A Public Health Value-Based Healthcare Paradigm for HIV

Background: HIV patients face considerable acute and chronic healthcare needs and battling the HIV epidemic remains of the utmost importance. By focusing on health outcomes in relation to the cost of care, value-based healthcare (VBHC) proposes a strategy to optimize quality of care and cost-efficiency. Its implementation may provide an answer to the increasing pressure to optimize spending in healthcare while improving patient outcomes. This paper describes a pragmatic value-based healthcare framework for HIV care. Methods: : A value-based HIV healthcare framework was developed during a series of roundtable discussions bringing together clinical stakeholder representatives from the Belgian HIV reference centers and VBHC specialists. Each round of discussions was focused on a central question translating a concept or idea to the next level of practical implementation: 1) how can VBHC principles be translated into value-based HIV care drivers; 2) how can these value-based HIV care divers be translated into value-based care objectives and activities; and 3) how can value-based HIV care objectives and activities be translated into value-based care indicators. Value drivers were linked to concrete objectives and activities using a logical framework approach. Finally, specific, measurable, and acceptable structure, process and outcomes indicators were defined to complement the framework. Results: : Our framework identifies 10 core value drivers focusing on 4 key areas where HIV care benefits most from improvements: Prevention, improvement of the cascade of care, providing patient-centered HIV care and sustaining a state-of-the-art HIV disease management context. Value drivers are further developed into objectives and activities. For each level of the framework (drivers, objectives and activities), process and outcome-based indicators are suggested. Conclusions: : This framework approach outlines how to define a patient- and public health centered value-based HIV care paradigm. . It proposes how to translate core value drivers to practical objectives and activities and suggests defining indicators that can be used to track and improve the framework’s implementation in practice.