Good healthcare does not need to be expensive. At NUHS, value-based healthcare focuses on improving patient health outcomes while using resources responsibly. It ensures patients receive care that is effective, appropriate and sustainable over the long term.
In 2015, NUHS became the first healthcare cluster in Singapore to adopt the Value Driven Outcomes (VDO) framework. This marked a shift towards measuring outcomes and improving care using data. Two years later, the Ministry of Health (MOH) in Singapore built on this work and introduced the National Value-Driven Care (VDC) initiative to drive value-driven care across all public healthcare institutions.
VDO is a patient-focused tool. To deliver outcomes which are value-based, a key step is to understand the true costs of care. This is achieved by mining data on goods and services provided within our healthcare institutions to determine which processes work best for the patient. Best practices are identified and incorporated as standardised processes, forming quality care pathways for patients. Some examples include the timeliness of administration of antibiotics and speed of recovery of the patient following a surgical procedure.
By combining outcomes and cost data, NUHS is able to improve care quality and consistency, reduce unnecessary variation, enhance the patient experience and deliver more value for patients and the healthcare system.
Patients
Lower cost, better outcomes, increased satisfaction
Providers
Improving quality of care. Fee-for-service shifts to fee-for-outcome model
Payers
Stronger cost control and focus on preventive healthcare for population
Partners/
Suppliers
Alignment of prices with patient outcomes
Population
Reduced healthcare spending and better overall health
Over the years, NUHS has expanded our work in Appropriate and Value-Based Care (AVBC) across conditions, care settings and populations.
As healthcare needs have evolved, so has the complexity of our projects – moving from single episodic monitoring to end-to-end care pathway analysis, outcomes measurement, and system level improvement:
Today, AVBC is embedded across NUHS. As our work continues to grow in scale and impact, learn more about NUHS Value-Based Healthcare Journey since 2015 below:
The team from NUHS visited the University of Utah Health, the birthplace of Value Driven Outcomes (VDO), to study how VDO was being used to enable healthcare providers to redesign care.
The visit proved inspiring, the open sharing of knowledge and best practices at the University of Utah Health, provided a trajectory for our team to explore innovative ways to implement VDO back at NUHS.
“Healthcare professionals want to do the right thing – to give care that we are proud of, at a cost that is affordable and sustainable to patients and the healthcare system. However, we lack objective tools that tell us, in as close to real-time as possible, whether we are accomplishing this. We were thus inspired by University of Utah Health and their work on Value Driven Outcomes, and were honoured to spend time with them in 2015. We were delighted to be able to contextualize this for Singapore and deploy it across our entire academic health system, from primary, secondary and tertiary care. We were equally delighted to share our methodology with the Ministry of Health and colleagues across Singapore, and through meetings to the region and beyond.”
Prof John Eu-Li Wong
Isabel Chan Professor in Medical Sciences
Senior Vice President (Health Innovation and Translation), National University of Singapore (NUS)
Senior Advisor, National University Health System (NUHS)
The First Public Healthcare Institution to Pioneer VDO in Singapore
The NUHS VDO task force was formed. Representatives from clinical, finance, operations, informatics and clinical quality, came together for a two-day workshop to define a framework to track desired quality and cost of treatment at episode level.
Two conditions were selected to pilot a feasibility study of VDO at the National University Hospital (NUH)
– Total Knee Replacement and Pneumonia.
Upon the successful pilot, VDO was extended to another five conditions – Hip Fracture, Cataract, Gout, Colorectal and Acute Myocardial Infarction.
Within NUHS Cluster
NUH added another 13 conditions – Laparoscopic Cholecystectomy, Hysterectomy, Caesarean Section, Streamline Workflow for Intervention of non-Functional or Thrombosed dialysis access (SWIFT), Hernia, Chronic Obstructive Pulmonary Disease (COPD), Bronchiolitis, Transcatheter Aortic Valve Implantation / Transcatheter Aortic Valve Replacement (TAVI/TAVR), Stroke, HyperAcute Stroke, Coronary Artery Bypass Graft (CABG), Breast Cancer and End-of-Life.
Ng Teng Fong General Hospital (NTFGH) became the second public healthcare institution within our cluster, to adopt the VDO framework and they started with six VDO projects – Total Knee Replacement, Cataract, Hip Fracture, Laparoscopic Cholecystectomy and Pneumonia.
At the National Level
Singapore’s Ministry of Health (MOH) adopted NUHS VDO initiative and introduced the National Value-Driven Care (VDC) initiative to all public healthcare institutions. VDO formed a crucial pillar in support of MOH’s “3 Beyonds” – Beyond Healthcare to Health, Beyond Hospital to Community and Beyond Quality to Value.
As a result, 17 ‘high impact’ conditions from the national perspective were identified to embark on the initiative by MOH. In the same year, NUHS was awarded the Gold Award at the National Health IT Summit.
“We were able to leverage data from our existing IT system to create the VDO framework. We pulled data from different silos and amalgamated it. Our biggest success was partnering enthusiastic Clinician Champions who provided meaningful insights to drive clinical change with improved patient outcomes.”
A/Prof James Yip
Executive Director, National University Heart Centre, Singapore (NUHCS)
NUHS VDO Office partnered with NUH Quality Improvement (QI) Department to drive Value-Driven Outcomes initiatives, and Rapid Improvement Event (RIE) to streamline processes, including:
NUH and NTFGH added more projects into the VDO framework for continuous improvement. High performance projects achieved a total cost avoidance milestone of approximately $10 million.
The National University Polyclinics (NUP) also embarked in VDO for Lipid and Hypertension conditions.
“VDO aims for sustainable patient care and outcomes. The three pillars, Finance, Data and Culture are equally important. Transparency of actual and predictable costs and outcomes provides the needed visibility, which is a key enabler to maintain sustainability.”
Ms Wong Soo Min
Group Chief Financial Officer, National University Health System (NUHS)
VDO projects covers about 20% of total case load, which accounts for approximately 30% of total cost across NUHS. Institutions continue to identify new projects and potential gaps for improvements which eventually translated to improved value and incredible care to patients.
Recognised for the value it brings, VDO was extended to support various cluster-wide strategic and research projects such as VECTor, Optimisation of Drugs Utilisation, and Application of Frailty Score on geriatric patients etc.
“VDO is a powerful tool measuring relevant data for all members of the healthcare team. It is patient-centric and allows clinicians to be cognisant of patient outcomes and benchmark themselves against their peers. Going forward, it will be increasingly important as we tackle the healthcare needs of a more elderly population whilst trying to ensure the health of the population under the care of NUHS and that of the nation as a whole.”
Adj A/Prof Diarmuid Murphy
“VDO is simply a very powerful tool that measures both the desired clinical outcomes as well as patient reported outcomes, and ensures that they are delivered in a sustainable and cost-effective way. This enables us to be guided by data in our mission to provide superlative care to our patients.”
Prof Yeoh Khay Guan
Chief Executive, National University Health System (NUHS)
