VBC Episode 3: VBC V EBM?

The third episode in our Value Based Care series is on its intricate relationship with Evidence Based Medicine. To make sense of this alphabet soup, we will look at three relationships that come up when setting up a VBC scheme, when maintaining it and when administering it.

As you remember, in a VBC scheme healthcare service providers are paid a flat rate for the patient they see, depending on what ails the patient. rather than by the services they provide them. This puts the onus of determining the cost of care on the payer (i.e. insurer or government) based on what the evidence stipulates should be done. So when setting up the scheme the best evidence for every covered condition must be determined.

The nature of healthcare means that VBC schemes need to be updated as new evidence is produced and as new innovations become available in the form of new drugs, devices and diagnostic tests. Therefore, maintaining a VBC scheme means keeping up with the evidence.

Administration of VBC, that is, reimbursement of healthcare providers is based on accurately measuring patient conditions and how better they got after receiving the service. This is very similar to running a clinical trial or a retrospective in EBM. In fact, these measurements which are routinely collected as part of VBC administration can have a secondary use as evidence for learning health systems.

As you can see, VBC both depends on vast amounts of evidence but also can generate a lot more evidence as a positive side-effect of its operation. Automation of evidence collection and dissemination is a prerequisite for value based care at scale.

Implementing the learning health system: from concept to action