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The Strategy That Will Fix Health Care
... For the industry to comprehend the benefits provided by the unique company, an organization must also concentrate on robust research that incorporates development and innovation, the ability to deliver highquality products or services, and efficient sales and marketing (Porter & Lee, 2013). The main technique used by SMEs is differentiation, in which the offered product or service differs from those that are currently available on the market. ...
... A company may boost earnings by lowering expenses and setting prices comparable to the industry norm. The second strategy is to increase market share by raising sales and lowering prices (Porter & Lee, 2013). In cost leadership, a company aims to become the industry's lowest-cost manufacturer, according to Porter (1998). ...
... Businesses that use the focused approach primarily target a specific niche market and make an effort to comprehend the industry's characteristics and the unique requirements of its clients (Porter & Lee, 2013). Additionally, the business concentrates on creating a distinctively low-cost and precisely defined product or service (Rangan et al., 2012). ...
Small and medium-sized enterprises (SMEs) are the foundation of Nepal's economy, but their competitive strategies significantly impact their success. The primary goal of this research is to investigate the effects of cost leadership and focus strategy on the performance of SMEs in Nepal. To address this, the study examined whether implementing cost leadership or focus strategies significantly impacts SME performance. Using a descriptive and causal research design, this study used a quantitative method with structured questionnaires distributed to 385 SMEs from various industries, including manufacturing, service, and retail. Structured-administered surveys were used to collect data, and statistical tools such as correlation, regression, and hypothesis testing were used to analyze the results. The findings indicate that the cost leadership strategy has a weak but statistically significant negative effect on performance. Although not a primary focus, the differentiation strategy had a slight positive effect. The focus strategy also had a weak negative impact on performance. These findings show that no single strategy significantly improves SME performance in isolation. Instead, a hybrid strategic approach is required for contextual challenges like high import dependence, limited scalability, and aggressive competition. The study suggests that SMEs in Nepal combine cost efficiency with innovation and market-specific targeting, while policymakers should create supportive environments through infrastructure, training, and strategic incentives. An operational, integrated strategic model is required for SME sustainability and growth in Nepal.
... Established in 2006, it applies VBC principles holistically, focusing on comprehensive, patient-centered diabetes care. Its integrated approach leverages six core VBC principles 10 The impact is significant: 55% of Diabeter's pediatric patients maintain HbA1c levels below 7.5% (compared to 28% nationally), with a hospitalization rate of just 3% (versus 8% nationally). 11 By demonstrating improved health outcomes and cost control, Diabeter sets a benchmark for VBC in diabetes care. ...
... While Switzerland has seen pilot projects incorporating aspects of VBC, no initiative fully integrates all six components outlined by Porter and Lee. 10 SwissDiabeter seeks to bridge this gap by offering comprehensive, patient-centered care tailored to the Swiss healthcare landscape. ...
... Scaling care delivery to multiple locations 10 Diabeter operates five clinics in the Netherlands SwissDiabeter will start with two hubs (Lausanne and Zurich) and expand via telemedicine ...
Objective
Global spending on diabetes care soared to $966 billion in 2021, a 316% surge over the past 15 years. This sharp increase underscores a need for more efficient and cost-effective care strategies. Value-based care (VBC), which prioritizes patient outcomes while controlling expenses, presents a promising solution. However, its real-world implementation remains challenging, particularly in diabetes care. This study examines SwissDiabeter, a proposed diabetes clinic initiative in Switzerland inspired by a Dutch VBC-based Diabeter clinic. We examine key barriers and facilitators during Diabeter's implementation in the Netherlands and assess forthcoming challenges and enablers for SwissDiabeter in Switzerland.
Methods
We employ a deep, extensive embedded single-case design conducting 27 interviews with healthcare professionals, insurers, and patient groups in Switzerland and the Netherlands. The main interview data were complemented by various secondary sources to enhance contextual comprehension, widen perspectives, and validate findings.
Results
We identify four key factors for successful VBC adoption: leadership in driving change, financial restructuring, operational improvements, and enabling digital technologies. We next derive practical recommendations to guide the implementation of value-based diabetes care, redesigning financial incentives for healthcare providers, partnering up with key stakeholders such as insurers or policy makers, and measuring outcomes on a voluntary and anonymous basis.
Conclusion
This study enhances the global discourse on VBC by analyzing key barriers and facilitators in implementing SwissDiabeter, drawing insights from the Diabeter model in the Netherlands. Our findings highlight the need for strong leadership, financial incentives, digital infrastructure, and interdisciplinary collaboration to drive outcome-driven care. Beyond diabetes, these insights provide a framework for scaling VBC across chronic disease management, promoting cost-effective, high-quality healthcare.
... 5,52 Traditional compensation models Currently, different compensation models ( Table 2, supplementary material) are used in different health systems, many of which coexist within the same ecosystem. [53][54][55] • The oldest and most prevalent form of compensation in health systems, including Brazil, is fee-for-service, which focuses on reimbursement based on the production of (Table 2, Supplementary Material). In this model, when using a health plan, both the user (patient) and the service provider (health professional or institution) establish a relationship in which deliveries are linked to the product (or service provided) and not to the actual gain (or benefit) in health. ...
... Value-based compensation provides a more appropriate incentive than other current models since its principle is to provide the best patient outcome at the lowest possible cost. 54 Consequently, unlike other models in which the financial return is linked to a greater number of services (fee for service) or reduced higher cost/risk procedures (bundles, capitation), value-based compensation is based primarily on patient outcome and, consequently, the interests of all the parties involved are aligned. 55 When using a value-based compensation model, it is important to understand that part of the outcome depends on the patient (e.g., medication adherence) and not directly on the healthcare professionals. ...
... The structuring line of the value-based payment model should focus on the adoption of best medical practices, based on scientific evidence and international guidelines, with a long-term time horizon of results. 54,55 Another alternative payment model is the Global Budgeting or Budget Transfer, which is a form of prospective compensation, in which the health establishment annually estimates its spending needs and presents them to the financing entity. In return, it commits to meeting performance targets, based on efficiency and quality metrics of service provision. ...
Value-based healthcare is a patient-centered concept that provides a broad view of all parties involved in the care process. This model is designed to achieve the best possible patient outcomes while maintaining cost sustainability. In its classic description, value-based care is the relationship between outcomes that matter to the patient and the costs required to achieve them. Later, other variables were considered in this equation, such as appropriateness and user experience, to make this model more replicable. With a view that aligns the interests of patients, physicians, and payers, value-based healthcare has great potential to improve medical practice sustainably. After more than a decade of discussions and publications, putting this concept into practice is still challenging and dynamic. Value-based healthcare has gained importance and should become a transformative model for health ecosystems. Medical compensation aligned with these principles appears to be a promising path toward such transformation. Nevertheless, the application of this concept depends on a more straightforward definition of the health value parameters in different clinical scenarios. Cardiology is a specialty that usually has a solid evidence base for medical decision-making and this generates great potential for the application of health value elements. In this article, the authors outline a review of the main concepts of value-based healthcare and its potential applications in cardiology.
... Atualmente, há diferentes modelos de remuneração (Quadro 2, material suplementar) aplicados nos diversos sistemas de saúde, muitos dos quais coexistem dentro um mesmo ecossistema. [53][54][55] • A forma de remuneração mais antiga e vigente nos sistemas de saúde, incluindo o Brasil é o pagamento por serviço (feefor-service), o qual foca em reembolso baseado na produção de atividades e, dessa forma, não alinha os interesses de todas as partes envolvidas (Quadro 2, material suplementar). Neste modelo, ao utilizar um plano de saúde, tanto o usuário (paciente) como o prestador de serviços (profissional de saúde ou instituição) estabelecem uma relação em que as entregas estão vinculadas ao produto (ou serviço prestado) e não ao real ganho (ou benefício) em saúde. ...
