Transitioning to High-Value Health Systems in G20+ Countries

Abstract

This report highlights and studies a major trend already underway in most health systems: the imperative to achieve better health outcomes and curb rising healthcare costs. Among G20+ nations, the major challenges that confront health systems and which drive this shift include, among others, unsustainable cost increases, rising citizen demand for health services, poor uptake of innovations, widening disparities in access to individual and public health services, and worsening inequalities in health outcomes. As a result, many G20+ countries seek to transform their health systems to deliver both ‘value for money and value for many’. However, to date, most initiatives designed to achieve this objective have occurred at the departmental or organizational level and have yet to improve the performance of health systems as a whole to achieve large-scale population-level impact. This study adopts a systems lens to explore how G20+ countries are embracing a value orientation and the policies, programs, innovations, and institutional arrangements they are introducing to improve the efficiency, effectiveness, equity, and responsiveness of health services, and thereby create value at the system level. The Health Systems Innovation Lab at Harvard University (HSIL) has developed the Harvard High-Value Health System Model (HVHS) that draws upon nearly three decades of health systems research, engagement with large global health initiatives, and empirical data to analyze and characterize the shift underway from a systems perspective. The HVHS model consists of 10 interdependent components that include (I) digital data systems, (II) analytics, (III) cost measurement systems, (IV) outcomes measurement systems (V) benchmarking, (VI) integrated care pathways with bundled services, (VII) value-based payment models, (VIII) value-based procurement, (IX) integrated provider networks, and (X) strategic change and innovation ecosystems. The study finds that while all countries appear to be embracing some of the 10 components, no single country has yet to advance decisively in all components and to the fullest extent, to achieve the HVHS transition. This study applies the HSIL framework to examine the progress of G20+ countries in transitioning to a HVHS, identify areas for improvement, and share best practices to accelerate progress. The research team surveyed experts, conducted interviews, and performed desk research to gather data on the progress of G20+ countries in relation to each component. The study found that while G20+ countries are certainly progressing towards the HVHS model, the level of progress in each of the 10 components varies substantially across countries. For each component, we ascertain whether a country has demonstrated major, moderate, or some progress that could benefit from accelerated progression. The components in which countries are experiencing major progress are digital data and strategic change programs. Meanwhile, the components related to analytics and cost and measurement systems registered the moderate progress. The components of value-based payment models and value-based procurement represent areas in which accelerated progression is needed. Most countries have established national policies on health data ownership and usage, and healthcare providers are widely utilizing digital data systems. However, there is still an opportunity to accelerate the use of existing data systems and deploy analytics at scale to improve policy and practice to create greater value. Additionally, less than 50% of the countries studied have established performance datasets that enable comparisons by regions or providers. The analysis also revealed that the countries studied have made slower progress in other areas, such as aligning financial incentives and establishing systems for regular measurement of costs and outcomes. Nonetheless, the study identified multiple examples of valuable initiatives that could inspire other governments to focus on specific components to improve and accelerate their transition to HVHS. We discuss three strategies that G20+ countries could pursue when transitioning to the HVHS model, and provide examples, namely: (I) Extension: extending scope—from one to multiple HVHS components—followed by expansion of scale—from a small initiative to a health-system wide intervention—; (II) Expansion: expanding scale followed by extension of scope, and; (III) Transformation: a hybrid approach that simultaneously combines extension with expansion with the introduction of system level transformations. While most countries appear to follow the expansion and extension strategies, fewer embark on a transformational approach. In pursuing these strategies, countries should invest in five critical enablers that could help accelerate the transition to the HVHS Model: • Development of a National HVHS Transition Strategy (NHTS): high-level strategic documents that recognize commitment to the HVHS model and align a nation’s vision for its health system transformation with national political, economic, and social objectives. • Leadership: the demonstration of distributed leadership across all major stakeholders involved in health systems instead of the zero-sum game that currently characterizes it. • Financing: expanded fiscal space and innovative financing measures to invest in NHTS and potentially transformative demonstration projects. • Global benchmarking and cross-learning: the development of a global HVHS data set and case study library to understand better health system transition in G20+ countries and promote cross-learning about what works and what does not among G20+ nations. • Innovation: the creation of an enabling ecosystem that promotes the design, introduction, and scale-up of value-based innovations in health systems and system level receptivity to innovation uptake and diffusion. The transition to a high-value health system is a critical goal for all G20+ countries to optimize health system functions and deliver high-value health services to citizens. The findings of this study provide valuable information to inform this transition. We propose that the G20+ countries conduct this survey annually to provide ongoing information about the group’s evolution in the path of a value-based health system. There is valuable experience among the group of G20+ countries in different components that should encourage cooperation and cross-learning initiatives to achieve a faster transition to a HVHS.