The Many Faces of Value-Based Healthcare

The definition of value-based healthcare has been debated for more than a decade, yet most of the discussion has focused on payment reform—a critical but notoriously slow and cumbersome process. If we define value more broadly as improving patient outcomes while making it more affordable to deliver those outcomes, there is a wider range of possibilities for product developers, providers and payers to collaborate, and signs of progress are easier to find.

As an example, heart failure, which affects 5.7 million adults in the U.S. alone, presents many challenges to the healthcare system. One in four heart failure patients is readmitted within 30 days of an initial hospitalization, and half of these patients die within five years of diagnosis. All of this costs an estimated $30.7 billion per year. 

The use of artificial intelligence (AI) to identify patients who are likely to become sick, and to take preventative action to keep them healthier can have a significant impact. The Boston Scientific HeartLogic™ Heart Failure Diagnostic is one such monitoring tool. The software is embedded within implantable defibrillators—which many heart failure patients need—and uses sensors to collect and analyze an ongoing stream of a patient’s physiological data. The technology can predict heart failure events an average of 34 days before they happen, using multiple sensors to track physiological signals in and around the heart. This allows clinicians to intervene with patients sooner, empowering them to take preventive action and ultimately avoid patient hospitalizations. 

There is tremendous potential to leverage more healthcare data—from implantable devices, electronic medical records and more —to identify problems while we have time to unlock the value of prevention. 

Just as better data from within the heart powers HeartLogic, better data on health economics can help health systems make smarter decisions about investing in new technologies. 

This year, a study in the Journal of the American Heart Association showed significant cost savings when patients who are at risk for stroke due to atrial fibrillation underwent a one-time, minimally invasive procedure to implant a device called the WATCHMAN™ Left Atrial Appendage Closure (LAAC) Device, as opposed to receiving lifelong treatment with anticoagulants such as warfarin. This research enables providers—as well as payers—to make more informed choices. At the same time, new research data is available to patients, equipping them to be more involved in the decision-making process.

Even with sophisticated analytics and data, not all clinical interventions can be predicted and avoided—there will always be a need for acute care, and health systems benefit from reexamining those processes as well. One powerful case study is Manatee Memorial Hospital in Bradenton, Florida. Manatee is a 295-bed facility with more than 800 healthcare professionals. Its Structural Heart acute care unit offers procedures including transcatheter aortic valve replacement (TAVR) for patients with aortic stenosis, LAAC for patients with non-valvular atrial fibrillation, and transvenous mitral valve repair (TMVR) for patients with mitral valve leakage.

Like many cardiac care centers, Manatee’s team was tasked with establishing a high-performing, market-differentiated program to manage these emerging therapies. They wanted to reduce patient wait times between referral and treatment. They also faced labor-intensive clinic workflows, and a fragmented approach to connecting patients with specialists. 

Seeking a value-based solution, Manatee’s medical directors, device implanters, IT staff and physicians partnered with our team of clinical and operational experts. Together, we standardized referral forms, upgraded tracking tools for those referrals, and developed better provider education materials. Today, Manatee offers pre-admission tests to better understand patients’ needs and steer them to specialists whose roles are well-defined within the structural heart program. 

Better coordination made a meaningful impact: referrals grew 65 percent, and the center was able to provide care for more patients with 60 percent more procedures over the year before. As a result of patients’ shorter stays and increased team productivity, Manatee realized about $175,000 in annual cost savings for certain case types. 

Delivering on the promise of value-based care and addressing the growing burden of chronic conditions, staggering costs of care and rising global healthcare spending will require a multi-faceted approach. The only way we can achieve better patient outcomes in a more accessible, equitable and efficient manner is by working together to shape a better future.

Safety information for the HeartLogic Heart Failure Diagnostic is available here.
Safety information for the WATCHMAN™ Left Atrial Appendage Closure Device is available here.

Maria Stewart is responsible for developing and directing global strategies for effective health economic and market access activities. She and her team work cross-functionally to support global technology assessments, coverage and funding for procedures using Boston Scientific products.