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Image by Martha Dominguez de Gouveia

VALUE-BASED HEALTHCARE
M
eaningful, Measurable & Timely
An Innovative Service Delivery Model for the
Future of Osteoarthritis

Current challenges with the present service delivery model for Osteoarthritis

PROVIDERS

  • Growing patient demand and expectations with
    diminishing resources.

  • Patient end2end workflow is siloed

  • Misused resources (MRI)

  • Out-dated fee-for-service model

  • Increasing adverse/never events

PAYORS

  • Healthcare budgets are misspent and not sustainable

  • Large variability in outcomes and return on value

  • Increasing demands with imbalance portfolios

  • The patient workflow, has numerous varied payors without synchrony of care.

  • Clinical / operational / financial adverse events

PATIENTS

  • Not engaged, dissatisfied outcomes, long waits

  • Significant levels of surgical dissatisfaction (Esp Knees) extremely costly revisions

  • Socio-Economic issues and mental stress

  • Increasing adverse/never events (Drugs, opioids)

  • Complex system to navigate

  • Loss of independence, increased dependency

The Problem

The landscape of healthcare is undergoing a significant transformation, and it is clear that change is long overdue.

The traditional fee-for-service model in healthcare is no longer effective, as evidenced by the increasingly negative impact it has on various aspects of the system. Front-line workers face overwhelming burdens, with their work becoming ineffective, fragmented, and burdened with excessive documentation. Similarly, patients experience inefficient, prolonged, and impersonalized care, leading to high costs.

Why has this situation arisen? The root cause lies in the loss of value within the healthcare system, perpetuated by circular reasoning and overly burdensome accounting practices. This quagmire has further complicated matters, making it challenging to deliver effective and efficient care.

It is evident that the current state of healthcare requires a fundamental shift towards a more sustainable and patient-centered approach. The time has come to reevaluate and revamp our healthcare system, ensuring that the value of care is prioritized and that both providers and patients can benefit from improved outcomes.

Caregiver
Image by Sven Mieke

Our Solution

Value-based care is a simple concept. It is to make the end result of the care being offered meet the needs and expectations of the patient and provide this in an economically, smooth way with transparency for all. This seems impossible currently. But, the reality is that it is not just possible but a very well-evidenced model to follow. The key is to use the good features and know works well and look for the weakest links in the pathways to make steady improvements. Improvement is by measuring what matters and using valid science-based methods so that when change is make we can evaluate the benefit. Then work from that to make another positive step. When we all follow this pattern improvements can happen fast.

The Value-Based Health Care model has been demonstrated to work well with hundreds of excellent examples

Our own pattern has been developed by the leader of a team for an Ontario Government Supported Initiative to drive down waits and costs for a major clinical issue, Cataract Surgery. Ron Kaczorowski was the CEO of the Team at the Kensington Eye Institute which led to major improvements in Value-Based Care for the millions with visual impairments. We are fortunate to have him direct our business development.

Our unique eConsult process provides value to all stakeholders:

 

Primary Care: A unified referral for Knee OA evaluation with guidance to initiate a care plan

Specialists: An improved Evidence-Based consultation

Patients: A faster convenient way to understand,  participate in and review their OA care needs.

Ontario Health: An effective means to improve the identification and requirements for surgical care and streamline the referral process.

Improving the Outcomes for Knee OA Surgery

Most patients with knee OA never require surgery. But, for the proportion that do this event can be life-changing. Total Knee Arthroplasty (TKA) has come a long way over just a few decades and now provides pain relief and major functional gains for billions of patients with knee OA. The demand is increasing in concert with our aging population. But, the dissatisfaction level persists despite impressive technological advances, including Robotic Surgery. When we dig deeper into the issue, as Gillian Hawker and her team have done recently (When is a Knee Replacement Appropriate), we learn that many dissatisfied patients have not had their expectations, such as being able to kneel or perhaps squat, addressed.

 

Numerous other studies have pointed to poorer outcomes for patients with less joint damage and this is more prevalent in those that are younger. While TKA use is largely cost-effective, for the dissatisfied patient and their family, costs and dependency continue. Also, should revision surgery be needed the new TKA is never as good as a first-time surgery; and, the costs are magnitudes greater than the primary event. The fact is that undergoing a TKA is the greatest single lifetime treatment expense of all OA care (Losina et al). So, deciding when and at what stage to recommend this surgery is a really critical decision that needs direct patient participation and buy-in as well as good surgery to provide value.

Understanding the landscape, assessing the clinical severity of the problem, identifying patient needs and expectations, and prioritizing the timing are keystones of good management. All these are central to the Value Proposition that OAISYS offers to improve the current management of Knee OA.

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