Comment / Why should finance directors invest in capturing patient-relevant outcomes?

Recently I chaired a roundtable discussion for HFMA on measuring outcomes in the NHS. The context was the growing interest in value-based healthcare and achieving value for patients. This means achieving outcomes that matter to people with the resources that society has available.

Too often there have been attempts to achieve value through the minimisation of costs only. This has involved paying attention only to reducing ‘low-value’ activity in the NHS, but neglecting corresponding investment into ‘high value’ activity. A greater commitment to capturing patient outcomes and using them day-to-day in our decision-making is necessary to address this problem.

When you think about it, it is amazing how little we know about the true outcomes we are achieving for those receiving healthcare in the NHS, at least from the perspective of patients. Collecting, analysing, presenting and using clinical and patient-relevant outcome data is a major undertaking when done properly and at scale, so why should finance directors want to invest in it?

I would like to suggest three reasons why finance directors should engage with this activity. But before I do that, I would like first to put forward a view that this is not primarily about collecting data to compare organisational performance, to benchmark, to assign value to a procedure or to attach payment by results. Healthcare outcome data, particularly in chronic disease, is much more nuanced in its interpretation with many factors influencing outcomes.

Reason 1 – understanding need

A patient-relevant outcome is not just an endpoint. It is a milestone of a person’s self-reported health status and this means it is telling us about need. This may be condition-specific in terms of the symptom burden of a disease. Or it could be generic in referring to quality of life elements such as pain and sleep.

Unmet need is what drives demand for healthcare and so it follows that if we have a good understanding of it we can find better solutions to meet it instead of designing services with guesswork and assumptions. After all, unmet need does not go away, and so it becomes a major factor in driving high rates of unscheduled healthcare utilisation.

Reason 2 – supporting clinicians in the consultation

Two of the clinicians at the roundtable spoke eloquently about how patient-reported outcome data could support direct care of patients and the essential need to embed this activity in normal clinical care to support shared decision-making. Patient-relevant outcomes should never be looked at as a data collection exercise – it is about enhancing communication.

Reason 3 – the knock on effects on digital support for healthcare

If we are to enhance communication with patients in this way at scale, it has to be done electronically for large numbers of people. This means embedding electronic communication as part of normal direct care. If we can do this we start to open up the possibility of new models of care, which not only are need-led and improve patient experience, but release capacity within our overstretched system.

What’s not to like?


For more information on value, visit the HFMA's Healthcare Costing for Value Institute's webpages