Value over activity – putting value at the heart of care delivery

In recent years, payment for care services in the US has shifted from a focus on quantity to quality, with the aim of making services more efficient and holding healthcare organisations accountable for the standard of care they provide. Medicare and Medicaid have begun introducing a new financial reimbursement system that sees organisations moving from activity-based pricing to value-based remuneration, paying providers based on patient outcomes and costs. In an article for the Journal of the American Medical Association, R. Scott Braithwaite highlights the need focus on outcome measures rather than process measures.


Value-based care models promote improvement by monitoring measures such as hospital readmission’s and population health. Using patient outcomes to quantify value has its complications, however, as outcomes are often influenced by factors outside of clinicians’ control and therefore are not accurately representing the quality of processes. This new payment system has, therefore, intensified the need for risk-adjustment tools in order for providers to understand and mitigate these factors.


These models have also put data at the centre of healthcare. US healthcare organisations have invested heavily in electronic health record (EHR) systems, but these are not designed to record patient outcomes in all their complexity, instead tailored to billing for payment. According to a 2018 survey of US physicians carried out by Deloitte, they perceive themselves as passive participants in EHR optimisation efforts and, at worst, they feel ignored. As a result of EHR systems not being aligned with the move towards value-based care, this has introduced the need for third party information systems that have the capability to measure quality.


While the NHS structure for renumeration differs from US healthcare organisations, many NHS trusts are implementing US EHR systems and the NHS is increasingly looking at improving the value of the services it provides. It seems, therefore, only a matter of time before we move towards an outcome-based commissioning system for UK healthcare, too. With a need to reduce costs, improving efficiency is high on the agenda and a payment system based on value rather than activity would support this priority.

  • 21 Nov, 2018
  • Claire Bale

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