... A remuneração baseada em valor apresenta um estímulo mais adequado do que os outros modelos vigentes uma vez que tem como princípio o melhor desfecho do paciente ao menor custo possível. 54 Por consequência, diferente de outros modelos em que o retorno financeiro se vincula a um maior número de serviços (fee for service) ou reduzindo procedimentos de maior custo/risco (bundles, capitation), a remuneração baseada em valor se baseia eminentemente no desfecho do paciente e, por consequência, há alinhamento de interesses de todas as partes envolvidas. 55 Ao usar um modelo de remuneração baseado em valor, é importante entender que parte do desfecho depende do paciente (ex: adesão medicamentosa) e não diretamente dos profissionais de saúde. ...
... A linha estruturante do modelo de pagamento baseado em valor deve focar na adoção das melhores práticas médicas, baseadas em evidências científicas e diretrizes internacionais, com um horizonte temporal de longo prazo de resultados. 54,55 Outro modelo alternativo de pagamento é a Orçamentação Global ou Transferência Orçamentária, que é uma forma de remuneração prospectiva, na qual o estabelecimento de saúde estima, anualmente, suas necessidades de gastos e apresenta ao ente financiador e, em contrapartida, compromete-se com o cumprimento de metas de desempenho, baseadas em métricas de eficiência e qualidade da prestação de serviços. 57 Uma das principais questões relativas a este modelo é a complexidade de sua implementação, e mensuração de indicadores, quando existem múltiplos pagadores de serviços vinculados àquele estabelecimento. ...
Value-based healthcare is a patient-centered concept that provides a broad view of all parties involved in the care process. This model is designed to achieve the best possible patient outcomes while maintaining cost sustainability. In its classic description, value-based care is the relationship between outcomes that matter to the patient and the costs required to achieve them. Later, other variables were considered in this equation, such as appropriateness and user experience, to make this model more replicable. With a view that aligns the interests of patients, physicians, and payers, value-based healthcare has great potential to improve medical practice sustainably. After more than a decade of discussions and publications, putting this concept into practice is still challenging and dynamic. Value-based healthcare has gained importance and should become a transformative model for health ecosystems. Medical compensation aligned with these principles appears to be a promising path toward such transformation. Nevertheless, the application of this concept depends on a more straightforward definition of the health value parameters in different clinical scenarios. Cardiology is a specialty that usually has a solid evidence base for medical decision-making and this generates great potential for the application of health value elements. In this article, the authors outline a review of the main concepts of value-based healthcare and its potential applications in cardiology.
... Time-driven activity-based costing (TDABC) is widely regarded as the most suitable tool for implementing VBHC [28,29], as it allows managers to measure actual costs by evaluating the time and resources required for each activity in a patient's care pathway [30]. TDABC simplifies cost analysis by estimating only two parameters: the unit cost of resource inputs and the time required for each activity [31]. ...
... In this context, this study contributes to the literature pointing out how the implementation of TDABC (and related sensitivity analyses), beyond its role in monitoring the cost of activities and optimizing the activities' timing [42], serves as a strategic tool to support the decisionmaking process of hospitals' organizational apex along a VBHC perspective, providing a suitable interpretation of value creation [29]. While previous literature recognized that TDABC is the most appropriate tool for implementing VBHC [28,29], its robotic surgery-related implementations have been confined primarily to comparative cost analyses of robotic assisted surgery versus traditional laparoscopic or open surgical approaches (e.g., [43]). ...
... In this context, this study contributes to the literature pointing out how the implementation of TDABC (and related sensitivity analyses), beyond its role in monitoring the cost of activities and optimizing the activities' timing [42], serves as a strategic tool to support the decisionmaking process of hospitals' organizational apex along a VBHC perspective, providing a suitable interpretation of value creation [29]. While previous literature recognized that TDABC is the most appropriate tool for implementing VBHC [28,29], its robotic surgery-related implementations have been confined primarily to comparative cost analyses of robotic assisted surgery versus traditional laparoscopic or open surgical approaches (e.g., [43]). Nonetheless, the case of the robotic surgery trial conducted at the AOUIVR serves as a compelling example of how TDABC can effectively bridge the inherent tension between clinical needs and administrative constraints within the professional bureaucracy structure of a healthcare organization [15]. ...
Background
The advent of novel robotic platforms requires that managers base their decisions on the value these platforms generate. This study showcases how micro-costing methodologies can assist managers in the decision-making process regarding the implementation of new robotic platforms within the value-based healthcare (VBHC) framework.
Methods
We applied time-driven activity-based costing (TDABC) to evaluate cost disparities between the da Vinci and Hugo robotic systems for robot-assisted radical prostatectomy (RARP). Data were collected from consecutively enrolled patients with organ-confined prostate cancer. Basic cost information was gathered from Azienda Universitaria Integrata di Verona’s finance and pharmacy departments. We conducted cost and sensitivity analyses to evaluate the most cost-sensitive parameters.
Results
The da Vinci system incurred higher total costs for RARP than the Hugo system (€4,97.21 vs. € 3,511.73, p-value < 0.001) However, excluding surgical kit costs, the da Vinci platform proved less expensive (€1,481.18 vs. €1,926.18, p-value < 0.001). Sensitivity analyses identified surgical kit costs as the most influential parameter, followed by surgical duration and platform costs.
Conclusions
This study highlights the importance of micro-costing practices in supporting managerial decisions within a VBHC framework. When clinical outcomes are equivalent, the value of robotic platforms is related to cost savings. By using TDABC and sensitivity analyses, managers can pinpoint critical activities and parameters to optimize the effective adoption of new platforms.
... Value is defined as health outcomes relevant to patients achieved relative to the costs incurred, emphasizing a balance between patient benefits and resources used. VBHC focuses on actual patient outcomes, such as improvements in health status, which should be patient-centered, measured across the entire care continuum, and adjusted for patient risk factors [2,3]. ...
... Quality in VBHC encompasses multiple dimensions, integrating clinical effectiveness and patient experience, and ensuring outcomes that are meaningful to patients [4]. According to Porter and Lee, moving towards VBHC involves several key strategies, including enhancing integrated care, measuring outcomes and costs, and broadening service availability geographically [3]. A crucial component of this transition is shifting from a fee-forservice (FFS) reimbursement model, which stimulates a higher volume of services, to a value-based payment (VBP) model that aims to maximize patient value [5,6]. ...
... Timely availability of data and/or integrated information technology (IT) system for data registration was the only factor of the entire study that achieved a very high level of consensus. This finding aligns with Porter and Lee's assertion that an "enabling IT platform" is essential for a high-value health delivery system, which should focus on patient-centered care rather than departmental silos [3]. Such a platform must utilize standardized language and encompass comprehensive patient data, enabling multidisciplinary teams (composed of clinicians and non-clinicians to collaborate effectively and contribute to the integration of care, one of the major elements in VBHC [38]. ...
Background
This study explores the facilitating and inhibiting factors in the design/development, implementation, and applicability/evaluation of value-based payment models of integrated care. The Delphi technique was used to reach consensus among a panel of (inter)national experts on these factors.
Methods
An expert panel of 15 members participated in a three-round Delphi study. Factors from experts and literature were used to compile a list of 40 facilitators and 40 inhibitors. Afterwards, experts were asked to rate the importance of these factors using a 5-point Likert scale.
Results
Eight facilitating (e.g., transparency, communication, and trust among involved stakeholders) and seven inhibiting factors (e.g., lack of motivation and engagement among involved stakeholders) achieved full consensus. Timely availability of data and an integrated information technology system for data registration (a facilitator) were the only factors achieving full consensus through a very high agreement.
Conclusions
Adequate outcome measures, targets, benchmarks, and incentives are important in value-based payment models. The less quantifiable items, such as strong leadership, transparency, communication and trust, and motivation and engagement of the involved stakeholders, are also important for successful adoption of these models and promote high-quality care at lower or equal costs.
... Health systems are moving to Value-Based Health Care (VBHC) to optimize 'value': patient-relevant outcomes relative to the resources used to achieve these over the full cycle of care [1,2]. VBHC alters healthcare professionals' job activities [3,4], often claimed positively [1,5,6]. ...
