The purchasing of health and social care around the concept of outcomes and value has been in development over a number of years, and is now in a phase of application around the UK and internationally.
‘Outcomes’ refer to the impacts or end results of services on a person’s life. Outcomes-focused services aim to achieve the aspirations, goals and priorities identified by service users – in contrast to services whose content and/or forms of delivery are standardised or are determined solely by those who deliver them. Outcomes are by definition individualised, as they depend on the priorities and aspirations of individual people.
This person-centred approach has been reviewed by the Health Foundation, concluding that person-centered care is about co-production, rather than the traditional provision of health services based on resource, feasibility and provider-centered issues. The US Institutes of Medicine describe six dimensions of patient-centeredness crucial to providing quality healthcare: 1) being respectful to patients’ values, preferences and expressed needs; 2) being co-ordinated and integrated; 3) providing information, communication and integration; 4) ensuring physical comfort; 5) providing emotional support and relieving, fear and anxiety; and 6) involving family and friends.
There is evidence that a patient-centered, outcomes-based approach can deliver improved health outcomes, overall cost savings, reduced acute activity, reduced bed-days, reduced rates of institutionalization and improved patient experience. If purchasers want the patient to experience care that is genuinely integrated, this needs to be explicit within a Service-level Agreement or contract (or contracts) that specifically aim for such a service.