U.S. Faces Obstacles to Improving Health Care Value

Boston Consulting Group Assessment of International Progress in Adopting "Value-Based Health Care" Shows U.S. Trailing All but a Few of 12 Countries Studied

Jun 06, 2012, 00:01 ET from The Boston Consulting Group

BOSTON, June 6, 2012 /PRNewswire/ -- The U.S. faces major obstacles in taking advantage of "value-based health care"one of the most promising developments in health care, according to a new study by The Boston Consulting Group (BCG).

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BCG assessed the progress of 12 developed-world countries in adopting value-based health care, an approach to better controlling health care costs by improving health outcomes at the same or lower cost. The results of the assessment appear in a report titled Progress Toward Value-Based Health Care: Lessons from 12 Countries, which is being released today.

The assessment evaluates national health systems along two dimensions. The first is the degree to which key supports of value-based health care are in place at the national level—for example, common national standards and IT infrastructure, national legal and consent frameworks, the ability to link health outcomes with costs, and high engagement on the part of clinicians and policymakers. The second is the quality of a country's existing disease registries (institutions that track selected health outcomes in a population of patients with the same diagnosis or who have undergone the same medical procedure), both in terms of the richness of the data and the sophistication of the medical community's use of the data.

"When it comes to implementing value-based health care, Sweden is the most advanced country of the 12 we studied, followed by Singapore, Canada, and the U.K.," said Neil Soderlund, a BCG partner and coauthor of the report. "By contrast, Germany and Hungary have the furthest to go."

The U.S. health system, which has the highest per capita costs of the 12 nations studied and spends 17.6 percent of GDP on health care, is also one of the laggards in the group. "The U.S. has some successful national disease registries, such as the Cystic Fibrosis Foundation Patient Registry, the Society for Thoracic Surgeons' STS National Database, and the American College of Cardiology's CathPCI Registry," said Peter Lawyer, a BCG senior partner and coauthor of the report. "And some integrated players such as Kaiser Permanente have made considerable progress in using clinical outcomes in their own patient populations to identify and disseminate best practices across their centers."

However, the fragmented nature of the U.S. health-care system has seriously limited the collection and use of national health-outcome data. "Reporting standards and clinical outcome metrics differ substantially across the system, even within the same speciality," said Lawyer. "There currently exists no national mechanism for compelling providers to report outcomes to disease registries. Nor is there a unique patient identifier in place that would enable research to combine data across different disease states to examine the effect of complex comorbidities."

Detailed International Comparisons

The report is one of the most detailed international comparisons of progress toward value-based health care, combining a top-down assessment of national enablers with a bottom-up assessment of data quality and use at existing disease registries across 12 major health conditions. It uses 35 specific assessment criteria developed on the basis of previous BCG research in the field, a comprehensive survey of the medical literature, and 139 interviews with representatives of national health departments and with international health-outcome experts.

"We learned that a number of countries have begun to build the infrastructure and processes to support a value-based approach, but some are significantly farther along the learning curve than others," said Stefan Larsson, MD, a BCG senior partner and coauthor of the report. "Despite this differential in development and despite major differences in the structure and organization of national health-care systems, there is much to learn from each country."

The challenge for U.S. health-care executives and regulators is how to close the gap with the rest of the world. "Notwithstanding the politics of health care reform, reimbursement is moving from a volume basis to outcomes," noted Martin B. Silverstein, MD, a senior partner and former global leader of BCG's Health Care practice.

For more widespread and systematic use of disease registries to take hold, key stakeholders will need to champion them. "National medical societies, in particular, have a leadership role to play," said Silverstein, "both in creating uniform standards for data collection and in securing broad support and participation of practicing clinicians."

The federal government can also support registries, Silverstein added, "by creating a legislative and regulatory framework that facilitates their establishment and by providing seed funding to get them up and running."

A copy of the report can be downloaded at www.bcgperspectives.com.

To arrange an interview with one of the authors, please contact Eric Gregoire at +1 617 850 3783 or gregoire.eric@bcg.com.

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