Through the lens of value-based health care: oncology care

Focus Area— Health

This Op-Ed was originally published in The Hill Times of Ottawa on February 3rd 2020. It was written by Dr. Isabella Moroz, senior associate and Dr. Monika Slovinec D’Angelo, director, health at the Conference Board of Canada.

Value-based healthcare "explicitly prioritizes focusing on achieving health outcomes that matter to patients relative to the cost of achieving those outcomes" and has been tried in other countries.

Despite being considered one of the highest spenders on healthcare when compared to other industrialized countries that offer universal care, our system consistently underperforms on key measures, such as access and quality, write Dr. Monika Slovinec and Dr. Isabella Moroz.

Concerns are growing over Canada’s health-care system not delivering value for the money spent. Despite being considered one of the highest spenders on health care when compared to other industrialized countries that offer universal care, our system consistently underperforms on key measures, such as access and quality.

The increasing and aging population is adding pressure on the already strained health-care system, compounded by the soaring costs associated with specialized treatments. Cancer care costs, for example, are increasing at a rapid pace due to several factors, including improved longevity, rising prevalence, and staggering costs of new innovative treatments, which remain a primary cost driver. The need for value-based oncology has reached a new level of urgency. Value-based health care is a growing international movement and a potential solution to the raising costs of healthcare. It explicitly prioritizes focusing on achieving health outcomes that matter to patients relative to the cost of achieving those outcomes.

Value-based health care approaches are being implemented to various extents throughout the world’s healthcare systems, all of which struggle with rising costs and uneven quality. While some countries are more advanced than others in their value-based health care journey, making this transformation is not easy and requires a radical restructuring of how health care delivery is organized, measured, and reimbursed.

In Canada, specific challenges get in the way of delivering care that is value-based: inability to measure (and act upon) patient reported outcomes; lack of transparency and consistency around measuring clinical and financial outcomes of care; lack of integrated patient care pathways for specific diseases/conditions; and lack of care coordination across these pathways. These limitations are not insurmountable. No organization in Canada has yet documented a systematic approach to addressing these challenges across its practice areas and continuum of patient care.

This is where the Conference Board of Canada’s strategic initiative on value-based healthcare, namely, value-based health-care Canada, comes into play. In addition to capacity building and policy research activities, the Conference Board, through VBHC Canada, is leading a series of demonstration projects to document and evaluate the application of the value-based health-care model in the Canadian context. The projects will produce evidence around outcome and cost measurement, patient care pathways, coordination of care, and administrative processes. The findings will be used to create a systematic approach to enable benchmarking and scale up across Canada.

One prospective demonstration project is in the area of oncology. Value-based Healthcare Canada is collaborating with experts at clinical centres of excellence for cancer care in the province of Quebec. The project will follow a defined patient population to map out their optimal care pathway from diagnosis to treatment, follow-up, and end-of-life care. Clinical outcomes, patient reported outcomes (including quality of life), clinical practices, and organizational management of cancer care will be measured and tracked throughout the entire care pathway. Sources of cost data will also be identified and, where possible, will be linked to care delivery to determine estimates of costs per patient—a number that currently is not well understood, but is essential to determining opportunities for improving efficiencies in healthcare.

The Demonstration Projects will produce real-time evidence around the effectiveness, outcomes, and system costs associated with value-based health care models. They will build on domestic and global experiences to demonstrate the feasibility and effectiveness of a systematic application of value-based health-care principles to healthcare transformation in Canada and inform policy decisions to support this transformation. The “Canadian-made” innovative solutions, along with lessons learned, will be shared and extended to other clinical conditions and population groups to ultimately provide every Canadian with the best, most valuable care possible.

Come and learn more at the upcoming ‘Value-based Healthcare Canada Summit’ on April 23, 2020, in Toronto.

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Isabella Moroz

Isabella Moroz

Senior associate, The Conference Board of Canada

Dr. Monika Slovinec D’Angelo

Dr. Monika Slovinec D’Angelo

Director, Health, The Conference Board of Canada