Caresyntax at WEF: Operationalizing Value-Based Care in Surgery

Surgical procedures are the epicenter of profitability and risk for global healthcare organizations. Approximately 30 percent of the global burden of disease is caused by conditions that can be treated by surgery or require the direct care of a surgeon. Each year, 4.2 million people around the world die within 30 days of surgery. Postoperative deaths account for 7.7 percent of all deaths globally, half of which occur in low- and middle-income countries. In the US, surgical procedures account for almost 50 percent of total hospital costs. If there are surgical complications or adverse events, that cost can become 40 percent higher.

To address these critical issues, Caresyntax is joining the World Economic Forum Global Coalition for Value in Healthcare to create a public-private platform for accelerating a value-based healthcare transformation.

Caresyntax invited to WEF Innovators Community

The World Economic Forum (WEF) platform for Shaping the Future of Health and Healthcare includes goals and priorities for enabling the smart development of technological advances. In 2022 Caresyntax was invited to join the Innovators community, an invitation-only group of the most promising startups at the forefront of ethical, technological, and business innovation. The WEF recognizes that innovation and increasing adoption of value-based care (VBC) can radically change the current structure of reimbursement and lead to a shift from a model based on quantity to one that focuses instead on the quality of care.

Working to operationalize the shift to value-based care

Caresyntax co-founder, Bjoern von Siemens joined the annual global healthcare conference with a newly crafted Consensus Statement that was the result of a recent round table discussion on operationalizing value-based care in the perioperative environment.

Source: BCG Analysis. WEF Global Coalition for Value in Healthcare.

This demonstrates the impact that innovative tech partners can have in creating a framework to realize the WEF stated goals to create a Value-Based Healthcare Framework, which include:

• Payment – Value-based payment models
• Informatics – Capturing relevant health data to share outcomes
• Tools – Benchmarking and data-based decision support models that can provide predictive analytics, risk stratification, and more.

Opportunities for global VBC models in the perioperative environment

Surgical treatment and optimizing surgical case volume are the most important reimbursement drivers of the perioperative environment. Focusing on quantity over quality can lead to unnecessary procedures and higher primary and secondary costs for patients, insurers, and healthcare organizations, especially if greater volume leads to increased likelihood of surgical adverse events or complications. As a result, VBC models will need to look at existing models of care and identify key opportunities in the perioperative environment:

•  Driving quality and outcome over frequency of surgery;
•  Reducing primary and secondary care costs;
•  Increasing patient satisfaction with their treatment and outcomes;
•  Avoiding inefficiencies and unnecessary clinical and operational variability;
•  Improving onboarding, training, and experience of medical staff; and
•  Optimizing perioperative workflows.

In addition to those opportunities, the WEF Global Coalition for Value in Healthcare should consider models used in other parts of the world. In the US, Accountable Care Organizations (ACO) have brought together physicians, health insurance companies, and healthcare providers to deliver coordinated care to improve population health and better management of chronic care conditions. Value-based care in the US has been working to move away from fee-for-service, while public-run systems in Europe have been focusing on coordinating patient care among providers and creating platforms to drive quality improvement and appropriateness of care.

Bjoern von Siemens and Karl Wilhelm Lauterbach, Germany Federal Minister of Health, at the World Economic Forum 2023

The Consensus Statement created for the WEF calls for considering adopting a similar structure for surgical procedures and interventions—a Surgical ACO. Surgical ACOs can provide a framework for surgeons, OR staff, hospitals, health insurers, liability insurers, and large employer groups to align on policy, technology, and payment structure.

 Real-time data from the operating room can be leveraged to refine existing risk prediction models and to develop new models. Data collection and transparency are important enablers of perioperative value-based care.

Challenges to adopting perioperative value-based care

Data-driven surgical technology platforms collect and analyze real-world data sets to identify leading indicators of risk such as surgical technique, teamwork dynamics, and unwarranted variation. This is in contrast with current models, which collect data retrospectively from claims and administrative/billing data. Real-time data from the operating room can be leveraged to refine existing risk prediction models and to develop new models. Data collection and transparency are important enablers of VBC, but there are barriers that must be overcome.

How Caresyntax tools and technology can shape the global delivery of value-based care

Collecting and aggregating clinical, operational, and financial data for all phases of the surgical workflow (preoperative, intraoperative, and postoperative) requires a vendor-neutral, integrated, and interoperable infrastructure. This infrastructure will enable hospitals to aggregate and exchange data among disparate vendors and IT systems from electronic health records (EHR), PACS (Picture Archiving and Communications Systems), patient-generated data, and more. Yet, creating a connected data flow infrastructure will require addressing country- and hospital-specific legal and regulatory barriers.

The Caresyntax data-driven surgery platform is uniquely positioned to provide insights into the tools and surgical technology needed to create Surgical ACOs (accountable care organizations) and implement Value Based Care reimbursement for surgical interventions or refine existing models between hospitals and insurance companies globally.

The Caresyntax data-driven surgery platform is uniquely positioned to provide insights into the tools and technology needed to create Surgical ACOs (accountable care organizations) and implement Value Based Care reimbursement for surgical interventions or refine existing models between hospitals and insurance companies globally.

Caresyntax brings data and informatics expertise and a proven platform for standardized capture and analysis of health outcomes and data. The company will leverage its work with key value partners to collaborate in sharing and analysis of outcomes and data. As the WEF endeavors to “accelerate the transition to value-based healthcare in health systems throughout the world,” Caresyntax and its value partners will be working together to shape the exchange of ideas and promote a global dialog around innovative solutions for the next generation of care delivery models. As a member of the WEF Global Innovators community, Caresyntax will continue to craft innovative surgical software solutions to enable better access to care, ensure continuous surgical improvement, and quality performance measurement.

To request a copy of the World Economic Forum Consensus Statement, “Round table on operationalizing Value-Based Care in perioperative environment,” contact us.