News and media

The time is right for the private sector to apply global best practice to the UK market

Date of publication: 11th Jan 2019

Categories: Independent Healthcare Voices

Dr Mark Ratnarajah, UK Managing Director of CRAB Clinical Informatics, looks at how healthcare data is being used around the world to drive improvements in patient outcomes and value for money.

Anyone with an eye on healthcare systems in the United States (US), Australia or New Zealand (ANZ) will know that healthcare companies are moving away from fee for service models towards value-based remuneration in recognition of the importance of measuring outcomes rather than process.

The shift in emphasis in the way healthcare providers are paid should help to promote improvement by monitoring outcomes such as hospital readmissions and reward better performing providers with higher volumes of referrals. There are inevitably some difficulties with this approach, for example, outcomes are often influenced by factors outside of clinicians’ control and therefore don’t accurately represent the quality of processes or delivery of a particular service.

This in turn has intensified the need for risk-adjustment tools in order for providers to both understand and mitigate against these factors and create a level playing field. Our experience with US and ANZ providers has shown that legacy electronic health record systems (EHR) are primarily focused on financial/operational performance and are unable to deliver meaningful risk adjusted clinical outcome measures in line with their existing Center for Medicare and Medicaid Services (CMS) remuneration rules.

Work is therefore being done to find more sophisticated ways to reward outcomes based care. The Independent Hospital Pricing Authority in Australia for example, has implemented a score card system for each hospital based on a range of specified hospital acquired complications and complexity of the cases, with penalties issued against hospital income that is applied on a rolling twelve-months basis.

Providers who are adapting to the new payment and reporting structure are benefiting from increased volumes of referrals, reductions in operating costs, lower medical negligence insurance premiums, and above all better patient outcomes.

While this experience shows the benefits of this approach for patients and providers alike, in the UK, there is a worrying move back to using block contracts over payment by results mechanisms, neither of which adequately reflect the cost of provision nor reward efficiency through high quality outcomes that go beyond the initial episode of care, e.g. reduced prosthetic joint revision rates which result from better quality joint replacement and post-operative care.

Private sector providers are well placed to demonstrate their ability to deliver high quality services with strong clinical outcomes. Indeed, with the joint NHS Digital/PHIN Acute Data Alignment Programme (ADAPt) is gaining momentum towards creating a single point of data across all healthcare provision in England, there is merit in the Private sector leading the way in demonstrating clinically relevant health outcomes performance data that can be applied across both sectors.

With pressure on resources and demand for care continuing to grow, there is a clear case for the UK to follow the direction of travel adopted by the US and ANZ to ensure that the right financial and regulatory mechanisms are in place so that patients can be assured of the highest possible quality of care.