3.4 Case studies
Case 1: Osteoarthritis care
Value-based healthcare has been applied by the New South Wales (NSW) Government in Australia to improve osteoarthritis care. NSW Health initiated the Osteoarthritis Chronic Care Program, where they refocused the outcome measures from the number of surgeries for knee replacement to addressing pain level and hip or knee functional outcome (Koff & Lyons, 2020). The new approach aligns with NSW Health’s definition of value-based healthcare, which incorporates what value means for all stakeholders involved, including patients and healthcare providers and ranging from improvement of health outcomes, improvement in the experiences of patients receiving care and of clinicians providing care, and overall better quality of care (Koff & Lyons, 2020). The program is a modified version of a bundled care model.
Several gaps were identified in the old system and initiatives were selected to address issues with existing clinical service delivery model, highlighting areas for potential patient benefit, including experiences and reported outcomes and strategies to reduce clinical variations across the system. Enablers of the new system included collaboration across teams and organisations to integrate NSW Health’s Leading Better Value Care program initiatives and a robust system of measuring and reporting patient outcomes.
Evaluation of the osteoarthritis chronic care program, including a pilot of 5,140 patients, showed that 4 per cent of hip and 11 per cent of knee patients who participated in the program were removed from the surgical waitlist as their conditions had improved and no longer needed surgical interventions. Similar initiatives were done in the areas of chronic heart failure, chronic obstructive pulmonary disease, management of diabetes mellitus for inpatients, falls in hospitals and renal supportive care (Koff & Lyons, 2020).
Case 2: Mental health treatment
Another recent case study demonstrating value-based healthcare in mental health focused on depression in a large psychiatry and psychology department in a hospital in Netherlands (Vegter et al., 2024). The team at St Antonius Hospital focused on measuring and improving the outcomes and costs of care for patients with depression using a scorecard with various indicators and a modified version of TDABC and activity-based costing. Indicators included outcomes, costs and processes to capture the whole patient management journey in the hospital, with specific indicators such as percentage of patients with more than 50 per cent symptom reduction according to a specific questionnaire, length of stay with and without clinical treatment, treatment duration and percentage of patients treated as outpatients.
In addition to creating a scorecard, the team underwent several consultations with patients and carers to identify issues with patient management. The team was able to map the necessary indicators without increasing the registration burden for patients. Moreover, the information platform at the hospital was updated to provide real-time data on patient conditions with an added function for patients to also enter their data. The improvement team acted as a champion for this process and coordinated with the rest of the department to collect input and implement improvements. There were also regular meetings and newsletters to all staff involved to update them on the initiative. This resulted in significant improvements in waiting time for various treatments, from 17 days to 10 days after the implementation (Vegter et al., 2024).
