Our life expectancy has risen significantly over the last century. But along with longevity comes an array of age-related diseases and chronic conditions, which contribute to rising healthcare costs. In 2023, Switzerland spent a whopping 11.5% of its GDP on healthcare. What can be done to stop costs spiralling out of control? For Noémie Voeffray-Remacle, Head of Transformation at Groupe Mutuel, the answer lies in value-based healthcare.

Let’s start with the basics. What is value-based healthcare, or VBHC?

VBHC is about aligning health systems with an approach based on value and quality. It helps healthcare providers deliver better care while keeping costs manageable. VBHC brings together key players in the healthcare sector – insurance companies, care providers, pharmaceutical companies and policymakers – around the shared goal of improving health outcomes for patients.

Today, our system is driven by quantity rather than quality. The more treatment healthcare providers churn out, the more they get paid. There’s little emphasis on assessing the quality of treatment, coordinating care or fostering a culture of prevention. VBHC is about shifting from volume to quality. Instead of being paid based on the number of procedures, healthcare providers are rewarded for delivering high-quality care.

How can VBHC help to keep healthcare costs manageable?

The Swiss healthcare system is known for its quality of care, but it’s also among the most expensive in the world. High costs are driven by incentives that encourage an increase in the volume of services.

On the other hand, quality is rarely measured or monitored effectively, leading to unnecessary or inadequate care, which accounts for as much as 20% of Swiss healthcare expenditure today. By introducing VBHC into our healthcare system, we can ensure patient care remains excellent while keeping costs sustainable.

Putting patients at the heart of our health system – by listening to their feedback, for instance – saves money. Research shows that for hip and knee surgery, many complications and unnecessary procedures can be avoided by focusing on quality and using what we call patient-reported outcome measures (PROMs). This is a fancy name for getting patients’ thoughts – through questionnaires – on their health and treatment outcomes.

How will VBHC change the Swiss reimbursement system?

Today, we rely on the DRG (diagnosis-related group) payment system, which, as I’ve previously mentioned, compensates hospitals based on the volume of care provided rather than its quality. If we want to shift the focus toward incentivising higher-quality care, it could begin with a value-based payment system.

At Groupe Mutuel, we’re doing pilot projects that explore such models – initiatives that reward providers based on the value of care delivered to the patient, rather than the number of services. These models aren’t part of the healthcare system yet but we’re working hard to implement them as soon as possible.

For example, we’re conducting a pilot project with Hôpital de La Tour to develop reimbursement models that incentivise providers to focus on patient outcomes – specifically for hip and knee surgery. We need to make sure it’s financially viable and test its feasibility – then our aim is to scale this model in Switzerland. But first we have a few challenges to overcome!

Tell us more about these challenges.

One huge hurdle is that it’s currently illegal for insurers and healthcare providers to share data due to privacy regulations. This makes it difficult for insurers to develop new payment models based on patient outcomes, so we’re exploring privacy-enhancing technologies that could allow legal data sharing.

Then, there’s the lack of standardisation in how we measure PROMs in Switzerland. More providers are starting to collect this data, but it doesn’t yet happen across the board. I think it might take around five years for the collection of PROMs to become the norm.

Another big challenge we face with VBHC is navigating the regulatory framework. The Swiss Health Insurance Act needs to be amended to allow these new reimbursement models to be fully accepted within the system. And we know that the Swiss healthcare system is resistant to change. This is perhaps the most significant barrier, as it involves a colossal change in mindset.

What does VBHC mean for the patient journey?

VBHC is all about putting the patient at the centre of care. Let’s take hip surgery as an example. Whether or not it’s a success depends on the patient leaving the hospital on time but also on achieving their therapeutic goal. Has their pain disappeared? Have they gained greater mobility? These outcomes become central to the equation, so patients benefit from high-quality care that leaves them better off in the long run.

How can we measure the results of VBHC?

I’ve talked about PROMs, which is one measure. To give a little more detail, PROMs aim to get a detailed picture of the patient’s health status, but also the therapeutic success and effectiveness of medical procedures. They measure the patient’s point of view in these areas before, during and after treatment. The idea behind these questionnaires is to get regular feedback on the patient’s state or health. They’re a very helpful tool for doctors to decide on the best possible care for patients.

Then we have patient reported experience measures (PREMs). Whereas PROMs focus on health outcomes, PREMs aim to capture the patient’s experience with healthcare services. For instance, they can express how they found communication with medical staff, how well they felt they were treated and what they thought of the hospital’s facilities.

We also use clinical-related outcome measures, or CROMs. These are the measures reported by doctors, and might include data like blood pressure readings, lab test results or surgical outcomes.

How can insurers help to put VBHC in place?

As one of the key players in the healthcare system, alongside care providers and patients, insurers have an important role to play in driving forward VBHC. Our main responsibility is to develop new payment models that will make the healthcare system more sustainable.

At Groupe Mutuel, our strategy is focused on moving away from the DRG system and shifting toward reimbursement models based on quality. But beyond payment models, we’re also trying to rethink the entire patient care pathway. We’re working on identifying patient-centred ways to improve customer experience and health outcomes. In all our pilot projects, we now include a patient representative. They provide valuable insights about the care pathway, the PROMs questionnaires and how we collect them. Patients need to be part of the conversation around developing and refining these models.

What needs to happen for VBHC to be widely used across Switzerland and beyond?

In Switzerland, we have the VBHC Switzerland Association, which Groupe Mutuel are a part of. One of the association’s goals is to standardise PROMs questionnaires and how they’re collected across healthcare providers. Without standardisation, it will be hard to roll out VBHC effectively across the country.

And more widely, in Europe, VBHC initiatives are already underway but each country’s healthcare system is unique. This makes it difficult to replicate models from one country to another. For example, what works in the Netherlands, Germany or Portugal might not be a good fit for Switzerland.

We’re certainly drawing inspiration from these international efforts, and there’s a lot to learn from systems in the US and Europe. But the Swiss healthcare system is complex, and we’ll have to adapt these ideas to fit our specific context rather than simply copying what works abroad.