NUHS is the first healthcare cluster in Singapore to look into adopting the Value-Driven Outcomes (VDO) framework in 2015 to drive value-based healthcare. Two years later, the Ministry of Health (MOH) in Singapore adopted NUHS VDO initiative and introduced the National Value-Driven Care (VDC) initiative to drive value-driven care across all public healthcare institutions.
“Using data to drive more value in our healthcare system will be one key priority. A good example is NUHS’ ongoing Value Driven Outcome project. By collecting, benchmarking and analyzing various quality and cost indicators, and providing the data to healthcare professionals, it enabled them to identify cost-effective clinical practices, reduce unnecessary variations and improve both cost and quality outcomes.”
Mr Gan Kim Yong, Minister for Health, Singapore
(Speech at the National Health IT Summit 2017, 30 May 2017)
Learn more about the NUHS Value-Based Healthcare Journey since 2015 below.
The team from NUHS visited the University of Utah Health, the birthplace of Value Driven Outcomes (VDO), to study how VDO was being used to enable healthcare providers to redesign care.
The visit proved inspiring, the open sharing of knowledge and best practices at the University of Utah Health, provided a trajectory for our team to explore innovative ways to implement VDO back at NUHS.
“Healthcare professionals want to do the right thing – to give care that we are proud of, at a cost that is affordable and sustainable to patients and the healthcare system. However, we lack objective tools that tell us, in as close to real-time as possible, whether we are accomplishing this. We were thus inspired by University of Utah Health and their work on Value Driven Outcomes, and were honoured to spend time with them in 2015. We were delighted to be able to contextualize this for Singapore and deploy it across our entire academic health system, from primary, secondary and tertiary care. We were equally delighted to share our methodology with the Ministry of Health and colleagues across Singapore, and through meetings to the region and beyond.”
Prof John Eu-Li Wong
Isabel Chan Professor in Medical Sciences
Senior Vice President (Health Innovation and Translation), National University of Singapore (NUS)
Senior Advisor, National University Health System (NUHS)
The First Public Healthcare Institution to Pioneer VDO in Singapore
The NUHS VDO task force was formed. Representatives from clinical, finance, operations, informatics and clinical quality, came together for a two-day workshop to define a framework to track desired quality and cost of treatment at episode level.
Two conditions were selected to pilot a feasibility study of VDO at the National University Hospital (NUH)
– Total Knee Replacement and Pneumonia.
Upon the successful pilot, VDO was extended to another five conditions – Hip Fracture, Cataract, Gout, Colorectal and Acute Myocardial Infarction.
Within NUHS Cluster
NUH added another 13 conditions – Laparoscopic Cholecystectomy, Hysterectomy, Caesarean Section, Streamline Workflow for Intervention of non-Functional or Thrombosed dialysis access (SWIFT), Hernia, Chronic Obstructive Pulmonary Disease (COPD), Bronchiolitis, Transcatheter Aortic Valve Implantation / Transcatheter Aortic Valve Replacement (TAVI/TAVR), Stroke, HyperAcute Stroke, Coronary Artery Bypass Graft (CABG), Breast Cancer and End-of-Life.
Ng Teng Fong General Hospital (NTFGH) became the second public healthcare institution within our cluster, to adopt the VDO framework and they started with six VDO projects – Total Knee Replacement, Cataract, Hip Fracture, Laparoscopic Cholecystectomy and Pneumonia.
At the National Level
Singapore’s Ministry of Health (MOH) adopted NUHS VDO initiative and introduced the National Value-Driven Care (VDC) initiative to all public healthcare institutions. VDO formed a crucial pillar in support of MOH’s “3 Beyonds” – Beyond Healthcare to Health, Beyond Hospital to Community and Beyond Quality to Value.
As a result, 17 ‘high impact’ conditions from the national perspective were identified to embark on the initiative by MOH. In the same year, NUHS was awarded the Gold Award at the National Health IT Summit.
“We were able to leverage data from our existing IT system to create the VDO framework. We pulled data from different silos and amalgamated it. Our biggest success was partnering enthusiastic Clinician Champions who provided meaningful insights to drive clinical change with improved patient outcomes.”
A/Prof James Yip
Head, Academic Informatics Office, National University Health System (NUHS)
Director, National University Heart Centre, Singapore (NUHCS)
NUHS VDO Office partnered with NUH Quality Improvement (QI) Department to drive Value-Driven Outcomes initiatives, and Rapid Improvement Event (RIE) to streamline processes, including:
NUH and NTFGH added more projects into the VDO framework for continuous improvement. High performance projects achieved a total cost avoidance milestone of approximately $10 million.
The National University Polyclinics (NUP) also embarked in VDO for Lipid and Hypertension conditions.
“VDO aims for sustainable patient care and outcomes. The three pillars, Finance, Data and Culture are equally important. Transparency of actual and predictable costs and outcomes provides the needed visibility, which is a key enabler to maintain sustainability.”
Ms Wong Soo Min
Group Chief Financial Officer, National University Health System (NUHS)
VDO projects covers about 20% of total case load, which accounts for approximately 30% of total cost across NUHS. Institutions continue to identify new projects and potential gaps for improvements which eventually translated to improved value and incredible care to patients.
Recognised for the value it brings, VDO was extended to support various cluster-wide strategic and research projects such as VECTor, Optimisation of Drugs Utilisation, and Application of Frailty Score on geriatric patients etc.
“VDO is a powerful tool measuring relevant data for all members of the healthcare team. It is patient-centric and allows clinicians to be cognisant of patient outcomes and benchmark themselves against their peers. Going forward, it will be increasingly important as we tackle the healthcare needs of a more elderly population whilst trying to ensure the health of the population under the care of NUHS and that of the nation as a whole.”
Dr Diarmuid Murphy
Group Chief Value Officer, National University Health System (NUHS)
Head, Division of Musculoskeletal Trauma, Department of Orthopaedic Surgery, National University Hospital (NUH)
“VDO is simply a very powerful tool that measures both the desired clinical outcomes as well as patient reported outcomes, and ensures that they are delivered in a sustainable and cost-effective way. This enables us to be guided by data in our mission to provide superlative care to our patients.”
Prof Yeoh Khay Guan
Chief Executive, National University Health System (NUHS)
