Partners In Health: Redefining the Possibilities of Health Care

 

Abstract

The definition of health is made up of three areas, namely physical, mental and social health, which should be prioritized in the provision of health care. The emergence of chronic diseases in aging populations has been an obstacle to building a healthier society. The concept of value-based healthcare seems to be in tune with the real goal of healthcare: to increase value. Value is created from health outcomes that are important to patients relative to the cost of achieving those outcomes. Health outcomes should include all health domains in a full cycle of care. To implement value-based healthcare, healthcare professionals and patients need to make transformations: establish real health outcomes, strengthen primary care, build integrated healthcare systems, implement appropriate health care payment systems that promote value and reduce moral hazard, enabling health information technology. , and create a policy that fits well with a community

Review

The ultimate goal of health care is to create a healthier society. Short-term goals like improving access to health care and increasing profits have been distractions. Since health is something that matters to patients, medical care should be centered on the patient, not the provider. The concept of value-based health care attempts to effectively increase health outcomes. Porter claimed that the quality rating did not reflect actual “quality”. Rather, it is a measure of a process that reports on compliance with the guidelines. The only real quality is in the circle of the patients, that is, in the health outcomes of the patients [5].

The first thing to consider when delivering value-based healthcare is defining what value is important to patients. Doctors often think they are providing good health care by increasing services, which translates to more visits. However, patients deserve good outcomes that translate not to more visits, procedures, or tests, but to better health and better value. Since value reflects results per dollar spent, we need to measure results accordingly. We need a mechanism to report and assess risk-adjusted outcomes for each medical condition, as well as the costs of achieving those outcomes. It should be noted that the results are not calculated simply from mortality and morbidity, but also from other multifactorial aspects that are significant for patients in a cycle of care, including complications, recovery time and the need for additional treatments. This outcome report should also be stratified or risk-adjusted, noting the current status of patients. Outcomes are not measured for an individual service or intervention, but for a full cycle of care [6].

Porter describes results at three levels. Level 1 involves health status achieved, including mortality and functional status. Level 2 addresses the nature of care and recovery, including readmission and duration of return to normal daily activities. Meanwhile, Tier 3 refers to health durability. Providers need to focus on all aspects of results and not settle easily for a single result. For example, a longer five-year survival rate does not necessarily reflect actual health status; however, we should be concerned about readmission, existing complication and pain, and the patient’s ability to perform daily activities independently [5].

Assessing functional status can be difficult. Therefore, the measure of patient-reported outcomes (PRO) was introduced. The PROMIS (Patient Reported Outcome Measurement Information System) information system provides an effective means of evaluating outcomes following medical treatments. This measure includes three domains of health (physical, mental and social). The validity and reliability of this measure have been assessed in a previous study [7]. Using computerized adaptive testing (CAT), the measurement of functional status after discharge can be individualized according to the future needs of each patient [8].

Currently, standard outcome sets for specific medical conditions have been proposed by the International Consortium for Health Outcome Measurement (ICHOM). ICHOM was founded in 2012 and has already worked on several medical issues, publishing comprehensive results [9]. For example, ICHOM results for coronary artery disease (CAD) and lung cancer have been published. In the CAD working group, they focused on short-term (hospitalization, 30 days post-discharge) and long-term (survival at 1 and 5 years) outcomes [10-11]. In addition to clinically measured outcomes, they also included patient quality of life using various instruments (Seattle Angina Questionnaire, Rose Dyspnea Score, and Patient Health Questionnaire). In the Lung Cancer Task Force, the results can be applied to patients with small and non-small cell carcinoma. Survival, complications and health status were measured by documenting patient-reported quality of life and end-of-life quality. These results were also adjusted for different risk factors determined by working groups.

 

Strengthening the role of primary care in healthcare system

Primary care is mainly concerned with preventive interventions. Despite the control of disease and the definition of health as the outcome of health-restoring medical interventions, as described earlier in this article, primary care outcomes are measured on the basis of their contribution to the maintenance of health. populations. , especially those with risk factors. Consistent with our discussion of value-based health care, this topic also merits our attention. How to provide effective and preventive drugs at the lowest cost must become a priority. One could be to increase the number of primary care physicians, as a higher proportion of primary care physicians appears to increase community health outcomes: lower infant mortality, low birth weight and all-cause mortality [12] . Based on this evidence, strengthening primary care, with sustainable epidemiological research and development strategies appropriate to the community they serve, will result in the most effective way to maintain health. For example, if acute coronary syndrome (ACS) is known to be the leading cause of mortality and morbidity in a specific population, epidemiological investigation to find the risk factors that contribute most to ACS in that population will be beneficial for planning. the next strategy to reduce the risk. In this case, the most effective and preventive intervention at the lowest cost should be favoured. This cycle must always be carried out continuously.

 

Conclusions

Although the WHO has published the definition of health, the perception of health can vary from one population to another. We are now facing an aging population with chronic diseases and exposure to risk factors. The precise definition of health will guide us in the management of a health system. Introducing a value-based health term leads us to evaluate our business, not just to talk about price and cost, but also to focus on results. Results are something that matters to patients, not physicians, and should encompass everything patients need in a complete cycle of care. The concept of value-based health care must be realized with the implementation of an adequate health payment system, inducing integrated and collaborative work of providers and the use of IT to provide effective health care. The concept of value-based healthcare aligns with patient-centered care, which attempts to humanize people rather than seeing healthcare as a commercial commodity by providing a range of services. The results depend not only on mortality, but also on quality of life. This concept goes best with the Hippocratic quote “Heal sometimes, treat often, comfort always”.