Opinion: Value-based health care could be the key to achieving UHC

Dec. 12 is Universal Health Coverage Day, an annual rallying point to improve access to basic health care for everyone. Achievements vary greatly but targets related to SDG 3 are lagging in most countries, especially in sub-Saharan Africa. With the current rate of implementation, countries such as Nigeria, Kenya, and Tanzania have little hope of achieving the universal health coverage, or UHC, target by 2030.

But it's not only more health care funding that's needed: Smarter use of the available funding is required, too. Health systems must be transformed, using the wide adoption of mobile and digital technology — and our suggestion on this UHC day is to prioritize value-based care models.

Ensuring access to care is not enough. While some countries have somewhat increased health spending overall, considering the economic contraction in Africa, health financing remains limited and health outcomes for patients are not improving fast enough: The region carries two-thirds of global maternal deaths and 90% of global malaria cases. In most low- and middle-income countries, or LMICs, poor quality of care provided by hospitals is more damaging to patients than the lack of access to care. Each year, an alarming 5 million deaths in LMICs are attributed to low-quality care, against 3.6 million due to a nonutilization of care.

Health providers suffer from the way health care is financed. Financial rewards for facilities are given on the basis of the number of services provided, with no incentive to ensure that these services are impactful. With little or no prepayment, providers struggle to invest in quality. Another source of complication are vertical, disease-specific funding streams, which can create inefficiencies, inequitable access to care, and a lack of contribution to an overall strengthening of the health care system.

So smarter use of funds is needed — and possible. Mobile and digital technology is rapidly transforming African economies and societies and provides a launchpad to do the same for health care systems, by empowering patients and placing them front and center of these systems.

Using mobile and digital technology can reform current systems and the way health care is financed by adopting a value-based care model, in which payments for providers are conditional on good health outcomes. By collecting data throughout the length of the patient journey, health providers and funders are empowered to improve the quality of care for the patients they serve.

Value-based care is not a faraway future model. These principles are already being adopted in high- and low-income countries, where efficient spending of resources is even more critical.

Health organization PharmAccess implemented MomCare in Kenya and Tanzania with the goal of reducing maternal mortality and poor health outcomes in the region. Patients receive a health wallet with entitlements for services during their maternity care journey. Data and technology are used to monitor the progress of the journeys, and financial and behavioral incentives are given to influence provider and patient behavior.

By supporting over 50,000 low-income women through 69 healthcare providers, MomCare has become the second-biggest implementation of value-based care worldwide. Observed results include an uptake in the number of antenatal care visits — critical to reduce pregnancy risks — from 3.3 to an average of 5.1 within the MomCare network in Tanzania. Moreover, pregnancy costs became accurate to predict, with only a 4% variance in Kenya.

Examples like this show that when health care is underpinned by data and technology, the quality of care delivery can improve. With aggregated data, health providers as well as governments and funders are empowered to make better, timely decisions. Mobile technology also provides the opportunity to effectively support care journeys for the most vulnerable. And when funding streams become transparent, international funding from multilaterals such as the Global Fund and U.S. President's Emergency Plan for AIDS Relief, or PEPFAR, can be leveraged with what is provided by local governments and national health insurances, reducing fragmentation and avoiding crowding-out effects.

To successfully adopt value-based care models, we recommend global health stakeholders to:

• First, focus on collecting data: A prerequisite for improvement.

• Target the most vulnerable in communities with funding, as they suffer most from gaps in health coverage and out-of-pocket costs.

• Integrate a feedback mechanism — preferably mobile-enabled — to increase patient centricity. This can be as simple as sending text messages to patients and asking for feedback on the care provided. These types of patient–provider interactions also help to reduce the risks of patients dropping out.

• Reimburse on the basis of health outcomes. Improving the quality of care requires a list of behavioral nudges, but when reimbursement for services is made conditional on health outcomes, the quality of care will make a jump.

• Make iterative improvements, with data continually being used to guide new interventions.

• Share findings with other actors in the field. Expert exchanges through organizations such as Leapfrog to Value and the World Economic Forum's Global Innovation Hub help to accelerate and scale the adoption of value-based care models for diseases such as HIV/AIDS and diabetes.

LMICs have a unique opportunity to adapt to new, digital approaches. They lack most of the legacy systems that are in place in higher-income countries. Therefore, health systems have the opportunity to innovate much quicker and rethink and transform approaches for financing, quality of care, and remote care delivery. 

UHC Day is the perfect occasion for health stakeholders to set bold ambitions to achieve universal health coverage — especially in Africa where the targets for improving health and rolling out UHC still fall short.

Adopting digitally enabled value-based care models is a promising and proven way to improve health outcomes and trust for patients so that they receive the care they deserve.