Value-based health care definition and characteristics: an evidence-based approach

Introduction

Value-based health care (VBHC) is a strategic goal that aims to align the entire healthcare system towards achieving outcomes that matter most to patients while minimising costs.^1,2 This approach emerged as a response to the shortcomings of traditional fee-for-service models, which tend to incentivise volume over quality.^3,4 VBHC shifts this focus by emphasising value, defined as the health outcomes achieved per dollar spent. The core principle is to create a system that delivers improved patient health, integrates care across different services, and reduces unnecessary interventions, ultimately optimising both clinical effectiveness and patient satisfaction.^5,6 By moving away from quantity-based metrics, VBHC encourages providers to focus on long-term health improvements, resulting in better overall patient experiences and health system efficiency.^7,8

A key aspect of VBHC is its patient-centred nature, which requires active collaboration between healthcare providers, patients, and other stakeholders.^9,10 Care delivery is designed to meet specific patient needs by integrating clinical care with non-clinical support, addressing not only medical conditions but also the social, emotional, and practical factors that influence patient outcomes.¹¹

Defining and characterising VBHC is essential because it helps establish a shared understanding among all stakeholders involved, including healthcare professionals, policymakers, payers, and patients.¹² Without a clear definition, the risk of inconsistent implementation becomes high, leading to variation in how VBHC principles are applied and measured.¹³ A well-defined framework provides the basis for standardised practices, quality benchmarks, and performance metrics that can be used to assess whether VBHC is effectively improving outcomes.^14–16 Furthermore, characterising VBHC helps in translating its theoretical principles into practical, actionable guidelines, allowing healthcare organisations to better adopt its values into daily practice.^17–19 This ensures that the focus remains on optimising patient outcomes and efficiency, ultimately leading to a more sustainable healthcare system that is equipped to meet the evolving needs of diverse populations.^20,21

To date, there are numerous definitions of VBHC.^22–28 Clarifying the definition of VBHC is crucial for optimising healthcare delivery, aligning incentives among stakeholders, and effectively responding to challenges such as rising healthcare costs and increasing patient expectations. Without a clear understanding of what constitutes VBHC, healthcare initiatives risk focusing narrowly on cost reduction or volume, rather than achieving meaningful health outcomes. A well-defined VBHC model allows for better alignment of care with patient needs, appropriate allocation of resources, and the establishment of standardised performance metrics that can drive quality improvements.^23,29 It also supports the integration of patient-centred approaches, promoting equitable care and ensuring sustainability within health systems.³⁰ This study aims to refine the definition of VBHC through a data-driven analysis and to map its key characteristics, facilitating a shared understanding that supports implementation across various healthcare settings.

Methods

A scoping review methodology was used to map all the definitions and characteristics of VBHC in nine databases including JBI EBP Database, EBM Reviews – Cochrane Database of Systematic Reviews, Embase, Global Health, Ovid MEDLINE(R), APA PsycInfo (1806 to November Week 2 2023), Social Work Abstracts, EBM Reviews – Database of Abstracts of Reviews of Effects, EBM Reviews – Health Technology Assessment, EBM Reviews – NHS Economic Evaluation Database, from their inception until November 2023.^31,32 Key search terms (including synonyms) encompassed the combination of two broad themes: ‘value’ and ‘health care’. We followed the guidance published by Tricco et al.³² in reporting the results of the review. Screening and data extraction were done by multiple authors (HK, CD, MA, and RA) due to the extensive nature of the search. We only included peer-reviewed articles published in English due to limited resources. Data extraction included authors' details, study design, the definition of VBHC, and its characteristics. Details of the protocol registration, search strategy, data screening, data extraction, and presentation of the results have been included in another publication by H. A. M. Khalil, C. Davies, C. Liu (unpubl. data).

Scoping reviews are valuable tools for identifying and clarifying concepts within a specific field, including topics such as VBHC.³³ They provide a structured method for mapping existing literature and identifying key ideas, definitions, and knowledge gaps. The concept of the review was any definition or description of VBHC cited in any peer-reviewed publication, and the context included any geographic areas.

To devise a definition and identify the characteristics of VBHC, extracted texts regarding definitions and characteristics of the included studies were analysed using a word cloud generated from https://www.freewordcloudgenerator.com/ and a word frequency table generated from Excel. By integrating findings from both analyses, a concise definition of VBHC was formulated along with the main characteristics of VBHC.

