NHIA to adopt: Value-Based Care to address health challenges

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

He disclosed this at the opening of a five-day workshop in Accra over the weekend.

The workshop organised by the PharmAccess Foundation in Gha­na in partnership with Leapfrog to Value and the Christian Health Association of Ghana aimed at finding solutions to a number of challenges confronting the health sector.

Value-based health care is a framework for restructuring health care systems with the overarching goal of value for patients, with value defined as health outcomes per units of costs.

Dr Okoe-Boye explained that the Value-Based Care (VBC) system, when successfully imple­mented, would provide all citizens with quality and equitable access to basic healthcare.

He said the digitalisation of these processes has enabled 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% of our claims management process was manual. People were forced to sit by papers to assist, and so on. It was not efficient. As we speak, approximately 75% of the process is now electronic,” he emphasised.

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

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

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

The new model he said would reduce the burden on the scheme when it comes to paying claims.

“The central goal of any health system is to provide optimal health outcomes – first, to individuals and, second, to ensure societal wellbeing 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.

Also at the event, Operations Manager at PharmAccess Foun­dation, Ghana, Dr GiftySunk­wa-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,” she added.


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