... However, robust evidence regarding VBHC's workforce implications is lacking [3,4,[7][8][9]. This gap is problematic as healthcare professionals play a pivotal role in VBHC [1,2,10], and the current workforce challenges require their retention [11]. Professionals' motivation and health are linked to patient outcomes and employee retention [12][13][14][15][16][17]. ...
... VBHC is a multifaceted concept [2,19], and hospitals have thus far implemented it in diverse and partial ways [8,[20][21][22][23]. Many hospitals focus on integrating value in patient discussions and pursuing value-based quality improvements [3,8,[22][23][24]. ...
Background
While aiming to optimize patient value, the shift towards Value-Based Health Care (VBHC) in hospitals worldwide has been argued to benefit healthcare professionals as well. However, robust evidence regarding VBHC’s workforce implications is lacking. This gap is problematic, as the motivation and health of healthcare professionals are central to the quality of care and crucial amidst contemporary workforce challenges. This study aims to qualitatively examine the implications of VBHC for healthcare professionals’ motivation, job strain, and ongoing participation in VBHC. In addition, it explores how these outcomes are regulated at both the individual and organizational levels.
Methods
Semi-structured interviews were conducted with 26 healthcare professionals across six Dutch hospitals. Interviewees engaged in three VBHC activities: (1) value-based outpatient consultations and/or; (2) value-based quality improvement activities; as well as in; (3) VBHC implementation. Interview questions and data analysis were guided by the Job Demands–Resources model.
Results
VBHC interacts with four themes perceived to affect professional’s motivation (perception of making a positive impact, enjoyability of job activities, personal development, and sense of community and support) and three themes perceived to affect job strain (workload, cognitive demands, and confidence). VBHC creates both gains (primarily increasing motivation; occasionally reducing strain) and pains (primarily increasing strain; sometimes reducing motivation). The perceived impact of VBHC depends on the fit between the individual, one’s activities in VBHC, the working conditions, and the pace of VBHC implementation. An observation that warrants attention is that healthcare professionals with a 'do-er' mentality and high ambitions to optimize patient value can become demotivated to continue advancing VBHC with the same intensity, particularly due to perceived slow progress.
Conclusions
While VBHC is centered around patients, this study emphasizes that the needs, experiences and changing role identities of healthcare professionals cannot be overlooked in this transition. VBHC currently presents as a double-edged sword for healthcare professionals: resulting in both gains and pains. In the move to VBHC, it is crucial to maintain alignment between the individual, their job activities, the work environment, and the pace at which VBHC unfolds. This is essential for fostering and retaining motivated individuals, who are not only vital to the workforce but also pivotal in advancing VBHC.
... Stratejik düşünme hemşirelerin ve diğer sağlık çalışanlarının karşılaştıkları sorunları analiz etmelerini, mevcut kaynakları verimli kullanmalarını, farklılaşan sağlık sorunlarını öngörmelerini ve gelişmiş çözümler üretmelerini sağlamaktadır (Kara, 2019). Bu beceri, hemşirelerin bireysel performanslarını kalıcı olarak korumakta ve aynı zamanda herkes için daha kolay erişilebilir, eşitlikçi, proaktif, yenilikçi ve sosyal olarak bilinçli sağlık profesyonellerinden oluşan bir sağlık sisteminin devamlılığı için zorunluluk olarak görülmektedir (Marmot, 2005;Pisapia, 2009;Porter-O'Grady & Malloch, 2010;Braveman ve ark., 2011;Porter & Lee, 2013). ...
... Hemşireler, yalnızca mevcut sorunları çözmeyle ilgili çözümler sunmamalı, gelişmeleri öngörerek bakımda sürdürülebilir bir kaliteyi sağlamaya yönelik çözümler de sağlamalıdır. Hemşireler bu süreçte hasta merkezli ve kalite standartlarına uygun bir bakım yönetimi sunmalı ve kaynakları verimli kullanmalıdır (Porter & Lee, 2013). Böylelikle, stratejik düşünmeyi sürdüren hemşirelerin liderlik rolleri güçlenmekte ve sağlık hizmetleri alanındaki çalışmaları da artmaktadır. ...
... Value-based healthcare: [23, 24, 29-32, 42, 45, 47] care that aims to achieve high value for patients, with value defined as the patient-relevant health outcomes (health gains) achieved per unit of cost spent for the entire care cycle [16,[52][53][54]. Related terms such as value-based procurement are derived from the value-based healthcare term. ...
... The term value-based healthcare concentrates on achieving high value for patients as the principal goal for stakeholders in healthcare-creating more value for money [16,54]. The value of care in this term is described as patient-relevant health outcomes (quality of care) achieved per unit of cost spent for the entire care cycle (cost of care) [16,[52][53][54]. ...
Background
Physicians have become more responsible for pursuing healthcare efficiency. However, contemporary literature uses multiple terminologies to describe healthcare efficiency. To identify which term is best suitable for medical education to equip physicians to contribute to healthcare efficiency delivery in clinical practice, we performed a narrative review to elucidate these terms' meanings, commonalities, and differences.
Methods
The PubMed-database was searched for articles published in 2019–2024 describing healthcare efficiency terminology. Eligible articles conceptually described and applied relevant terminologies for physicians, while empirical studies and practice-specific articles were excluded. The screening was supported by an open-source artificial intelligence tool (ASReview), which prioritizes articles through machine learning. Two reviewers independently screened the resulting articles, resolving disagreements by consensus. Final eligibility was determined through predefined inclusion criteria.
Results
Out of 3,655 articles identified, 26 met the inclusion criteria. Key terminologies: cost-effectiveness, high-value care, low-value care, and value-based healthcare, were identified, and explored into more depth. ‘Value’ is central in all terms, but our findings reveal that the perspectives herein differ on what constitutes value. Within cost-effectiveness, resource allocation to the population’s needs drives decision-making—maximizing value at population-level. Within value-based healthcare, patient-centricity guides decision-making—maximizing value at individual patient-level. High-value and low-value care are somewhat ambiguous, depending solely on cost-effectiveness results or patient preferences to determine whether care is considered as low or high value.
Conclusions
Cost-effectiveness may be too rigid for patient-physician interactions, while value-based healthcare might not ensure sustainable care. As physicians are both stewards of finite societal resources and advocates of individual patients, integrating cost-effectiveness (resource allocation for population needs) and value-based healthcare (individualized care plans) seems necessary. Both terms emphasize delivering high-value care and avoiding low-value care. We suggest that medical education: (1) train (future) physicians to apply healthcare efficiency principles through case-based discussion, (2) use the cost-effectiveness plane to evaluate treatments, (3) deepen knowledge of diagnostic and treatment procedures’ costs within evidence-based guidelines, and (4) enhance communication skills supporting a healthcare efficiency-driven open shared decision-making with patients.
... Business analysts utilize data-driven insights to optimize processes, improve resource allocation, and support strategic decision-making. These efforts not only enhance operational performance but also directly impact patient outcomes, making business analysis an indispensable function in today's healthcare landscape (Porter & Lee, 2013). ...
... Analysts also leverage tools like predictive analytics to anticipate future needs, helping organizations proactively address potential issues and maintain optimal performance. By integrating such advanced methodologies, business analysts contribute to a more resilient and adaptive healthcare system (Porter & Lee, 2013). ...
The United States healthcare system faces ongoing challenges, including rising costs, inefficiencies in operations, and the need for enhanced patient care outcomes. Amid these complexities, innovative solutions driven by business analysis are essential to improving organizational efficiency and positively impacting patient outcomes.
... By reducing direct and indirect fnancial burdens, as evidenced by improved clinical outcomes and optimized resource utilization, VBHC contributes to a fnancially sustainable healthcare model [24,30]. As healthcare organizations strive to maximize resource efciency and improve system performance, VBHC bridges the gap between fnancial viability and PCC, ensuring that healthcare expenditures are aligned with meaningful health improvements [37]. ...
