Outcomes in Healthcare: the payer perspective (UK)

The UK national health service (NHS) is held in high regard by the public. Yet it is also overly bureaucratic, costs the taxpayer billions and is heading towards bankruptcy as a result of increasing demand and decreasing money. The NHS is facing the same pressures as any other state health service provider such as:

  • an increase in lifestyle-related conditions such as heart disease

  • increasing public expectations

  • the impact of social inequality

  • people living longer

  • huge variations in standards of care which impacts patient outcomes

To survive, the NHS must change in order to keep people well, out of hospital and back to work. Driving through change means working with the private sector, something that is already happening in the form of public/private partnerships. The majority of private hospital groups now perform between a quarter and 80 percent NHS work.

Change also means measuring meaningful outcomes. Like most of the public sector, the NHS manages only what it is measured on,e.g. hospital waiting times. They should instead be focusing on other matters such as making patients feel good, according to Fiona Driscoll. A need exists for different measurements driven by outcomes

A new outcomes framework

In response, the NHS has launched a five year plan, a new outcomes framework drawn up by people in the industry, not solely by ministers. The NHS aims to do things ‘faster and better’ by:

  • stimulating the economy as well as transforming patient care

  • partnering with,e.g. entrepreneurs, drug companies, app and device developers

Academic health science networks (AHSN)

Academic Health Science Networks (AHSNs) are key to the NHS vision of improved care outcomes, economic growth and reduced cost.

Launched in 2013, AHSNs do not commission but instead act as agents for change. Fifteen AHSNs have been set up across England with a five year mandate to pull together the adoption and spread of innovation with clinical research and trials, informatics, education, and healthcare delivery.

They have no formal powers so have to rely on persuasion by building strong relationships with their regional scientific and academic communities and industry.

These links enable them to develop solutions to healthcare problems, not just focus on targets. Using investment funding, AHSNs can back products from small businesses then get care providers to implement these ideas across the NHS and to change pathways.

The patient-centric model of AHSNs has resulted in: 

  • Fewer hospital admissions and greater patient satisfaction. 

  • Patients being helped to manage and control their own lives. 

  • Hundreds of hours of GP time freed up by pushing down work in surgeries and out to pharmacies 

Incentivising the patient to achieve successful outcomes 

“We have a very patriarchal relationship with our patients yet we rely on them to do everything.” 
Fiona Driscoll 

Prevention is key in overcoming global healthcare challenges. There are different approaches that payers like the NHS can employ to encourage patients to take responsibility for good health outcomes. Effective incentives can change lifestyle behaviours or increase medicine compliance. 

The NHS is shifting towards withholding treatment from patients in certain circonstances. People with poor lifestyle habits are encouraged to take steps towards health improvement, for example losing weight. 

However, the NHS still relies on people understanding risk and wanting to live, not on tough messages such as ‘You’re fat. Go away’ or on costly incentives such as free cinema tickets. Other countries though are taking a more forceful approach. 

Medication adherence rates can be poor though when the payer relies on patients to act on advice. Wasted medicines cost the NHS billions because patients are not asked if they are going to take their medication. Compliance for diabetes treatment is around 55 per cent for example.

Content from Gensearch Whitepaper “Life Science Talks”

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