Presentation (CTI)

Problem Statement: Aortic stenosis (AS) is a common heart valve disease in Europe. Prognosis is poor if a severely stenotic valve is not replaced with a prosthetic valve. Transcatheter Aortic Valve Implantation (TAVI) is expensive, and traditional healthcare fee-for-service billing ignores the health benefits achieved, which creates pressure on funding. Prevalence of AS is increasing with age[i]. With the demographic transition toward an older population, focus on cost-efficient treatment for these patients is needed. In Finland, the share of those aged 65+ has risen from 22% to 37% since 2000 and is expected to reach 45% by 2040. The 85+ population will more than double, pushing healthcare spending (6.8% to 7.7% of GDP by 2070)[ii],[iii]. In response, Finland’s 2023 reform transferred health and social service responsibilities from municipalities to 21 Well-being Service Counties (WbSC) to improve efficiency. The reform replaced activity-based reimbursement with a fixed funding model to promote equity, efficiency, and outcomes. Finnish government strategies increasingly emphasize collaboration between healthcare providers and the life-sciences sector to address healthcare budget pressures[iv]. Heart Hospital in Tampere, Finland is a cardiac-center managing ~140,000 patient-events annually. Heart Hospital has adopted a value-based healthcare (VBHC) strategy to improve outcomes, efficiency, and sustainability through strategic partnerships that align economic and patient goals.
ⁱ https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-18/epidemiology-of-aortic-valve-stenosis-as-and-of-aortic-valve-incompetence-aiⁱⁱ https://www.scoperatings.com/ratings-and-research/research/EN/172529iii https://www.bofbulletin.fi/en/2021/5/long-term-sustainability-of-the
-public-finances/?utm; https://link.springer.com/article/10.1007/s10433-022-00699-x?utmⁱⁱⁱ https://www.sitra.fi/en/publications/the-finnish-health-sector-growth-
and-competitiveness-vision-2030/#preface;^iv https://www.businessfinland.fi/en/for-finnish-customers/services/programs/
health-360-program#:~:text=About%20program&text=The%20Health%20360%
20program%20supports,with%20investors%20and%20funding%20operators
Description: In 2024, Heart Hospital launched a TAVI-lifecycle payment model incorporating value-based risk-sharing with guarantee and patient-reported outcome bonus/sanction payments for WbSC. Heart Hospital announced a tender with a similar risk sharing and payment model towards the industry, allowing physicians to choose optimal products while ensuring economic stability over time. Anonymized outcome data was shared pre-tender to allow industry partners to calculate outcome probabilities and outcome-driven prices. Medtronic offered a long-term subscription-based payment model with risk sharing on relevant clinical outcomes and is currently supplying TAVI valves under this VBHC contract. Medtronic also supports PROM data collection in this partnership to track patient value.
Lessons Learned: By engaging in data-driven, risk-sharing partnerships, industry and healthcare providers can streamline workflows, ensure guideline-based treatment whilst alleviating healthcare budget pressure. The innovative TAVI lifecycle model offers a sustainable way to finance high-cost care by linking payments to treatment outcomes and was awarded the “efficacy impact of the year” award in Finland in 2024: “⋯The act is an example of a progressive building of risk sharing, it is scalable across patient groups and has national economic significance”[v].
^vhttps://vaikuttavuusseura.wordpress.com/2024/12/05/vuoden-2024-
vaikuttavuusteot-on-valittu/
Stakeholder Perspective: Provider/industry perspective.