Ireland’s health service finds itself at a critical juncture. Our population is ageing and ageing rapidly - Central Statistics Office figures predict that the number of people resident here aged 65 years will increase by 27% by 2030. Meanwhile, the aftershocks of Covid-19′s impact on both the health services and on patient outcomes will be felt for years to come. Delayed and missed diagnoses of cancer, the mental health crisis, and record-breaking waiting lists will place increasing pressure on what is already an overstretched system.
In the midst of these challenges, the health service will need to re-evaluate how care is delivered to patients. This represents an opportunity to think more deeply about reforms that can improve care, enhance patient outcomes and ensure the HSE gets value for money.
Over the past year, my company Janssen Sciences Ireland sponsored an interesting series of discussions hosted by the RCSI on the Future of Value-Based Health Care in Ireland. In these seminars experts from across the health service discussed what ‘value’ means in healthcare, including topics such as patient contributions to health decision-making, better measurement of health service outcomes, and redesigning budget structures.
As we heard throughout the series, there are many examples of innovative thinking when it comes to healthcare. Our healthcare system is designed to be reactive and not proactive, treating rather than preventing illness. Irish healthcare is not unique in this regard. However, a paradigm shift is needed. We need to re-design the system so that it prioritises – and funds – the prevention of illness and maintenance of health.
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This is the central premise behind value-based health care, a broad term describing approaches to maximise quality of care and health outcomes relative to expenditures. Simply put, the ‘value’ in value-based care is derived from measuring health outcomes in a real-world setting against the cost of delivering the outcomes. In recent years its application has accelerated across health services in Europe.
By doing this throughout the care pathway, health services can collect and process critical information that enables better allocation of resources, maximising value to patients, the health service, and society. ‘Paying for value’ means investing in health interventions that don’t just treat and cure, but also drive other outcomes that matter to patients: quality of life and treatment experience, avoiding hospitalisation, and most of all – prevention.
One important application is how health services adopt new medical technologies and medicines.
Irish healthcare generally performs well against its European peers in terms of quality of care and patient outcomes. However, one area in which Ireland falls down is in slower access to new treatments. This has worrying implications for standard of care in certain areas, such as cancer care or rare diseases. Historically, the health service has also struggled with the sustainability of health budgets and finding funding for new medicines and technologies, even those that offer remarkable clinical advances.
Other countries also struggle with the question of how to fund new medicines, vaccines or medical technologies. However, there are many international examples of alternative payment models, whereby health services and manufacturers work together to ensure patients achieve the maximum benefit. For example, ‘pay for performance’ contracts that involve paying for medicines based on agreed outcomes are slowly becoming more commonplace elsewhere in Europe. These strategies can offer health systems assurances that value for money is achieved on their investment. While there is still a long way to go before these become the norm, being open to the opportunities such models offer could allow Ireland to maximise its spending power without sacrificing patient access to ground-breaking therapies.
In other performance-based agreements in Europe, contracts are tied to the offset of other costly healthcare interventions, such as surgeries, physician visits, and hospital stays. New medicines are an important consideration in areas like cancer in minimising hospitalisations. They can deliver more, alleviate pressure on overstretched healthcare capacities, and provide a marked improvement to the quality of life of both patients and carers.
Importantly, ‘paying for performance’ within our health sector would require building a more robust health information infrastructure, including unique patient identifiers, electronic health records and monitoring registries.
This would allow the health service to collect real-world data to support decision-making and ensure smarter allocation of available healthcare resources. By comparison with our peers, Ireland fares poorly in the routine collection of real-world data. However, the great strides made by the health service in adopting technology during the pandemic offer a glimmer of hope. This could make ‘better data’ across the health service a realistic and reachable goal.
A key stakeholder who must be included in the decision-making process and discussion around value-based healthcare is the end-user of innovative treatments – the patient. Patients no longer occupy a passive role in our healthcare system. Patients and patient advocacy groups provide invaluable expertise on living with disease and the impact treatments can have on quality of life. We need them to be involved at the most senior levels of strategy, policy and oversight to ensure the right decisions are being made at the right time for the right patients.
And change is possible. The pandemic illustrated the Irish health service’s capacity for almost instantaneous reform. Stakeholders in health looked on in amazement as ideas spoken about for years were rapidly tested and put into action as part of the response to the health emergency.
In the wake of all this activity, there is a window of opportunity. The goal must be to shape a health system that both incentivises newer, better treatments and offers the best value to patients and the health service overall. We are truly in a golden age of medical innovation. But for Irish patients and the health service to fully benefit from the pipeline of new treatments being researched today, collaboration and creativity will be required to guarantee Irish patients access to these medical innovations.
You can watch back the webinar series here.
References available upon request.