Background: Value-based healthcare (VBHC) aims to improve the quality of healthcare delivery while reducing costs and also aims for outcomes that are of utmost importance from patients’ perspectives. Despite a growing interest in VBHC, a significant knowledge gap persists within the existing literature in the absence of a clear conceptualization of VBHC itself.
Aim: The aim of the present study was to develop a comprehensive understanding of the concept of VBHC in order to arrive at a definition based on the evidence in the existing literature.
Method: A concept analysis approach was used to identify the concept’s defining attributes, its antecedents, consequences, and its empirical referents.
Results: The analysis of the concept yielded three defining attributes: monetary value of health service, quality of care, and patient-centered care. The analysis also identified several crucial antecedents for transitioning traditional fee-for-service models to those focused on value; it also identified key interrelated consequences: improved patient outcomes, cost reduction, and increased patient satisfaction.
Conclusion: The concept analysis of VBHC provides a comprehensive framework for understanding its key components and challenges. By aligning healthcare delivery with the values and needs of patients, VBHC represents a promising avenue toward achieving high-quality, sustainable healthcare. The findings from this analysis call for a collaborative effort among healthcare leaders, researchers, and policymakers to further refine and implement VBHC models, ensuring healthcare systems are both patient-centered and cost-effective. These findings also have implications for nursing management.
... By integrating AI and ML, AIOps systems are designed to offer advanced anomaly detection capabilities, predictive maintenance, and automated root cause analysis, thereby improving operational efficiency and reducing the mean time to resolution (MTTR). The relevance of AIOps in the modern IT landscape is underscored by its potential to transform IT operations from reactive to proactive, enhancing overall system reliability and performance [3]. ...
AI and machine learning revolutionize IT processes in AIOps. AI and ML improve operational efficiency, decision-making, and IT service management, including AIOps. This article discusses AIOps and how it could improve IT operations through opportunities and obstacles. Machine learning and AI detect abnormalities, maintain projects, and automate root cause research in IT. ML algorithms diagnose IT system issues early. Analytical predictions of hardware or software faults reduce downtime and maximize resource use. AI-based root cause analysis minimizes MTTR and improves system reliability by discovering operational issues quickly. We study telecom, healthcare, and banking AIOps. AIOps helps banks detect fraud, track transactions, and comply with legislation. AIOps improves hospital IT infrastructure management and EHR reliability. AIOps improves telecom network performance, customer experience, and resource allocation by improving service availability and latency. Though disruptive, AIOps adoption is hard. Complete, accurate data is needed for AI/ML models. AIOps-IT integration is hard. Stakeholders must be trained for AI-enhanced operations, therefore user acceptability and organizational change management are crucial. Study covers AIOps research. AIOps requires AI-driven automation, mixed AI, and advanced ML. Data quality, model interpretability, and AI deployment ethics drive progress. AI/ML enables AIOps, a major IT advancement. AIOps can improve operational efficiency, decision-making, and IT service management by overcoming major obstacles and leveraging new research. This paper discusses AIOps' uses, issues, and research goals for practitioners and researchers.
... Value-Based Health Care (VBHC) is a care delivery model that aims to optimize the value of care to the patient [1,2]. VBHC supports the organization of care around the patient in care pathways and the continuous improvement of value by measuring outcomes over costs [3]. Following the VBHC principles, providers are incentivized to offer patient-centered care that reduces unnecessary procedures and improves patient-relevant outcomes. ...
Background
Value-Based Health Care (VBHC) implementation motivates providers to reduce unnecessary procedures to improve outcomes and costs, i.e. value. In thyroid cancer care, adequate use of Fine Needle Aspiration (FNA) may prevent downstream diagnostics, costs, and delays in the care process. This study aims to evaluate the impact of needle selection in FNA on Bethesda I classifications, duration of FNA appointments, and care utilization.
Methods
In October 2021, a Modified Menghini-type needle needle replaced the regular syringe needle used for FNA. An interrupted time series (ITS) analysis using generalized linear models was conducted with data from radiology and pathology reports coupled with care utilization data at the patient level. Outcomes included frequency of Bethesda I classifications per month, appointment time, and health care utilization in the first patient year (in 2024€).
Results
Between July 2020 and May 2022, 345 FNA in 224 patients were included. Implementation of the Modified Menghini-type needle needle was associated with a 78% level decrease in the odds of Bethesda I classification during FNA (OR (95% CI) 0.22 (0.06;0.71)), and, on average, a 4% (1.25 min) reduction in FNA appointment time. Despite a higher FNA unit cost postintervention (additional cost of €17.56 per FNA), there were no changes in the diagnostic and overall costs.
Conclusion
VBHC implementation provides the tools to identify and monitor improvement projects that enhance the value of thyroid nodule diagnostics and management. Implementing a Modified Menghini-type needle needle in FNA resulted in increased adequate diagnostic results, time savings, and no changes in diagnostic and care costs.
Clinical trial number
Not applicable.
... In the essay by Porter & Lee, the person-centered medicine strategy is supported by the economic discourse [30]. It evidences the need to equate the pertinence of the treatment offered, its quality and its results so that there is control over the costs and meaning for those involved. ...
Background/Objectives: The aim of this study is the operationalization of the International Classification of Functioning, Disability and Health (ICF) in the rehabilitation care performed at the Institute of Cancer of the State of São Paulo through structuring a goal-oriented tool with relevant categories of evaluation and follow-up for cancer outpatients to be applied by physiatrists, physiotherapists, physical educators, occupational therapists, and psychologists. Methods: A qualitative study based on a literature review and a modified Delphi exercise, Estimate-Talk-Estimate (ETE) technique, was performed with the service’s rehabilitation experts. Consensus was obtained after four rounds under the 80% agreement threshold. Results: Forty categories were identified for neuropsychological evaluation and thirty-three for psychoaffective support, with 12 goals. Thirty-five categories with 13 goals were accounted for physiotherapy. Physical educators identified 18 categories, with 7 goals. Occupational therapists selected 54 categories, with 10 goals. A referral for personal factors was established. Functional Assessment of Cancer Therapy-General (FACT-G) was the quality of life tool chosen to be applied. Conclusions: A set of relevant ICF categories was structured, tailored by a clinically meaningful routine of assessment and follow-up of cancer outpatients based on specialists’ clinical practice and scientific literature. It will contribute for analyzable institutional health data. Its implementation and future discussion may promote the instrument’s refinement.
... Unlike the traditional fee-for-service model, which incentivizes volume over quality, value-based payments offer a compelling solution to the challenges of epilepsy care by aligning financial incentives with measurable patient outcomes and improving efficiency. 24 For individuals with epilepsy, this approach means prioritizing primary and preventive care, optimizing medication adherence, and providing timely access to specialized treatments to prevent unnecessary hospitalizations and emergency room visits. One example of value-based payments in epilepsy is the implementation of care bundles for seizure management ( Table 2). ...
Epilepsy exemplifies many of the systemic challenges of modern health care—fragmented care delivery, inequitable access, financial strain, and so on. The current “system of systems” (SoS) structure of U.S. health care fosters siloed operations among its member systems (e.g., insurers, health care institutions, providers, researchers, pharmaceutical companies, and technology vendors), failing to address interconnected issues like care continuity, clinician burnout, and appropriate resource allocation. This article proposes embracing a health care ecosystem approach as a solution, emphasizing interdependence, collaboration, and equity. Section 1 examines the shortcomings of the current care model, with a focus on its financial challenges and the systemic inefficiencies it perpetuates. Section 2 explains the concept of a health care ecosystem and its potential to drive equity through organic coordination and collective accountability. It highlights the role of key member systems—patients, advocacy groups, professional organizations, health care providers, payers, purchasers, policymakers, researchers, and industry leaders—in achieving equity in brain health care. Finally, Section 3 presents a roadmap for transitioning from SoS to ecosystem, outlining multiple actionable strategies, such as enhancing advocacy and data sharing by professional organizations, adopting integrated and multidisciplinary care models by health care providers, and prioritizing affordability and collaboration by industry leaders. Policymakers and federal research organizations can support the transition by incentivizing collaboration, expanding funding for health services research, and supporting data‐driven decision‐making. Advocacy groups can amplify collective voices and help prioritize improvement opportunities. Using epilepsy care as an example condition, this article argues that coordinated, multi‐sector, and multi‐level efforts can successfully and efficiently address systemic challenges, improve outcomes, and reduce inequities. It offers a replicable framework for achieving sustainable, scalable, and equitable care for chronic neurological conditions.
