For decades, low- and middle-income countries (LMICs) viewed increasing access to healthcare as a top priority, and for good reason. Increasing access to evidence-based interventions like skilled birth attendance and immunizations saved millions of lives. Success was largely based on volume—delivering more services would lead to better outcomes. Given that priority, health systems have been designed to maximize the quantity of services delivered, to track and maximize coverage rates, and to finance inputs and outputs.

However, we are now at a turning point where these volume-based systems no longer address the greatest threats to public health. Last year, the Lancet Quality Commission delivered a decisive reckoning: quality has eclipsed access as a driver of survival. Their analysis showed that of the mortality amenable to healthcare, 60% is due to poor quality of care, compared to 40% due to lack of access. Quality of care is the key to addressing persistent mortality from maternal and child conditions and from infectious diseases. Growing health threats, including chronic conditions, also require high quality longitudinal care delivered by skilled healthcare workers. To meet the demands of this new era, health systems need to undergo structural reforms, redefining how they measure performance, deliver care, and pay providers.

Value-based care offers a compelling framework to advance the quality agenda. It puts forth best practices in measurement, delivery, and payment that maximize outcomes achieved for the resources invested. Measurement is the north star of value-based care. Instead of focusing on the volume of health services delivered, value-based measurement tracks outcomes that matter to patients and costs. Providers learn from that data and continuously improve delivery to maximize value, often shifting the focus to preventive care and incorporating social and behavioral interventions. Value-based payment reinforces this more efficient delivery by rewarding the providers who deliver the highest value care.

Website: Leapfrog to Value Initiative Website