Value-based health care initiatives remain limited in scope, global study finds

Value-based health care initiatives are still in early adoption stages worldwide, according to a comprehensive scoping review published in JAMA Health Forum. The study examined how value-based healthcare (VBHC) initiatives have been introduced in health systems globally between 2007 and 2023.

Researchers reviewed 50 value-based healthcare initiatives and found that 94% came from high-income countries, with 31 originating in the United States. Only two initiatives were from upper-middle-income countries, and only one from a lower-middle-income country.

The study revealed that value-based health care adoption remains largely confined to departmental or institutional levels. “VBHC adoption remains confined to the departmental or institutional level, with few examples of systemwide or national implementation,” the authors noted. The authors found limited evidence of comprehensive health system transformation.

Most initiatives incorporated several value-based healthcare components, including outcome measurement systems, cost measurement systems and integrated care pathways. However, none of the examined initiatives achieved full implementation of all elements of the value-based healthcare framework or all components of high-value health systems (HVHS).

Research confirmed that the initiatives often focused on specific medical conditions such as cardiovascular disease, joint replacements and cancer care. Digital platforms and electronic medical records were commonly used to track patient outcomes and costs, but only 28% of the reviewed initiatives used data analytics and benchmarking to compare results across institutions.

According to the authors, “These findings highlight the need for research on effective implementation models, particularly in lower-resource settings, to guide policymakers and health system leaders in scaling VBHC and transitioning toward HVHS.”

The researchers concluded that while value-based healthcare has been recognized as a strategy for improving health system performance since its formal introduction in 2006, large-scale adoption will require a strategic shift toward integrating value-based components at national and regional levels.