... 3. Identify key interventions-such as remote patient monitoring, post-discharge follow-ups, and integrated care networks-that enhance patient management. 4. Provide policy recommendations and best practices for healthcare organizations seeking to implement VBC frameworks effectively. ...
The shift from fee-for-service to value-based care (VBC) models has been instrumental in improving patient outcomes while reducing healthcare costs. This study examines how VBC models leverage data-driven approaches to minimize hospital readmissions and emergency department (ED) utilization. By integrating predictive analytics, social determinants of health (SDOH), and care coordination strategies, healthcare providers can proactively manage patient risks and improve care continuity. Key interventions such as remote patient monitoring, risk stratification, and multidisciplinary care teams contribute to reducing avoidable hospital visits. The findings highlight the effectiveness of VBC frameworks in enhancing population health management, optimizing resource allocation, and promoting cost-efficient, patient-centered care. These insights provide valuable implications for policymakers, healthcare organizations, and providers striving to enhance healthcare delivery.
... By integrating AI and ML, AIOps systems are designed to offer advanced anomaly detection capabilities, predictive maintenance, and automated root cause analysis, thereby improving operational efficiency and reducing the mean time to resolution (MTTR). The relevance of AIOps in the modern IT landscape is underscored by its potential to transform IT operations from reactive to proactive, enhancing overall system reliability and performance [3]. ...
AI and machine learning revolutionize IT processes in AIOps. AI and ML improve operational efficiency, decision-making, and IT service management, including AIOps. This article discusses AIOps and how it could improve IT operations through opportunities and obstacles. Machine learning and AI detect abnormalities, maintain projects, and automate root cause research in IT. ML algorithms diagnose IT system issues early. Analytical predictions of hardware or software faults reduce downtime and maximize resource use. AI-based root cause analysis minimizes MTTR and improves system reliability by discovering operational issues quickly. We study telecom, healthcare, and banking AIOps. AIOps helps banks detect fraud, track transactions, and comply with legislation. AIOps improves hospital IT infrastructure management and EHR reliability. AIOps improves telecom network performance, customer experience, and resource allocation by improving service availability and latency. Though disruptive, AIOps adoption is hard. Complete, accurate data is needed for AI/ML models. AIOps-IT integration is hard. Stakeholders must be trained for AI-enhanced operations, therefore user acceptability and organizational change management are crucial. Study covers AIOps research. AIOps requires AI-driven automation, mixed AI, and advanced ML. Data quality, model interpretability, and AI deployment ethics drive progress. AI/ML enables AIOps, a major IT advancement. AIOps can improve operational efficiency, decision-making, and IT service management by overcoming major obstacles and leveraging new research. This paper discusses AIOps' uses, issues, and research goals for practitioners and researchers.
... By focusing on costeffective care delivery and preventive interventions, VBC can help to control healthcare costs and improve population health outcomes. Furthermore, VBC models often involve performance-based payments, rewarding healthcare organizations for achieving positive patient outcomes [3]. ...
Value-Based Care Implementation Issues VBC mandates healthcare businesses abandon FFS resource allocation. Prevention, care coordination, and community health management trump volume. Human and technical VBC installation issues are discussed. VBC shortages may affect healthcare workers. VBC supports preventative care, chronic illness management, and community health management, which need skills beyond diagnosis and treatment. FFS-trained physicians may struggle with risk categorization, data-driven decision-making, and multi-provider care coordination. Primary care doctors, nurses, and mental health professionals are few, worsening the competence gap. VBC implementation is hindered by the lack since comprehensive and coordinated therapy needs adequate personnel. Problems with tech VBC usage is limited by EHR fragmentation. EHR incompatibility hinders provider data sharing and care coordination. Information silos in this fragmented environment hinder patient outcomes and treatment continuity. Data analytics hinder VBC adoption. Data-driven decision-making helps VBC identify high-risk patients, follow results, and assess intervention cost-effectiveness. Strong data analytics assist healthcare organizations understand patient demographics and enhance treatments and budgets. Many PHM tools hinder VBC setup. Chronic illness treatment, high-risk screening, and outcomes monitoring need these tools. PHM tools and EHR systems are incompatible, making data integration and VBC strategy information flow difficult. Resource Allocation Optimization Ideas To solve these difficulties, VBC implementation requires extensive resource allocation optimization. Few staff and tech. Healthcare firms may teach VBC. Maintain population health, care coordination, data analysis, and value-based compensation. Learning methods include classroom, online, and VBC expert coaching. Telehealth may fill underrepresented staffing needs. Telehealth experts can treat and prevent chronic diseases. Working together, VBC experts can heal chronic conditions quicker. Physician extenders, nurses, etc. are medically supervised. Physicians may concentrate on difficult patients while team members prevent, treat, and educate them. VBC adoption requires provider-data-sharing EHRs. For integrated care planning, quality transitions, and population health management, these systems give entire patient data. VBC models' massive patient data may be used by data-driven healthcare organizations. These strategies identify high-risk individuals for preventive or monitoring. Data analysis examines patient outcomes, intervention cost-effectiveness, and patient group resource allocation. RPM systems offer rich VBC potential. These devices may help chronically ill people monitor vital signs and health data for early diagnosis and treatment. RPM technology early installation may minimize hospitalizations.
... Healthcare systems are facing the challenge of an ageing population, increased rates of chronic disease and rising healthcare costs [1][2][3]. This challenge is likely to escalate, with the global number of people aged 60 years and over projected to double over the next 30 years [4]. ...
Purpose
To test the feasibility of a co-designed PROMs collection system for hospitalised older adults.
Methods
A mixed-methods feasibility study was conducted sequentially across one acute and one sub-acute ward, over a 12-week period. Patients aged ≥ 60 years who discharged from hospital were eligible. The EQ-5D-5L with added items on fatigue and cognition was administered on discharge and at 3–6 months post-discharge. Administration was by either a research assistant or volunteer using a variety of modes (tablet computer, phone, SMS). Feasibility was evaluated using a feasibility framework to capture demand, implementation, practicality, and acceptability. Descriptive statistics were applied. Interviews were conducted with volunteers and analysed using deductive content analysis.
Results
Completion rates indicated high demand (discharge = 84%, n = 110/131; follow-up = 81%, n = 90/110). At discharge, most completed PROMs on the tablet (57%) and 9% were administered by a volunteer. Most required assistance using the tablet (67%) and the average time to administer PROMs was longest for the tablet (17.9 min, SD = 3.3), followed by phone (8.8 min, SD = 4.4) and SMS (1.3 min, SD = 0.5). Fewer participants reported acceptability with using the tablet (61%) compared to SMS (100%). At follow-up, most completed PROMs on the phone (82%) and the average time to administer PROMs was less than discharge (4.9 vs. 13.4 min). Volunteers reported administering PROMs to unwell patients was challenging.
Conclusion
A co-designed PROMs collection system demonstrated feasibility in hospitalised older adults with phone and SMS having greatest acceptability. Administration of PROMs by volunteers was not feasible.
Trial registration
ACTRN12623000576628. Registered 25 May 2023.
... In the current context of the health sector, hospital management, as described by Porter and Lee (2013) in "The Strategy That Will Fix Health Care", plays a key role in ensuring the efficiency and effectiveness of health care. Healthcare management is the planning, coordination, organization and evaluation of resources and processes in a healthcare system, with the aim of providing efficient, equitable and patient-centred care (Desebbe et al., 2016). ...
