The authors of the New England Journal of Medicine Catalyst article urge countries to allocate 1 percent of their health care budgets toward establishing standards and processes for assessing the value of health outcomes. What matters most to patients is the fundamental principle of value-based health care. The cost of unnecessary care amounts to billions every year, not only in the United States but worldwide. This article presents the context for an international “moonshot” aimed at enhancing health care.
Some aspects of this paper address incentives for physicians. For instance, in France, ophthalmologists receive bonuses for reporting outcome measures (such as post-op visual acuity and improved daily living activities) after cataract surgery. By sharing data on cataract surgery outcomes, eye surgeons can set standards or benchmarks for their procedures. By promoting transparency through incentives, the French establish a platform for “pay for participation” rather than “pay for performance.” However, as more data accumulates, the performance of individual surgeons will be compared to that of their peers.
The underlying theme of this paper is that a significant amount of care is funded but is either unnecessary or inefficient in its delivery, or both. Improved health care models depend on shared clinical information, with the potential to structure clinical trials across diverse populations to enhance medical practice. Encouraging best practices for clinicians to evolve ensures that they remain current by the time professional organizations publish them.
The moonshot analogy proposed by the authors holds true only if there is consensus and cooperation among governments. The inadequacy of U.S. federal programs in covering episodes of care led many accountable care organizations to reject risk-contracting with the federal government. The authors highlight a new federal division dedicated to providing financial support for infrastructure improvements, spanning from the molecular to societal levels, with the goal of delivering transformative solutions for all individuals.
In the United States, a potentially significant step in the right direction is the recent creation of the Advanced Research Projects Agency for Health (ARPA-H), proposed by the Biden administration and authorized by the U.S. Congress in March 2022.” ARPA-H aims to “transform critical areas of medicine and health for the benefit of all patients in ways that cannot be readily achieved through traditional research or commercial activity.
However, introducing a new federal agency that picks economic winners and losers disregards the private sector’s contribution to developing superior care models, particularly within self-insured employer groups.
In summary, the drive to assess the value of health outcomes will persist as both the public and private sectors collaborate on improving delivery models. The “clinical trials” for enhanced health care delivery models are already underway, whether at the local, national, or international level. The results will narrate the story of how health care expenditures can be best utilized.
Paul Pender is an ophthalmologist and author of Standing Up & Speaking Out for Patients & Doctors and Rebuilding Trust in Healthcare: A Doctor’s Prescription for a Post-Pandemic America.
