcare experts across sectors as second stage value assessment.
3. Making health decisions based on real data insights. The Canadian Foundation for Healthcare Improvement: Value-Based Healthcare Toolkit (January 2020) has defined their highest priority as the establishment of meaningful metrics, outcomes and cost data, clear scope and material impact.

Each of these organizations is contributing important research, insights, and points of view that can and should guide a patient-centred approach to achieving better health outcomes as a return on the investment Canadians make in care delivery. At the same time as these inputs are being reviewed, the innovations made by key #MedTech organizations in this country and around the world should also be considered, and included in the decision-making matrix.

Innovation: A Critical Part of Positive Change

Value-based healthcare is not just an ideal. In its most pure form, it is an ethic of delivering every aspect of care in visionary ways – adopting proven practices that support the best possible patient health outcomes. At a recent symposium in the U.K., MedTech hosts, patient advocates, health professionals and administrators came together to discuss a devastating, yet preventable, impact on patients: surgical site infections. As presented in the Clinical Services Journal, “Surgical site infections (SSIs) are among the most reported healthcare-associated infections. They have an adverse economic impact on hospitals, as well as on the patient.” The Journal noted that “SSIs can lead to increased length of hospital stay (7–10 days), as well as doubled mortality, while patients with an SSI are 60% more likely to spend time in the intensive care unit and five times more likely to be readmitted.” These are disastrous, life-threatening procedural outcomes…and they simply shouldn’t happen. At the Burden of Infection Symposium, former distinguished British surgeon and current University of Huddersfield Emeritus Professor David Leaper presented multiple studies which proved that there are “simple, and relatively inexpensive steps to implement care bundles that can have a dramatic impact on rates of surgical site infection.” ‘Care bundles’ are a series of actions – combining best practices in areas such as wound cleaning, application of medications, and then suturing, that – when performed in a clinically proven but simple step-by-step manner – can drastically reduce[1] the occurrence of SSIs. The challenge is that several steps use innovative materials that might not pass ‘lowest cost’ procurement assessments. As with the research noted above, internationally proven findings, such as those presented by Professor Leaper, should be equally weighed, as our systems move towards adoption of VBHC principles.

Moving From Discussion to Action

Over the last several months, through working meetings with provinces, conversations focused on investments through the Canada Health Transfer have established important criteria for better care, more equitably accessed across the country. These criteria hold out hope that decision-makers will look more strategically at the overall economics of care, and support moves to advance innovations that reduce total costs over a time horizon – rather than focusing more narrowly on individual components of care. Clearly, innovations – such as those which prevent surgical site infections – improve patient health outcomes across the continuum, as well as increase efficiencies and operating room productivity.

For VBHC delivery models to supplant our current practices, the changes must be ‘good for four.’ By this I mean that VBHC must prove beneficial for patients, for physicians and other providers, for those who pay – or, more specifically those who allocate funds towards – our healthcare systems and infrastructure, and good for producers of innovation.

• Patients must have access to their own data, which is aligned to global standards, and which can be used to impact practice improvements continuously and positively.
• Providers of the care we receive must be supported in their ability to perform at the highest possible levels and encouraged to do their best work.
• Payers, from procurement administrators to federal and provincial policy makers, must support expansion of our health delivery systems, and the ability for both providers and patients to gain access to innovative health technologies; and
• Producers – whose research, development, and solutions fuel innovation across the healthcare continuum – must be fairly, equally and strategically considered, in VBHC decision-making.

If we can achieve these objectives, lofty as some may see them, I have no doubt that our systems and health professionals can deliver the care Canadians need and deserve, for our investment. The changes we must be bold enough to make – leveraging the excellent existing and new research currently underway – should be non-negotiable. Making commitments to change is never easy. But I believe the immense value of the outcomes made possible if we do, would be well worth the hard-fought journey.

1. Studies cited at the Symposium illustrated that the use of care bundles, specific to a range of various surgical procedures, resulted in 60% reductions in SSIs.