Voice of the Patient driving value-based healthcare in Australia’s private sector

Our healthcare system is regarded as world-leading, but it still grapples with siloed data and insights, patient dissatisfaction, clinician shortages, exhaustion and rising costs.

As we look towards practical solutions and innovation, we must acknowledge the value of patient-reported data and perspectives as fundamental elements to sustainable, systemwide improvement.  

Each year, Australians present for almost 12 million hospital interactions. Private hospitals account for 41% of that load and are responsible for the vast majority – over 60% – of elective surgery procedures. Meanwhile, there are more than 14 million Australians with private health coverage – around 50% of the population – making their experiences and outcomes crucial to the performance of our entire, mixed system.  

But Australia’s private sector has historically lacked patient-reported data to help drive innovation and improvement. Instead, it has relied on cost and clinical data, which might help to assess service output but fail to capture the true experiences and outcomes of patients, or the value of treatments. 

Recent innovations are helping to change this narrative, and strides are being made towards establishing systems that both assess, improve and innovate healthcare services.  

During this year’s International Consortium for Health Outcomes Measurement (ICHOM) Conference 2023 in Portugal, the session titled ‘Exploring the Relationship Between Patient-Reported Data and Hospital-Recorded Complications: A Comprehensive Analysis’ explored exactly this notion. The session focused on the ‘Voice of the Patient’ platform, which launched in partnership with the Australia Health Service Alliance (AHSA) and Insight Actuaries and exemplifies the drive towards value-based healthcare in Australia.  

Employing a multidimensional approach, the Voice of the Patient gives an unparalleled view of what private patients in Australia value and experience via a wide range of data sources: patient-reported data, event and cost data, clinical coding data, patient and population data, and geographic information.  

Already, the Voice of the Patient has offered abundant insights and results.  

One especially compelling link is that between patient-reported data and the incidence of adverse events like hospital-acquired complications (HACs) and low-value outcomes. It shows us that a positive patient experience while in a facility is associated with fewer complications and better long-term health outcomes.  

According to the Voice of the Patient results, facilities that achieve patient reported experience measure (PREM) scores in the top 33%, as reported by patients, outperform their counterparts in the middle or bottom third. They are generally cheaper (3% to 5% for pacemakers and knee procedures and 7% for general procedures, for example), fewer instances of adverse events or hospital acquired complications, and better long-term outcomes (patients reporting better function, less pain and higher levels of recovery).  

The results point to the importance of the value and quality of treatment while in hospital. Even with the impact of rehabilitation and recovery outside of hospital, what happens in the facility matters. 

The Voice of the Patient platform enables hospitals to learn and improve, leading to better outcomes, more efficient service delivery and reductions in adverse events like HACs.  

Such efficiencies are an important part of improving the Australian healthcare system, especially as the country grapples with long queues for surgery, shortages in hospital beds and healthcare professional workforces.  

For hospitals, it allows them to view and act on patient-centred insights, meaning they can tangibly move the needle on quality of care. It means having another valuable resource to review practices and processes and align them closer to patient values and expectations. 

For health insurers, funders and policymakers, it makes it possible to independently verify the value and performance of services in conjunction with the outcome.   

But most critically is the benefit to patients. As we saw at ICHOM, international focus is now squarely on ensuring patients play a more active role in the healthcare market, and their active participation is what gives Voice of the Patient its strength.  

The Voice of the Patient gives privately insured Australians a more significant say in their healthcare experiences, the ability to assess their care and engage with the journey.  

With 100,000 patients across Australia invited to participate and an impressive near 50% participation rate, the Voice of the Patient is indeed at the forefront of this transformative journey.   

By prioritising the patient’s voice and perspective, all healthcare stakeholders can work towards the single goal of achieving a patient-centred system. A system that seeks to eradicate inefficiencies, reduce low value interventions, address siloed patient information, dissatisfaction, clinician exhaustion, and unsustainable costs.

Daniel Erasmus

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Daniël is an actuary with a wealth of experience in a number of markets. His areas of expertise relate to private health insurance, hospital and doctor interactions and negotiations, risk equalisation and funding solutions as well as regulatory and policy initiatives. He has also worked in life insurance and pensions.

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