... Porter defines value as the achievement of 'outcomes that matter to patients' relative to costs. To achieve this he proposes six steps: organising around patients' medical condition rather than physicians' medical specialty, measuring costs and outcomes for each patient, developing bundled prices for the full care cycle, integrating care across separate facilities, expanding geographic reach, and building an enabling IT platform [22]. These changes undoubtedly are part of achieving value, however, they involve as much changes of individual attitudes as structural change to working styles and workplace infrastructure. ...
The concept of ‘values’ in healthcare is widely debated, with no universal definition despite its central role in health system reform. This paper does not seek to define value narrowly but instead aims to stimulate a generative discussion among stakeholders. Using a systems-thinking framework, we explore four key perspectives: the subjective and value-laden nature of ‘value,’ the influence of financial interests, the role of personal values in shaping care delivery, and the potential for a shared human-centred value framework. By highlighting the diverse and often conflicting interpretations of value, we encourage an inclusive dialogue to guide the development of health systems that are equitable, patient-centred, and sustainable, benefiting individual stakeholders and society at large.
... Patient-centered care stands out as a paramount objective within the framework of the nation's healthcare system. However, despite its prominent status, the empirical evidence derived from patient experience surveys consistently portrays a stark reality: the healthcare system remains some distance away from fully realizing this overarching goal (Porter & Lee, 2013;Campbell, Elmore, et al., 2015;). Recognizing this imperative, a set of fundamental strategies has been meticulously identified and accentuated. ...
Purpose: This study examines strategies to enhance training and development in healthcare management, particularly in response to challenges posed by the COVID-19 pandemic. It aims to identify and assess training needs, emphasizing customized approaches to address emerging demands. Research Design and Methodology: This study employed a qualitative approach incorporating a literature review and case studies. The study focused on the pandemic’s impact on healthcare management strategies and evaluated key training requirements. Findings and Discussion: The research identified critical training needs, including health record management, supply chain processes, patient-centered care, customer service, financial management, corporate governance, and fostering a learning organization. Implications: The findings highlight the importance of tailored training programs to improve operational efficiency, patient care, financial stability, and continuous learning. This study offers valuable insights for healthcare organizations to adapt and thrive in a post-COVID-19 landscape.
... Furthermore, perceived value could be produced when patient's expectations align with the requirements for the goods or services (Dobre et al., 2013). The main objective in healthcare have to be to increase value for patients, where value is described as the ratio between the health outcomes attained that concern to patients and the cost of getting those results (Porter and Lee, 2013 Value is based on customer assessment; thus, it is subjective where the advantage and benefit have to be favorable (Itani et al., 2019). ...
The main objective of this study is to discover the influence of service quality on customers' perceived value. The research problem is that since individual perspectives varies from time to time and place to place and there is no demand or willingness to pay for the healthcare services offered by private hospitals without considering quality. Hence, the question of whether service quality plays a role in customer perceived value in the healthcare sector has been asked .A quantitative approach via questionnaire has been adopted. Moreover, a total of 498 questionnaires have been gathered among patients and their companions in 35 private hospitals in Kurdistan Region of Iraq (hereafter KRI). Besides, to analyze the collected data, Pearson Correlation and Simple Linear Regression were employed to approve or reject the hypotheses of the study via SPSS program. The main results have revealed that there is a statistically significant correlation between service quality and customer-perceived value in some private hospitals in KRI. The results also discovered that as a service quality dimension, reliability received the greatest rating, while assurance received the lowest rating, followed by responsiveness, tangibility, and empathy. Furthermore, to satisfy their consumers in all dimensions of service quality, organizations have to concentrate more on the quality of their services. Finally, to improve customer perceived value, marketers have to better comprehend the customers' perceived value which is dependent on the context and nature of the conceptualization, its dimensional interactions, and its influence on consumer satisfaction .
... Proper execution of multimodal strategies is associated with an overall organizational culture change as effective IPC practice can be a reflector of quality healthcare, a positive organizational culture, and an enhanced patient safety (1) . This transformation can be facilitated through the involvement of champions or role models . ...
The "National IPC Centers of Excellence Guidance" (June 2023) provides a comprehensive framework for establishing Infection Prevention and Control (IPC) Centers of Excellence (CoEs) in Ethiopia. These centers aim to reduce healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) while promoting a culture of quality, safety, and continuous learning in healthcare facilities. Anchored in evidence-based practices, the guide emphasizes the significance of infrastructure, staffing, governance, and strategic operations to enhance IPC implementation across healthcare settings.
Key elements include the rationale, purpose, and goals of CoEs, outlining their roles as model facilities for best practices, research, and capacity building. The guide details the steps for establishing CoEs, from defining strategy and securing funding to operationalization and performance monitoring. Criteria for site selection prioritize facilities with strong IPC foundations, leadership commitment, and strategic location. Emphasis is placed on collaboration with national and regional health bodies, leveraging partnerships to optimize resources, training, and mentorship.
The document underscores the importance of effective governance, communication, and continuous performance monitoring to ensure the sustainability and scalability of CoEs. By fostering innovation and knowledge-sharing, these centers are envisioned as pivotal in enhancing healthcare quality and safety in Ethiopia.
AI and machine learning revolutionize IT processes in AIOps. AI and ML improve operational efficiency, decision-making, and IT service management, including AIOps. This article discusses AIOps and how it could improve IT operations through opportunities and obstacles. Machine learning and AI detect abnormalities, maintain projects, and automate root cause research in IT. ML algorithms diagnose IT system issues early. Analytical predictions of hardware or software faults reduce downtime and maximize resource use. AI-based root cause analysis minimizes MTTR and improves system reliability by discovering operational issues quickly. We study telecom, healthcare, and banking AIOps. AIOps helps banks detect fraud, track transactions, and comply with legislation. AIOps improves hospital IT infrastructure management and EHR reliability. AIOps improves telecom network performance, customer experience, and resource allocation by improving service availability and latency. Though disruptive, AIOps adoption is hard. Complete, accurate data is needed for AI/ML models. AIOps-IT integration is hard. Stakeholders must be trained for AI-enhanced operations, therefore user acceptability and organizational change management are crucial. Study covers AIOps research. AIOps requires AI-driven automation, mixed AI, and advanced ML. Data quality, model interpretability, and AI deployment ethics drive progress. AI/ML enables AIOps, a major IT advancement. AIOps can improve operational efficiency, decision-making, and IT service management by overcoming major obstacles and leveraging new research. This paper discusses AIOps' uses, issues, and research goals for practitioners and researchers.
In the evolving landscape of Medicare Advantage (MA), quality performance is not only a regulatory requirement but a strategic imperative. This paper explores how data engineering and advanced analytics are transforming provider performance through data-driven quality improvement initiatives. By integrating claims, EHR, patient-reported outcomes, and social determinants of health, organizations can generate a holistic view of care delivery. Predictive modeling, provider scorecards, and incentive-aligned financial models enable proactive interventions and measurable improvements in CMS Star Ratings and financial outcomes. The paper also addresses operational challenges such as data silos and provider buy-in, emphasizing the role of cloud platforms, collaborative ecosystems, and robust data governance. Looking forward, technologies like AI, NLP, and blockchain promise to elevate the impact of analytics in value-based care. This study provides a comprehensive, data engineer–oriented perspective on optimizing MA offerings through scalable, real-time, and compliant analytics strategies that support long-term sustainability and patient-centered outcomes
Hospital management faces a multitude of challenges that must be addressed both nationally and at the European level. The coming decade will be marked by profound changes in demographics, technology, finance, and regulation. To successfully navigate these changes, strategic planning is essential. This chapter highlights the key strategic challenges that hospital management in Germany and Europe must address and provides insights into possible solutions.
