Time to change how we value health

Time to change how we value health, but are we ready to listen?

Andrew Sando, CEO, Australian Health Service Alliance

From our frontline health services to those creating lifesaving medicines and technology, to hospital administrators, policymakers and payers, most people in our sector are inherently driven by a common goal: get the best outcomes for the patient.

But, like all essential industries, health services are a finite resource. Australia – and the world – simply does not have enough clinicians, equipment, facilities or money to service every patient, everywhere or every time. A lesson we’ve learned the hard way in recent years.

So how do we achieve more, with less?

Many across healthcare agree that Australia’s system needs fixing. For starters, our fee-for-service model, which pegs value to the volume of procedures done and patients seen, is not fit for purpose when doctor and nurse shortages are a permanent feature of our universal system.

Value-based care, on the other hand, incentivises care based on the patient outcomes generated relative to the total cost of delivery. Under such a framework, we would not only support the pursuit of optimal outcomes, quality and efficiency of care, but increase access by consequently reducing hospital acquired complications and readmissions.

Start with listening

To paraphrase some ancient wisdom: We were given two ears and one tongue so we would listen more and talk less. When it comes to achieving value in healthcare, we should heed this advice.

For the AHSA, listening to how patients define great care is central to what we do.

Of course, this will vary by patient. A marathon runner needing a knee operation has a different definition of success to someone who needs the same operation to do the gardening.  Despite the motivation, both share the same hope that the procedure will get them back to doing what they love, sooner.

That’s how patients define great care. That’s how we, as service providers and payers, should hear them.

Giving patients a voice

In Australia, we are in the early days of leveraging the patient voice to foster change, improve services and reduce demand on our hospitals. Nonetheless, there are a few notable initiatives.

The Voice of the Patient – managed by us at the AHSA with Insight Actuaries – is one such platform drawing thousands of responses every day from patients who have received private care at hundreds of hospitals nationwide. It is a collaboration between the not-for-profit and member-owned health funds, hospitals, clinicians and actuaries.

A lot has been learned since we established the platform, and with a 45% patient response rate – almost twice the international average for similar survey measures – one message is abundantly clear.

Like politics, the economy or the rule of law, Australians know their voice can ignite change in health. They want to have a say in their healthcare experience and to improve the system for generations to come.

What patients have to say

A significant 45% response rate from the Australian patient community means we can confidently say, hospital facilities across Australia that attract the top 33% of patient experience and outcome scores are providing “great care”.

They tell us that top-performing facilities:

• Provide holistic care, prioritising patient understanding and support while managing expectations.
• Manage their clinical needs exceptionally well across units and teams through superior coordination and communication.
• Strictly implement, apply and adhere to clinical protocols.
• Ensure effective and proactive pain management, and relevant measures.
• Are responsive to the mental health needs of patients beyond treatment protocols.
• Promptly inform patients of mistakes, despite potential consequences. Healthcare does not come with a 100% success rate guarantee; honesty, action and prevention distinguish great facilities.

But naturally, with the good also comes the bad. Care can fail at the patient level when:

• Providers are slow to respond to patient needs – a result of process rather than priority.
• They are poor at care-coordination. This can be as mundane as providing patients meals that align dietary requirements or allergies, as well as communication between staff.
• Patients are kept in the dark about potential issues with their treatment, causing them to grow anxious or suspicious.

Turning insights into action

Pursuing a value-based system, geared toward better outcomes, is not going to be a walk in the park. It will require all of us in healthcare to listen and to receive good news and hard truths.

Patient-reported experience and outcomes measures, along with platforms like the Voice of the Patient, provide a tremendous opportunity for all of us to uncover new and valuable insights direct from the patient to act upon.

This means assessing our performance, honestly and fearlessly, adapting and evolving our ways of working to deliver better, more proactive, coordinated and value-driven care.

Promisingly, people who work in healthcare are by nature not afraid to confront such challenges nor do they shy away from pursuing the most optimal outcome.

So, whatever patients tell us, we are ready to listen.

About Andrew Sando

Andrew has unique experience and insights on how to be successful in healthcare, having during his career held Chief Executive and General management roles in private hospitals, pathology, medical centres and now working with Private Health Insurance funds. Andrew is the Chief Executive Officer of the Australian Health Service Alliance (AHSA), a role he has held for over 12 years. Prior to AHSA, he held multiple senior and strategic roles at Healthscope. He holds qualifications from Harvard Business School (Advanced Management Program) and a Masters of Business Administration to complement his initial Honours degree in Science.

About the AHSA

Australian Health Service Alliance (AHSA) is a member-owned, not-for-profit service organisation and the largest aggregated contract negotiator for privately funded healthcare in Australia, making it a crucial element to affordable and sustainable healthcare for millions of individuals, households and families. AHSA serves small to medium not-for-profit and member owned health funds to achieve the shared goal of a quality, sustainable private health insurance industry for their members. The AHSA facilitates arrangements with healthcare providers on behalf of our funds. As a large service provider and negotiating group, our funds benefit from our collective size to achieve successful outcomes for members. Negotiation of competitive, patient-focused contracts brings value to fund members and contributes to the viability of Australia’s healthcare industry. AHSA exists for our funds our funds exist for their members. Together, we strive for high quality private healthcare at an affordable price.