Results

The searches of the databases yielded a total of 2785 studies that were imported for screening. After removal of duplicates and ineligible studies, a total of 145 studies were included in the scoping review. Only 70 (48%) of them included a definition and details of characteristics of VBHC. The data extracted included author, year of publication, country, and definition of VBHC and its characteristics, as shown in Supplementary material Table S1.

The word cloud was generated by importing all the data of the 70 articles on the definition and characteristics of VBHC into the tool from the scoping review.

Fig. 1 presents a visual representation of the key themes within VBHC (extracted from the included studies in the scoping review) highlighting the relative importance of different concepts. Larger words such as ‘care,’ ‘value,’ and ‘outcomes’ dominate the image, indicating their central role. The emphasis is also on terms such as ‘patient,’ ‘quality,’ and ‘cost,’ showcasing the priorities of patient-centred care, improving outcomes, and managing costs effectively. Other recurring concepts include ‘efficiency,’ ‘improvement,’ and ‘clinical,’ suggesting a focus on enhancing both processes and patient recovery while emphasising efficiency and quality.

Fig. 1.

Word cloud generated from the definition and characteristics of value-based health care included in studies from the scoping review.

The word frequency table shown in Fig. 2 reveals detailed insights into the recurring themes in VBHC by quantifying word occurrences. The most frequently mentioned word is ‘care’ (52 times, 6%), followed by ‘outcomes’ (32 times, 4%) and ‘value’ (28 times, 3%), emphasising their core role in the framework. ‘Quality’ (25 times, 3%) and ‘cost(s)’ (42 times, 4.5%) also appear prominently, reflecting a balanced focus on care quality and cost management. The frequent mention of ‘patient’ and related terms such as ‘providers’ and ‘clinical’ further supports the patient-centred, provider-involved approach in achieving improved health outcomes. Words such as ‘improvement,’ ‘reduce,’ and ‘efficiency’ suggest a systematic drive towards enhancing performance, reducing costs, and maintaining sustainability.

Fig. 2.

A graph presenting the word frequency found in the included studies.

Discussion

This paper reports on the first evidence-based approach to develop a definition for VBHC generated from the literature. Using word frequency analysis and visualisation derived from relevant studies on the topic to devise a definition of a concept and describe its characteristics provides an objective, data-driven understanding of key themes. This approach allows for a clear identification of the most frequently mentioned terms, ensuring that the definition accurately reflects what is most central to the topic. By eliminating subjective bias, this method ensures consistency and reliability in identifying the core elements of a concept. The frequent occurrence of certain terms indicates their importance, and this helps highlight the priorities and values associated with the concept, such as ‘care,’ ‘value,’ and ‘outcomes’ for VBHC.

The visual representation of word frequencies, through charts or word clouds, allows for an intuitive understanding of the relationships between terms and the emphasis placed on various aspects of the concept. These visualisations are helpful in recognising patterns and connections, making complex information easier to understand. Furthermore, this approach is particularly efficient when summarising extensive material, as it condenses key themes into an accessible format, providing a comprehensive overview without requiring exhaustive reading of source texts.

By focusing on the most frequently used words, this method not only captures the essence of the concept but also aids in efficiently characterising its attributes. It helps identify priorities and interrelationships among different aspects, providing insights into which elements are considered essential. This makes word frequency analysis a powerful tool for defining and understanding complex or multi-faceted ideas.

The definition of VBHC that is derived in this manuscript using word frequency analysis differs from those found in the literature in several ways, primarily in focus and level of abstraction. In the approach used here, the emphasis was on identifying and synthesising the most frequently used terms, such as ‘care,’ ‘outcomes,’ ‘value,’ ‘cost,’ and ‘patient.’ This led to a data-driven definition centred on optimising health outcomes, improving efficiency, and focusing on patient-centred care while managing costs effectively.

