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The VBHC big picture: an umbrella review #MMPMID41331454
Moreira A; Crispim J
BMC Health Serv Res 2025[Dec]; ? (?): ? PMID41331454show ga
BACKGROUND: Value-Based Health Care (VBHC) aims to improve patient outcomes while optimising healthcare costs. Despite global interest, its adoption varies widely due to system-specific contexts and stakeholder dynamics. Challenges such as organisational inertia, inconsistent data, and limited evidence on patient-reported measures hinder widespread implementation. PURPOSE: This umbrella review synthesises global evidence on the implementation of VBHC, identifying key impacts, challenges, and opportunities. It seeks to uncover patterns, assess the effectiveness of VBHC initiatives, and inform future research and system improvements. METHODS: A systematic search across four databases identified reviews and meta-analyses on VBHC published between 2006 and April 2024. The Context, Intervention, Mechanism, Outcome (CIMO) framework guided data extraction, and methodological quality was assessed using the Joanna Briggs Institute's checklist. RESULTS: Forty-eight studies were included and grouped into seven categories. VBHC initiatives show the potential to improve care quality, efficiency, and patient satisfaction while reducing costs. However, challenges persist, including fragmented performance metrics, limited integration of Patient-Reported Outcome Measures (PROMs) and Patient-Reported Experience Measures (PREMs), resistance to organisational change, and inadequate cost evaluation models. Payment models such as Pay-for-Performance and bundled payments yield mixed outcomes, often hampered by complexity and stakeholder scepticism. The Value-Based Insurance Design has proven effective in improving treatment adherence. Efforts to reduce low-value care show moderate success, underscoring the need for validated de-adoption strategies. Skill gaps among leaders and professionals further limit effective VBHC adoption. CONCLUSION: VBHC offers a compelling framework for health system transformation but requires coordinated reforms in structure, culture, technology, and education. Priorities include standardising outcome metrics, aligning payments with value, improving cost transparency, and engaging stakeholders. Future research should focus on contextual barriers, refined evaluation methods, and enhanced patient involvement to realise the full promise of value-based healthcare.
BMC+Health+Serv+Res 2025 ; ? (?): ?
