Editorial comment: How true outcomes-based commissioning can really ‘liberate’ healthcare services

Abstract

Kelley et al’s paper provides further evidence of how healthcare decision making can be more sensitive to what matters to both patients and the funders of healthcare, and how this developing approach can make a positive contribution to healthcare service purchasing at a population level. The paper is produced by members of the newly established UK-based team of the International Consortium for Health Outcomes Measurement (ICHOM), a not-for-profi t organisation founded by the Harvard Business School, the Boston Consulting Group and the Karolinska Institute. The conceptual thinking and development of outcome-based commissioning gathered momentum globally following the publication of Michael Porter and Elizabeth Teisburg’s seminal text Redefi ning health care in 2007.1 In Thorpe’s (2007) review of their book,2 he states what so many of us (clinicians and patients) think, ‘of more interest is their proposal for restructuring the system to focus on what matters the most, maximising the health outcomes per dollar spent’. Within the UK, a conceptual shift in government thinking led by Lord Darzi in 2007 moved away from a target-driven mentality to an outcome-based approach, with emphasis on evidence-informed decision making (outcome led) underpinning healthcare commissioning decisions. Since then we have seen an openness to embed this thinking into system restructuring and new models of care, increasingly important as complex fi nancial decisions have to be made at a population level and at the same time illustrate how these refl ect what matters most to patients. All of this is occurring within a climate of increasing complexity and austerity! Interestingly, the NHS Confederation animate this thinking by saying that we should ‘begin with the end in mind’, in effect reverse engineering healthcare systems that focus on patient/service users shaping the outcomes that matter to them; not necessarily historic metrics that get routinely reported.