Abstract
Background: Value-based care (VBC) aims to optimize patient outcomes relative to costs, and to deliver care efficiently. In Singapore, VBC expanded under HealthierSG, as healthcare funding transitions from workload-based to capitation-based models. Despite implementation since 2015, VBC initiatives remain limited in scale and fragmented, often disease-based or linked to specific health technologies. Large-scale deployment of VBC to drive integrated care remains a challenge.
The National Healthcare Group (NHG), a regional health system serving 1.5 million residents in Central and North Singapore, conducted a systemic VBC workshop to unite stakeholders across institutions to identify gaps, co-create and align VBC efforts. It emphasized the structural drivers of VBC including governance, financing, data infrastructure, care delivery, manpower, and technology.
Approach: A 90-minute workshop at the Singapore Health and Biomedical Congress was conducted in October 2024. It involved 80 participants including clinicians, administrators, policy makers, & value office members from various institutions, along with public and shared care partners. The workshop had three parts:
Part I: Participants mapped current VBC initiatives onto a health system template based on WHO building blocks and Value Driven Care Framework from World Economic Forum. Facilitated discussions followed on how the initiatives contributed to VBC.
Part II: Participants individually and collectively identified patterns and gaps within the initiatives and recorded insights on an online whiteboard. Discussions followed on aspects of VBC which were working well and needed improvement, particularly on how NHG could concert efforts further to support a value-driven regional health system.
Part III: Participants reflected on key insights and committed to actionable changes, focusing on how they or their organizations could improve VBC initiatives.
Results: Part I revealed variations in VBC initiatives mapping across health system domains, with gaps identified in governance, leadership, and human resource. Care delivery and technology-enabled initiatives were well represented, while broader system-level enablers were less so.
Part II discussions emphasized the need for improved governance, centralized coordination, and better financial incentives to scale VBC. Participants identified the need for a robust data infrastructure and systematic measurement tools for systemic VBC implementation. Financial gaps, including insufficient clarity on value-based incentives, were also noted.
Part III reflections underscored the importance of cross-collaboration, communication, and a common platform to avoid fragmented efforts. Value-based incentives were deemed critical to sustaining projects. Participants expressed a need for all initiatives to have clear impact on patient outcomes, and the importance of understanding true costs to make VBC actionable for clinicians.
Implication: The workshop revealed several strengths of the current VBC landscape in NHG, including a clear VBC strategy, as well as a strong focus on care delivery and technology. However, opportunities for improvements were found in governance for systemic deployment, financial incentives, and systematic evaluation. Addressing these gaps requires further alignment in leadership and focus, harmonized communication, and a systemic approach that links system wide initiatives to meaningful patient outcomes. The insights from participants can provide a roadmap for advancing VBC in other health systems, emphasizing coordinated governance, effective evaluation, and sustainable incentives for meaningful and impactful care.