Can the patient voice reduce low-value care? Australia’s first large-scale hospital initiative seeks answers

In an Australian-first, a not-for-profit private health insurer will ask hospital patients to rate not only their clinical care but also their satisfaction with doctors and procedures.

The HBF program is inspired by an international model that has been implemented in other regions for several years. It relies on two key metrics: PREMS (Patient Reported Experience Measures) and PROMS (Patient Reported Outcome Measures), which aim to capture both patient experience and the outcomes of their treatment.

HBF notes that while some Australian health funds and hospitals have used similar models, they have generally been limited to in-house or small-scale applications that lack broader comparison and trend analysis capabilities.

The initiative will be rolled out in the coming months, targeting private hospital patients and private patients within public hospitals among its one million Western Australian members. HBF expects to distribute up to 800,000 surveys annually, gathering substantial data to enhance healthcare insights.

The PREMS/PROMS model aligns with the principles of value-based care, aiming to eliminate low-value treatments – a concept championed by Harvard Business School Professors Michael Porter and Elizabeth Teisberg.

“If they had a joint replacement, after 12 months are they able to sit or stand properly, are they able to jog or run?” said HBF Group Executive Insurance and Health Services, Dr Daniel Heredia. “So it’s very disease-specific, and there is a significant evidence base behind these surveys. They’re standardised and being used internationally.”

The need for such a program is underscored by the rising costs of healthcare, which often do not correlate with improved outcomes. Some studies estimate that up to 30% of healthcare spending is wasted on low-value or duplicative services, with 10% potentially resulting in harm or adverse effects.

Leanne Raven, CEO of Crohn’s and Colitis Australia, took to social media to raise a bold question: “Is this patient voice washing? Wouldn’t it be a stronger voice if health insurers partnered with patient organisations and healthcare providers to truly understand the unmet needs, rather than using patients as pawns in their commercial healthcare ventures?”

She did not hold back, adding, “Why would patients want to give them their data anyway?”

A decade ago, the International Consortium for Health Outcomes Measurement (ICHOM) developed over 40 datasets covering outcomes for 60% of global diseases, including atrial fibrillation and diabetes. HBF believes that patients themselves are the best judges of how their illness and treatments impact their lives, yet current healthcare lacks a comprehensive method to capture this feedback.

Dr Heredia noted that HBF would be the only major Australian health fund to implement both PREMS and PROMS on such a large scale.

“Because those numbers are so big, we will be uniquely placed that within six, 12, 18 months we will start to have significant amounts of data that we can share back, initially with the hospitals, and over time with the doctors,” he explained. “We can also ultimately drill down to what was the difference depending on the operator – that’s how powerful the data is once you get the numbers there, but that takes a long time.”

The primary goal is to share performance insights directly with doctors and hospitals, not the general public, according to HBF. The experience internationally shows that most healthcare professionals, once they actually receive the data, are motivated to do something with it.

HBF has partnered with analytics company, Insight Actuaries, which developed the PREMs and PROMs platform called Voice of the Patient.

In reimagining healthcare, Health Industry Hub^TM is the ONLY one-stop-hub uniting the diversity of Pharma, MedTech, Diagnostics & Biotech sectors to inspire meaningful change. The exclusive leadership and influencer podcasts and vodcasts offer unparalleled insights and add immense value to our breaking news coverage.

The Health Industry Hub^TM content is copyright protected. Access is available under individual user licenses. Please click here to subscribe and visit T&Cs here.