AI and machine learning revolutionize IT processes in AIOps. AI and ML improve operational efficiency, decision-making, and IT service management, including AIOps. This article discusses AIOps and how it could improve IT operations through opportunities and obstacles. Machine learning and AI detect abnormalities, maintain projects, and automate root cause research in IT. ML algorithms diagnose IT system issues early. Analytical predictions of hardware or software faults reduce downtime and maximize resource use. AI-based root cause analysis minimizes MTTR and improves system reliability by discovering operational issues quickly. We study telecom, healthcare, and banking AIOps. AIOps helps banks detect fraud, track transactions, and comply with legislation. AIOps improves hospital IT infrastructure management and EHR reliability. AIOps improves telecom network performance, customer experience, and resource allocation by improving service availability and latency. Though disruptive, AIOps adoption is hard. Complete, accurate data is needed for AI/ML models. AIOps-IT integration is hard. Stakeholders must be trained for AI-enhanced operations, therefore user acceptability and organizational change management are crucial. Study covers AIOps research. AIOps requires AI-driven automation, mixed AI, and advanced ML. Data quality, model interpretability, and AI deployment ethics drive progress. AI/ML enables AIOps, a major IT advancement. AIOps can improve operational efficiency, decision-making, and IT service management by overcoming major obstacles and leveraging new research. This paper discusses AIOps' uses, issues, and research goals for practitioners and researchers.
One of the foremost challenges confronting healthcare companies today is the dual objective of reducing the cost of care while enhancing healthcare quality for patients. The term "cost of care" refers to the expenses incurred by healthcare insurance companies in managing a patient's health. A prevalent factor exacerbating these costs is the "fee-for- service" (FFS) payment model. In this model, providers are reimbursed for each service performed, thereby incentivizing the ordering of unnecessary tests and procedures, which inflates healthcare costs. This approach does not prioritize cost-efficient management, making it difficult for patients and healthcare companies to anticipate total expenses prior to receiving care. Consequently, healthcare companies are actively exploring alternative payment models that lower costs and improve patient health outcomes. The Value-Based Care (VBC) model presents a promising alternative for health insurance companies. Unlike the FFS model, VBC compensates healthcare providers based on patient outcomes rather than the volume of services rendered. This research into the Value-Based Care model aims to address persistent issues within the healthcare sector, such as medical waste and unsustainable healthcare expenditures. While responses to VBC models vary, the approach is increasingly receiving positive recognition from the physician community. Given the high demand for ongoing advancements in Value-Based Care programs, it is crucial to emphasize the significance of patient-physician relationships and the enhancement of patient outcomes.
One of the foremost challenges confronting healthcare companies today is the dual objective of reducing the cost of care while enhancing healthcare quality for patients. The term "cost of care" refers to the expenses incurred by healthcare insurance companies in managing a patient's health. A prevalent factor exacerbating these costs is the "fee-for- service" (FFS) payment model. In this model, providers are reimbursed for each service performed, thereby incentivizing the ordering of unnecessary tests and procedures, which inflates healthcare costs. This approach does not prioritize cost-efficient management, making it difficult for patients and healthcare companies to anticipate total expenses prior to receiving care. Consequently, healthcare companies are actively exploring alternative payment models that lower costs and improve patient health outcomes. The Value-Based Care (VBC) model presents a promising alternative for health insurance companies. Unlike the FFS model, VBC compensates healthcare providers based on patient outcomes rather than the volume of services rendered. This research into the Value-Based Care model aims to address persistent issues within the healthcare sector, such as medical waste and unsustainable healthcare expenditures. While responses to VBC models vary, the approach is increasingly receiving positive recognition from the physician community. Given the high demand for ongoing advancements in Value-Based Care programs, it is crucial to emphasize the significance of patient-physician relationships and the enhancement of patient outcomes.
One of the foremost challenges confronting healthcare companies today is the dual objective of reducing the cost of care while enhancing healthcare quality for patients. The term "cost of care" refers to the expenses incurred by healthcare insurance companies in managing a patient's health. A prevalent factor exacerbating these costs is the "fee-for- service" (FFS) payment model. In this model, providers are reimbursed for each service performed, thereby incentivizing the ordering of unnecessary tests and procedures, which inflates healthcare costs. This approach does not prioritize cost-efficient management, making it difficult for patients and healthcare companies to anticipate total expenses prior to receiving care. Consequently, healthcare companies are actively exploring alternative payment models that lower costs and improve patient health outcomes. The Value-Based Care (VBC) model presents a promising alternative for health insurance companies. Unlike the FFS model, VBC compensates healthcare providers based on patient outcomes rather than the volume of services rendered. This research into the Value-Based Care model aims to address persistent issues within the healthcare sector, such as medical waste and unsustainable healthcare expenditures. While responses to VBC models vary, the approach is increasingly receiving positive recognition from the physician community. Given the high demand for ongoing advancements in Value-Based Care programs, it is crucial to emphasize the significance of patient-physician relationships and the enhancement of patient outcomes.
This manuscript examines the expanding role of population health strategies in neurology, emphasizing systemic approaches that address neurological health at a community-wide level. Key themes include interdisciplinary training in public health, policy reform, biomedical informatics, and the transformative potential of artificial intelligence (AI) and large language models (LLMs). In doing so, neurologists increasingly adopt a holistic perspective that targets the social determinants of health, integrates advanced data analytics, and fosters cross-sector collaborations—ensuring that prevention and early intervention are central to their efforts. Innovative applications, such as predictive analytics for identifying high-risk populations, digital twin technologies for simulating patient outcomes, and AI-enhanced diagnostic tools, illustrate the transition in neurology from reactive care to proactive, data-driven interventions. Examples of transformative practices include leveraging wearable health technologies, telemedicine, and mobile clinics to improve early detection and management of neurological conditions, particularly in underserved populations. These emerging methodologies expand access to care while offering nuanced insights into disease progression and community-specific risk factors. The manuscript emphasizes health disparities and ethical considerations in designing inclusive, data-driven interventions. By harnessing emerging technologies within frameworks that prioritize equity, neurologists can reduce the burden of neurological diseases, improve health outcomes, and establish a sustainable, patient-centered model of care benefiting both individuals and entire communities. This integration of technology, interdisciplinary expertise, and community engagement fosters a future where brain health is preventive, accessible, and equitable.
Care coordination is a critical component of healthcare delivery, particularly in the context of value-based care (VBC) models, where the emphasis is placed on improving patient outcomes and reducing costs. Effective care coordination can play a pivotal role in preventing hospital readmissions by ensuring smooth transitions from hospital to home, managing chronic conditions, and improving patient adherence to treatment plans. This study examines the role of care coordination in reducing readmissions under VBC frameworks, exploring the strategies and interventions that facilitate continuity of care, enhance communication among healthcare providers, and address social determinants of health. Evidence suggests that coordinated care models, involving multidisciplinary teams, patient education, and community resources, significantly reduce readmission rates, improve patient satisfaction, and enhance clinical outcomes. The findings highlight the importance of a patient-centered approach and the need for healthcare systems to integrate care coordination into their value-based care strategies to improve healthcare quality and cost-effectiveness.
The shift from fee-for-service (FFS) to value-based care (VBC) models has significantly transformed healthcare delivery, aiming to enhance patient outcomes while controlling costs. This study conducts a comparative analysis of patient outcomes under VBC and FFS models, evaluating key performance indicators such as hospital readmission rates, patient satisfaction, and chronic disease management. The research draws on empirical data from healthcare institutions that have adopted VBC frameworks, highlighting improvements in preventive care, care coordination, and patient engagement. Findings suggest that VBC leads to better long-term health outcomes and cost efficiencies compared to FFS, which incentivizes volume over quality. However, challenges such as implementation costs, data integration, and provider adaptation remain barriers to widespread adoption. This study underscores the need for policy frameworks that support the transition to VBC while addressing disparities in care access.
One of the foremost challenges confronting healthcare companies today is the dual objective of reducing the cost of care while enhancing healthcare quality for patients. The term "cost of care" refers to the expenses incurred by healthcare insurance companies in managing a patient's health. A prevalent factor exacerbating these costs is the "fee-for- service" (FFS) payment model. In this model, providers are reimbursed for each service performed, thereby incentivizing the ordering of unnecessary tests and procedures, which inflates healthcare costs. This approach does not prioritize cost-efficient management, making it difficult for patients and healthcare companies to anticipate total expenses prior to receiving care. Consequently, healthcare companies are actively exploring alternative payment models that lower costs and improve patient health outcomes. The Value-Based Care (VBC) model presents a promising alternative for health insurance companies. Unlike the FFS model, VBC compensates healthcare providers based on patient outcomes rather than the volume of services rendered. This research into the Value-Based Care model aims to address persistent issues within the healthcare sector, such as medical waste and unsustainable healthcare expenditures. While responses to VBC models vary, the approach is increasingly receiving positive recognition from the physician community. Given the high demand for ongoing advancements in Value-Based Care programs, it is crucial to emphasize the significance of patient-physician relationships and the enhancement of patient outcomes.
