Comment / Data holds key to system value

Improvements that drive value most effectively and efficiently are those that tackle unwarranted clinical and financial variation at the same time. While all parts of the service need to focus on value, the agenda needs to be led by systems. It is only by working together that we will maximise value at the population level.

As Sir Muir Gray has articulated, value can be thought about in three ways. Personal value is about improving the outcomes that matter to patients. Technical value is about the efficient use of resources and elimination of waste. And population or allocative value is about allocating the right level of resources to the right programmes of care and point in the pathway.

In all these cases, data is the catalyst to delivery – and a new briefing from the HFMA considers the finance data needed to drive value at the population level. Delivering value is about improvement; effective improvement is fed by knowledge; knowledge is fed by information; and information is fed by data.

A key component of a high value healthcare system is financial sustainability, which, in turn, means that financial data is a vital part of the equation.

Where can data help? The answer is: throughout the process. Initially, data provides the answer to ‘where should we focus our improvement attention?’ – with variation on outcome, quality, throughput and cost between our data and our peers’ data suggesting areas for further exploration. During the improvement process, data ensures we remain on track. And after changes have been made, it is a key ingredient in evaluation and subsequent learning.

The data we can use for that initial ‘where to look?’ question comes from a number of sources including robust programme level data to support the identification of opportunities for population and allocative value. It also includes more granular data such as patient-level costs, which can help in the delivery of personal value for individual patients.

During the improvement process, the same data can help us build the solution and the case for implementing it. For instance, we can model the changes to our allocative value by tracking the anticipated changes to the data that feed programme costs. And we can see changes in our technical value via modelled changes to patient costs and organisational financial flows. 

The same information can help to show the necessary re-allocations across parts of the pathway – and between organisations and programmes of care. Knowing this informs the changes that are best co-ordinated at whole system level – that is, the co-ordinated re-allocation of capacity and resource within the health and social care economy. Following implementation, evaluation looks at the subsequent movements in the data in order to understand impact.

Looking at value at the population level means understanding whole patient pathways. We have an excellent starting point with a common patient identifier in the NHS number. We have increasingly robust patient-level financial data. And in programme budgeting, we have a model capable of providing robust system information. The NHS is one of few healthcare systems in the world that can build programme-level financial information, which makes us one of the few with the optimal data-framework to drive allocative value.

Combining programme budgeting and patient-level models could provide the holy grail – one financial dataset that, when combined with clinical data, drives both the population and individual value agenda at national, regional and local level.

So, what to do? The first step is to ensure we are continuously improving what we have – improving the way we collect, collate and use the data. A more accurate set of data that tells us more about pathways and systems, with narrower confidence intervals, can only be a good thing.

But in the meantime, we need to use what we already have to best effect. The HFMA’s briefing moves the agenda forwards by both highlighting what can be done already with existing data and where the gaps are. It is an important agenda – and one that needs to be taken forward. All parts of the system have a role to play in doing this.

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The Healthcare Costing for Value Institute is holding an international symposium on making value-based healthcare a reality on 3 October. More details can be found here.