Paper: "Defining Health in the Era of Value-based Care ..." mapped to Hodges' model

individual

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INTERPERSONAL : SCIENCES

humanistic --------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

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group

Q. What is value? Demand (Individual) freedom to lead lives they have reason to value [Why we need a global generic conceptual framework:  Self care =  transformation of Demand into Supply] Patient Reported Outcome Measures (PROMs) 'benefit' across Hodges' model? 'harm done' across Hodges' model? Shared Decision Making -  patient centred care,  choice, autonomy,  Right Care, Right Time, Right Place?*

A's.  Value = outcomes achieved – money spent (Porter) 1.Allocative value – how to allocate resources equitably in such a way that maximum value for the whole population is obtained 2.Technical value – increased value associated with improvements in quality and safety of healthcare 3.Personalised value – individual patient values, in combination with best evidence and assessments of the person’s condition. (Gray) Supply - Outcomes PROMS: hip replacement, knee replacement, groin hernia and varicose veins Right Care, Right Time, Right Place Chronic disease Improving medical technology

Demand Social determinants of health "Unlimited healthcare intervention provision may lead to increased harm." Friends and Family Test Person- and community-centred approaches, such as peer support, self-management education, health coaching, group activities and asset-based approaches. Local - Community - National Porter recommends classification of outcomes in three tiers [16]. Tier one is ‘Health status achieved or retained’, including measures such as survival at one or five years, or for those with life-limiting conditions, the degree of health or recovery achieved or maintained. Tier two, ‘Process of recovery’, includes the time taken to return to normal activities and disutility of care, such as errors and adverse events in care, incorrect diagnosis, and discomfort. Tier three is ‘Sustainability of health’ and includes recurrence and long-term consequences of treatment.

"The definition proposed by Gray ... defines value in healthcare as ‘the net benefit, that is the difference between the benefit and the harm done by a service, taking into account the amount of resources invested’" Supply - Outcomes Health Economics limited healthcare budgets Governments - Industries Relationships demand - drug costs Moving FROM: cost-effectiveness and pay for performance TO: Value-based pricing Healthcare-associated harm Value-based healthcare has the potential to be used in local and national priority setting and policy development.

*This brief paper provides a very good outline of value-based care. 'Mental' in this paper is mentioned early on in a definition of health, thereafter you will find 'mental' in funda-mental, environ-mental plus incre-mental. 'Mental health' and values-based care will no doubt be discussed elsewhere. This brief paper suggests however, that we really do need a generic conceptual framework for health and social care. To be fully-realised value-based care must also reach, encompass and incorporate mental health and public mental health.


Gentry S, Badrinath P (March 06, 2017) Defining Health in the Era of Value-based Care: Lessons from England of Relevance to Other Health Systems. Cureus 9(3): e1079. DOI 10.7759/cureus.1079