U.S. ranks near last in value-based healthcare, report says

BOSTON – A report released Wednesday from Boston Consulting Group shows the United States trailing behind eight countries with regards to value-based care adoption, suggesting criticism of the U.S. healthcare system may be merited.

The Boston Consulting Group (BCG) study examined the progress of 12 industrialized countries in adopting value-based healthcare – an approach experts say would improve health outcomes while also reducing the industry’s expenditures. 

The report, title, "Progress Toward Value-Based Health Care: Lessons from 12 Countries," evaluates national health systems along two dimensions. 

The first is the degree to which key supports of value-based healthcare 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 healthcare, 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. 

Some experts say the fragmented nature of the U.S. healthcare system has 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 specialty,” said Peter Lawyer, a BCG senior partner and coauthor of the report. “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.” 

“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. 

The challenge for U.S. healthcare 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, he added. “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, he said, “by creating a legislative and regulatory framework that facilitates their establishment and by providing seed funding to get them up and running.”