Experiences and learnings from developing and implementing a co-designed value-based healthcare framework within Victorian public oral health sector

Shalika Hegde; Susan McKee; Deborah Cole; Zoe Wainer

doi:10.1071/AH24017

RESEARCH ARTICLE (Open Access)

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Experiences and learnings from developing and implementing a co-designed value-based healthcare framework within Victorian public oral health sector

Shalika Hegde ^A ^* , Susan McKee ^A , Deborah Cole ^B and Zoe Wainer ^C

+ Author Affiliations

- Author Affiliations

^A Dental Health Services Victoria, Melbourne, Vic., Australia.

^B Independent Consultant.

^C Department of Health Victoria, Melbourne, Vic., Australia.

^* Correspondence to: Shalika.hegde@dhsv.org.au

Australian Health Review 48(2) 134-141 https://doi.org/10.1071/AH24017

Submitted: 17 January 2024 Accepted: 29 February 2024 Published: 28 March 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Objective

This study aimed to describe the development and implementation of a co-designed value-based healthcare (VBHC) framework within the public dental sector in Victoria.

Methods

A mixed-method study was employed. Explorative qualitative design was used to examine patient, workforce and stakeholder perspectives of implementing VBHC. Participatory action research was used to bring together qualitative narrative-based research and service design methods. An experience-based co-design approach was used to enable staff and patients to co-design services. Quantitative data was sourced from Titanium (online patient management system).

Results

Building a case for VBHC implementation required intensive work. It included co-designing, collaborating, planning and designing services based on patient needs. Evidence reviews, value-stream mapping and development of patient reported outcomes (PROMs) and patient reported experience measures (PREMs) were fundamental to VBHC implementation. Following VBHC implementation, a 44% lower failure to attend rate and 60% increase in preventive interventions was reported. A higher proportion of clinicians worked across their top scope of practice within a multi-disciplinary team. Approximately 80% of services previously provided by dentists were shifted to oral health therapists and dental assistants, thereby releasing the capacity of dentists to undertake complex treatments. Patients completed baseline International Consortium for Health Outcomes Measurement PROMs (n = 44,408), which have been used for social/clinical triaging, determining urgency of care based on risk, segmentation and tracking health outcomes. Following their care, patients completed a PREMs questionnaire (n = 15,402). Patients agreed or strongly agreed that: the care they received met their needs (87%); they received clear answers to their questions (93%); they left their visit knowing what is next (91%); they felt taken care of during their visit (94%); and they felt involved in their treatment and care (94%).

Conclusion

The potential for health system transformation through implementation of VBHC is significant, however, its implementation needs to extend beyond organisational approaches and focus on sustaining the principles of VBHC across healthcare systems, policy and practice.

Keywords: co-design, equity, health outcomes, health systems, models of care, patient-centred care, population health, PREMs, PROMs, value-based healthcare, VBHC.

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