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Value-Based Care is the key to improving healthcare delivery – NHIA Boss

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Dr. Bernard Okoe Boye, Chief Executive Officer of the National Health Insurance Authority (NHIA), has said the NHIA is adopting a Value-Based Care system to address some of the challenges in healthcare delivery in Ghana.

According to him, the Value-Based Care (VBC) system – when successfully implemented – will provide all citizens with quality and equitable access to basic healthcare.

He made the comments at the opening of a five-day workshop organised by the PharmAccess Foundation in Ghana, in partnership with Leapfrog to Value and the Christian Health Association of Ghana.

He noted that data analytics and digitalisation of the NHIA system will be key to the implementation of value-based care.

He said the NHIA has, in recent years, deployed digital technologies to enhance the provision of healthcare in Ghana. Among these technologies are the mobile NHIS renewal system which helps subscribers to renew and pay their insurance premiums in a convenient way; and the digital claims submission – CLAIM-IT application – which helps providers to submit their claims without hassle.

Dr. Okoe Boye said the digitalisation of these processes has enable the NHIA to analyse and visualise its data to aid decision-making for improving the sustainability of the scheme.

“Well, I am excited because you can have so much data but if you don’t sit down to look at the data, you might not profit from the data. A few years ago, 80 percent of our claims management process was manual. People were forced to sit by papers to assist and it was not efficient. As we speak, approximately 75 percent of the process is now electronic,” he added.

He said these digitalised processes are the spade works that will ensure the authority’s digital transformation in managing providers and subscribers.

“These digitalised processes allow us to consolidate all the information we have about Ghanaians who attend hospitals,” he said.

He revealed that careful analysis of claims using technology has enable the authority gain insights into the disease patterns of subscribers and the cost of care for these diseases over time.

Speaking of Value-Based Care (VBC), he mentioned that it makes provision for investing in preventive interventions that improve the health of the population. “VBC will tell you where to push your resources, so that you have the best outcome; and that is what we are here to do,” Dr. Okoe Boye said.

He added that the VBC will be a component of the NHIA’s quality strategy to reform how healthcare is delivered and paid for in Ghana.

He acknowledged that the current system is a drain on the government’s limited resources, and that a rethinking of the current system will help contain the escalating payments in government claims.

He further appealed for expedited action in the implementation of a value-based care system.

The NHIA will pilot VBC with its partners PharmAccess Foundation, Leapfrog to Value, and the Christian Health Association of Ghana (CHAG). The model is centred on patients, and it guarantees efficient use and allocation of resources, ensures quality, and improves health outcomes.

The NHIA CEO commended PharmAccess Foundation for leading the way with digital technologies to improve healthcare delivery in Ghana.

Dr. Peter Yeboah, Executive Director of the Christian Health Association of Ghana (CHAG), for his part, said the current challenges in health insurance administration have magnified the need for VBC.

The new model, according to him, will reduce the burden on the scheme when it comes to paying claims. He said the current National Health Insurance Scheme (NHIS) rewards the volume of healthcare delivered rather than the quality of service.

Dr. Yeboah further noted that: “The central goal of any health system is to provide optimal health outcomes – first, to individuals; and second, to ensure societal well-being at all levels. And therefore, the Value-Based Care concept is about the way healthcare is supposed to be organised, delivered, and paid for. In other words, rather than the volume of services, it is the focus on the value, the health that could be gained from the resources available to the entire health sector”.

He emphasised that the VBC will ensure optimal clinical outcomes for clients within the entire health system, while deepening efficiency gains via cost containment.

The NHIA and its partners – PharmAccess Foundation, Leapfrog to Value, and the Christian Health Association of Ghana – have begun work on a human-centred design for piloting. The design will include parameters for the selection of a care pathway, measurement, delivery, and payments as well as incentive criteria for the Value-Based Care to be piloted in Ghana. The pilot is expected to assist critical decision-making as well as policy formulation in a bid to improve healthcare delivery in Ghana.

The Operations Manager at PharmAccess Foundation in Ghana, Dr. Gifty Sunkwa-Mills, said the Value-Based Care model, when implemented will provide transparency for providers into outcomes and cost data.

“We are aligning patients, payers and providers to ensure that we deliver the best quality of care at the most efficient cost. So, it’s a model where we measure outcomes, deliver, and then pay for the healthcare using a cost-efficient approach while focusing on clinical outcomes, quality of care and client experience of care” Dr. Sunkwa-Mills added.


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