In contrast, the definitions from sources such as the Australian Healthcare and Hospitals Association (AHHA) describe VBHC as a ‘global movement’ aimed at delivering health outcomes that matter to people and communities, emphasising the equitable and sustainable use of resources across a full pathway of care.³⁵ This definition also emphasises the need for a ‘mindset shift’ in healthcare delivery, moving away from purely cost-centric approaches to ones that focus on achieving value through community involvement and population health perspectives, particularly in universal health coverage contexts.^36–39

Additionally, AHHA’s definition highlights VBHC as not just a set of processes but a broader approach to restructuring the health system, focusing on outcomes that matter to patients with the lowest possible resource use.³⁵ The literature also places emphasis on VBHC being patient-centric and evidence-based, with an aim to address the sustainability issues undermining healthcare systems.^40–42

Teisberg et al.²³ emphasises that VBHC is about ‘measured improvement in a patient’s health outcomes for the cost of achieving that improvement’. It explicitly states that VBHC is not merely about cost reduction but about achieving better outcomes that matter to patients, such as capability, comfort, and calm.²³ This definition is more nuanced, offering a clear distinction between outcomes-focused care and other concepts such as quality improvement or patient satisfaction. This is in contrast to the definition generated here which is based on the frequency of important terms such as ‘care,’ ‘value,’ ‘outcomes,’ ‘quality,’ and ‘patient,’ emphasising these elements without much deeper exploration into their interrelationships. This approach provided a general overview of VBHC, focusing on outcomes relative to costs, improving quality, and enhancing patient-centred care. Moreover, the authors' strategic framework provided an operational perspective of implementing VBHC as opposed to the definition derived from the word frequency analysis, which is more descriptive.

Furthermore, the definition of VBHC derived from the word frequency analysis has the advantage of being simpler, more concise, and data-driven compared to existing academic definitions. It focuses on the essential elements of VBHC – such as improving outcomes, efficiency, and patient care – without the complexity of implementation frameworks.

For practice, the derived definition of VBHC offers a simplified and accessible approach to communicating core concepts, making it ideal for training healthcare professionals and educating stakeholders. It provides a foundational guide for aligning practices with patient-centred care, quality improvement, and cost efficiency, enabling practitioners to adopt value-based care more readily. The straightforward focus also aids policymakers in framing initiatives that align system goals with optimising patient outcomes and resource use.

For research, the definition highlights key themes that can serve as starting points for further investigation into the interplay between quality, outcomes, and efficiency in health care. It provides a foundation for developing conceptual frameworks and models that emphasise the most frequently mentioned elements in value-based care.

It is important to note that the included literature in this scoping review is dominated by studies derived from the US and other Western countries. In the US, the VBHC movement can be driven by health insurance as a tool to save medical costs. Cultural values of VBHC are rarely discussed in the included literature.⁴³ A recent study shows that patient-preferred values can be very complex and difficult to measure, and resource constraints can shape the characteristics of VBHC under different system contexts. This highlights the importance of contextualised studies using a system-wide view.⁴³

Moreover, the chosen methodology – a scoping review complemented by word frequency analysis – is well-suited for the study’s objective of synthesising key characteristics of VBHC as reflected in modern literature. Scoping reviews are widely recognised for their ability to systematically map existing knowledge, identify thematic patterns, and highlight gaps, making them an appropriate choice for capturing the broad spectrum of how VBHC is currently conceptualised and applied. They also allow examination of similarities and differences of all definitions about value-based care although it is not suitable for generating a theory-based definition.

Even though it is acknowledged that word frequency analysis alone is not a robust tool for theory generation, its inclusion provides valuable insights into dominant themes and evolving terminology associated with VBHC. This study’s approach offers an accessible and empirical means of understanding contemporary discourse on VBHC, allowing for a data-driven synthesis of its defining features. However, as noted, developing a new theoretical definition of VBHC may require additional methodologies, such as realist reviews or qualitative synthesis, to better capture contextual variations and conceptual evolution. Despite this limitation, the study contributes meaningfully to VBHC scholarship by systematically identifying and summarising key characteristics and trends, which can inform future research aiming to refine the theoretical foundations of VBHC.

Conclusion

VBHC is a multifaceted approach that aims to improve patient outcomes while maintaining cost efficiency and focusing on quality and patient-centred care. This paper has explored a different method for defining VBHC, including word frequency analysis and comparisons within existing academic literature. The derived definition, created using a data-driven approach, has the advantage of being accessible, concise, and effective for general communication. It provides a clear foundation for practice, making it easier for healthcare providers and policymakers to understand and adopt value-based principles.

Supplementary material

Supplementary material is available online.