Value-based healthcare in its simplest form is about measuring the outcomes than on the unit cost of care provided. Image Credit: Shutterstock

By 2030, approximately three-quarters of a billion people will live in the MENA region - people are also living longer. While this is a testament to the many advances made in medical science, we are seeing a rising incidence of non-communicable and chronic diseases, including rare diseases.

Rare diseases are not actually rare collectively in the Middle East. There are as many as 2.8 million people known to have such a disease, out of a total regional population of around 400 million. Among those affected, 75 per cent are children, for whom there is a high risk of early mortality.

Adding to this burden, the negative impact of COVID-19 stretched healthcare systems to their limits, even setting back several achievements. What this also translates to is that healthcare costs are set to soar.

Against this backdrop, healthcare systems need to be reimagined to address these economic challenges and many health inequities highlighted and amplified by COVID-19 in order to deliver improved patient outcomes. A new value-based model is gaining popularity, which many stakeholders advocate has the potential to revolutionize healthcare by providing greater value to patients.

Under such a value-based healthcare model; valuation for medical services - such as the cost of a medicine or medical procedure - would no longer be defined on a unit basis. Instead, it would be based on the patient outcomes it achieved, as opposed to consumption. In other words, healthcare providers would be financially compensated based on their positive impact on patients and society more broadly, such as improvements to patient health and less dependence on caregivers.

All about outcomes

A value-based healthcare model would ultimately incentivize stakeholders to deliver better patient outcomes. Moreover, it critically has the potential to benefit underserved communities. By evaluating treatments based on outcomes, biopharma companies will be more likely to invest in the R&D of treatments for diseases with low prevalence, such as rare disease, thus providing innovation to underserved populations.

Recognizing the potential of value in health, Dubai Health Authority launched the first-of-its-kind value-based healthcare model. Known as Ejadah, the model is value-based contracting rather than volume-based and is expected to improve patient outcomes and performance with a focus on enhancing preventive care, helping improve overall population health and reducing healthcare expenditure.

There has been a series of roadblocks identified in the epidemiology of rare and complex diseases in applying value-based public health strategies to these conditions. These include creating a revised culture of health and well-being, reviewing how the delivery of prevention and healthcare services are organized, further to improving the inclusion of marginalized groups.

Such a model of Ejadah could offer much respite and support to patients with rare diseases. As a performance-based payment model, Ejadah will measure patient outcomes and is symbolic of the pace of transformation in healthcare reimbursement we are seeing, setting an example in an industry which otherwise has seen some level of stagnation. With its Diagnosis Related Group system that uses a case-mix system - based on a per-case basis at uniform amount per hospitalization - we will see clear evidence of lowered costs and reduced average length of hospital visits.

Extended care for all

Ejadah can be a template to support several patients who may be excluded and undeserved in a traditional system. Within this system, many services that were costly and will require special focus can also be considered, to ensure that patients’ outcomes are best delivered. This holds true regarding payments as well, as they are performance-and case-based and will continue to guide innovation and access.

We subscribe to the same idea that care must be based on patient outcomes through a model that helps deliver greater value for all. Among the many factors that could support such a model is health data, absolutely integral to determining patient outcomes, reducing variations in care quality and experience, manage inequalities in healthcare service provision and reduce wastage of resources and equipment.

To ensure a long-term commitment to value-based care, learnings from data must continually optimize systems and, critically, the patient outcomes themselves. We also recognize there is no one-size-fits-all model; value must be determined and measured based on the specific needs of the communities concerned on an ongoing basis and reported industry-wide.

Beyond collaborating on data, industry partners must cooperate in developing the framework and setting the standards for patient outcomes. While the transition to such a system will not be simple, the challenge and opportunity remains responsibly allocating more resources to the high-value care that provides the most benefits to patients.