One of the foremost challenges confronting healthcare companies today is the dual objective of reducing the cost of care while enhancing healthcare quality for patients. The term "cost of care" refers to the expenses incurred by healthcare insurance companies in managing a patient's health. A prevalent factor exacerbating these costs is the "fee-for- service" (FFS) payment model. In this model, providers are reimbursed for each service performed, thereby incentivizing the ordering of unnecessary tests and procedures, which inflates healthcare costs. This approach does not prioritize cost-efficient management, making it difficult for patients and healthcare companies to anticipate total expenses prior to receiving care. Consequently, healthcare companies are actively exploring alternative payment models that lower costs and improve patient health outcomes. The Value-Based Care (VBC) model presents a promising alternative for health insurance companies. Unlike the FFS model, VBC compensates healthcare providers based on patient outcomes rather than the volume of services rendered. This research into the Value-Based Care model aims to address persistent issues within the healthcare sector, such as medical waste and unsustainable healthcare expenditures. While responses to VBC models vary, the approach is increasingly receiving positive recognition from the physician community. Given the high demand for ongoing advancements in Value-Based Care programs, it is crucial to emphasize the significance of patient-physician relationships and the enhancement of patient outcomes.
The advent of Healthcare 5.0 heralds a groundbreaking revolution in digital healthcare, superseding the achievements of its predecessor, Healthcare 4.0. Integrating cutting-edge technologies such as the Internet of Medical Things (IoMT), smart wearables, and the extraordinary capabilities of Artificial Intelligence (AI), Healthcare 5.0 envisions a unified framework that grants seamless access to health records, fosters interconnectedness among individuals, resources, and institutions, and empowers intelligent responses to medical concerns. However, the realization of Healthcare 5.0 faces a significant challenge in the form of high-speed data transmission using smart devices. Conventional AI approaches relying on centralized data processing raise compelling concerns surrounding information privacy and scalability within the Healthcare 5.0 context. Amidst this backdrop, federated learning emerges as a beacon of hope, offering a decentralized AI paradigm that facilitates on-device machine learning without compromising end-user privacy through centralized data export. Safeguarding data integrity, federated learning holds the key to unlocking the full potential of Healthcare 5.0. In this pioneering study, we conduct an extensive survey, exploring the transformative implications of federated learning within the realm of Healthcare 5.0. By shedding light on recent advancements tailored to this paradigm, we delve into the fundamental concepts of resource-awareness, privacy preservation, incentivization, and personalization, all within the framework of federated learning. Moreover, we meticulously scrutinize key parameters including security, sparsification, quantization, robustness, scalability, and privacy, providing an authentic evaluation of the current progress in federated learning for Healthcare 5.0. This comprehensive survey serves as an indispensable cornerstone for the evolution of Healthcare 5.0, offering invaluable insights into its unique requirements and untapped potential. By harnessing the capabilities of federated learning in this context, we envisage a transformative era in digital healthcare, fostering a more interconnected, secure, and intelligent healthcare landscape for the betterment of society.
Purpose
Outcome-based pricing models which consider domains of value not previously considered in healthcare, such as societal outcomes, are of increasing interest for healthcare systems. Societal outcomes can include family-reported outcome measures (FROMs), which measure the impact of disease upon the patient’s family members. The FROM-16 is a generic and easy-to-use family quality of life tool, but it has never been used in the context of patients undergoing advanced therapy medicinal product (ATMP) treatment. The use of potentially curative ATMPs is limited due their high cost and the low number of eligible patients. Using the FROM-16 to collect the impact on family of disease and treatment in ATMP patients may demonstrate additional value created by an ATMP intervention and strengthen the case for its use.
Methods
This feasibility study aimed to test the validity of the FROM-16 in family members of ATMP patients as a prelude for its use in ATMP value estimation. Patients and family members (n = 24) were recruited from ATMP treatment centres in England and Wales. Family members completed the FROM-16 and were invited to a short debriefing interview.
Results
The FROM-16 showed high validity demonstrated by strong internal consistency (Cronbach’s alpha = 0.917) and intraclass correlation (0.803, 95%). Interviews identified that whilst the FROM-16 covered most areas of quality-of-life impact experienced by the participants, some explained that they also experienced other impacts upon their personal health and future outlook.
Conclusion
This feasibility study provides evidence that the FROM-16 could be used as part of a structured systematic approach to measure family quality of life impact in ATMP patients.
Purpose
“Sustainability” in a health-care context is defined by the sustainable development goals (SDGs) adopted by the United Nations in 2015, and in particular the third SDG. Accordingly, this research summarizes seminal studies and draw on it to identify the waves of challenges affecting this sector. This study aims to contribute to the discourse on sustainability in health-care organizations (HCOs) by exploring the role of performance monitoring systems (PMS), such as the balanced scorecard (BSC).
Design/methodology/approach
To explore this issue further, the authors illustrate the transformation model of the HCOs, from inputs to outcomes. The authors rely on the systems and organizational analysis/behavior theories. They use a qualitative case study approach (the American University of Beirut Medical Center in Lebanon – AUBMC) to delve into the intricacies of PMS implementation in an HCO.
Findings
The authors’ findings underline the role of PMS in operationalizing sustainability within HCOs. By adopting a PMS, HCOs can facilitate the integration of environmental, social and economic factors into decision-making processes. HCOs can enhance their performance and create long-term value.
Research limitations/implications
Despite the important findings, this paper is not enough to “generalize” and “replicate” the results. However, this paper is able to highlight a road map for HCO’s managers. Furthermore, it does not take into account the impact of artificial intelligence on the design, implementation and analysis of the results produced by such a PMS.
Practical implications
This paper highlights the importance of strong leadership and a well-defined approach for HCOs to achieve sustainability. It highlights that sustainability is no longer just about reputation; sustainability can enhance organizational performance across various aspects. Leaders need to integrate sustainability into the organization’s mission, vision and values. Thus, implementing a PMS like the BSC is crucial. On the other hand, a focus on sustainability can attract and retain top talent who are increasingly concerned about environmental and social responsibility. Furthermore, sustainability efforts should consider patient needs. And finally, sustainability can drive innovation through developing new services, partnerships and technologies that reduce environmental impact and improve financial performance.
Social implications
This study highlights how adopting a sustainable approach in HCOs aligns with and supports achieving the UN-SDGs related to health care (SDG 3: Ensure healthy lives and promote well-being for all at all ages). The findings conclude on the HCO’s sustainability efforts to: improve access to quality care (by providing more efficient operations and resource allocation, potentially allowing HCOs to treat more patients and improve access to quality care − SDG 3.1, 3.8); encourage investments in preventative care programs and public health initiatives (by contributing to a healthier population and reducing treatment burdens − SDG 3.3, 3.4); support environmental responsibility (by reducing energy consumption and waste disposal in HCOs can lessen their environmental footprint and contribute to a healthier planet − SDG 3.9); focus on the employee well-being (by creating a more positive work environment with better air quality and potentially stress-reducing practices, potentially improving employee well-being − SDG 3.9); and innovate for better health care (sustainability can drive innovation in areas such as telemedicine, renewable energy sources for powering HCOs and developing environmentally friendly medical equipment − SDG 3.b).
Originality/value
This research contributes to the emerging field of sustainability in health care by providing empirical evidence of the role of PMS in achieving sustainability goals. The case study offers practical insights for HCOs seeking to improve their sustainability performance and highlights the potential of a PMS as a strategic management tool.
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