MEASURED BUT NOT USED: THE GAP BETWEEN OUTCOME MEASUREMENT AND PAYMENT IN VALUE-BASED CARDIOVASCULAR CARE ACROSS 15 EUROPEAN HEALTH SYSTEMS
Author(s)
DR MARCOS Gallego Llorente, PhD1, Liselotte Tjon, MS2, Alexander Carter, PhD3, Areej Malik, MSc4, Ruben van Zelm, PhD5, Alice Masini, PhD6, Lian Y Rekker, MS7, Luuk C Kieviet, MS7, Daniel Breucker, MS8, Moritz von Scheidt, MD8, Gerard Pasterkamp, MD7, Marish Oerlemans, MD7, Hugo Bastiaan Amesz, MSc2, Pim van der Harst, MD9.
1Manager, Vintura BV, Utrecht, Netherlands, 2Vintura BV, Utrecht, Netherlands, 3Department of Health Policy London School of Economics & Political Science, London, United Kingdom, 4London School of Economics and Political Sciences, London, United Kingdom, 5HU University of Applied Science Utrecht, Utrecht, Netherlands, 6University of Eastern Piedmont, Novara, Italy, 7UMC Utrecht, Utrecht, Netherlands, 8TUM University Hospital German Heart Center, TUM School of Medicine and Health, Technical University, Munich, Germany, 9Universitair Medisch Centrum Groningen, 9713 GZ, Netherlands.
1Manager, Vintura BV, Utrecht, Netherlands, 2Vintura BV, Utrecht, Netherlands, 3Department of Health Policy London School of Economics & Political Science, London, United Kingdom, 4London School of Economics and Political Sciences, London, United Kingdom, 5HU University of Applied Science Utrecht, Utrecht, Netherlands, 6University of Eastern Piedmont, Novara, Italy, 7UMC Utrecht, Utrecht, Netherlands, 8TUM University Hospital German Heart Center, TUM School of Medicine and Health, Technical University, Munich, Germany, 9Universitair Medisch Centrum Groningen, 9713 GZ, Netherlands.
OBJECTIVES: Value-based healthcare models pay providers for patient outcomes, but it is unclear whether European cardiovascular systems have translated outcome measurement capacity into real examples of provider payment models. We characterized the relationship between outcome measurement and provider payment across 15 European systems, asking whether the roadblock on value-based cardiovascular care is measurement capacity or payment model design.
METHODS: Within EuroHeartPath, an international research and quality improvement program in cardiology, a structured survey in 15 countries (152 respondents) captured cross-cutting system items: reimbursement coverage; outcome-measurement infrastructure (national registries, data linkage, MACE/mortality/neurological-outcome and quality-of-life tracking); presence of any internal value-based methodology; and free-text expense-calculation models. Payment mechanisms were coded against a strict definition of outcome-contingent payment (varying with patient outcomes), distinct from process- or quality-linked schemes.
RESULTS: Outcome measurement was widespread: 93/149 (62.4% of surveyed centres) held a national quality registry; MACE was tracked by 30/43 (69.8%) and heart-failure mortality by 30/45 (66.7%). Yet only 24/147 centres (16.3%) reported any internal value-based methodology, describing outcome benchmarking, audit and registry feedback, not payment. Across 143 expense-model descriptions, payment was activity/case-based (DRG), fee-for-service, flat-rate/bundled, or global-budget. Genuine outcome-contingent payment was isolated: one institutional model tied to survival/MACE, plus pilots. Respondents who indicated some kind of outcome-linked payments (e.g. performance benchmarking and primary-care quality incentives such as QOF) rewarded process quality, not patient outcomes.
CONCLUSIONS: European cardiovascular systems appear to measure outcomes more often than they use them for provider payment. In these data, the main implementation gap was payment design: most reported models remained activity-, case-, or budget-based despite available outcome data. Because the outcome data measurement precondition is largely in place, policy efforts should focus less on additional measurement mandates and more on how payment models use those outcomes.
METHODS: Within EuroHeartPath, an international research and quality improvement program in cardiology, a structured survey in 15 countries (152 respondents) captured cross-cutting system items: reimbursement coverage; outcome-measurement infrastructure (national registries, data linkage, MACE/mortality/neurological-outcome and quality-of-life tracking); presence of any internal value-based methodology; and free-text expense-calculation models. Payment mechanisms were coded against a strict definition of outcome-contingent payment (varying with patient outcomes), distinct from process- or quality-linked schemes.
RESULTS: Outcome measurement was widespread: 93/149 (62.4% of surveyed centres) held a national quality registry; MACE was tracked by 30/43 (69.8%) and heart-failure mortality by 30/45 (66.7%). Yet only 24/147 centres (16.3%) reported any internal value-based methodology, describing outcome benchmarking, audit and registry feedback, not payment. Across 143 expense-model descriptions, payment was activity/case-based (DRG), fee-for-service, flat-rate/bundled, or global-budget. Genuine outcome-contingent payment was isolated: one institutional model tied to survival/MACE, plus pilots. Respondents who indicated some kind of outcome-linked payments (e.g. performance benchmarking and primary-care quality incentives such as QOF) rewarded process quality, not patient outcomes.
CONCLUSIONS: European cardiovascular systems appear to measure outcomes more often than they use them for provider payment. In these data, the main implementation gap was payment design: most reported models remained activity-, case-, or budget-based despite available outcome data. Because the outcome data measurement precondition is largely in place, policy efforts should focus less on additional measurement mandates and more on how payment models use those outcomes.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HPR252
Topic
Health Policy & Regulatory
Topic Subcategory
Insurance Systems & National Health Care, Public Spending & National Health Expenditures, Reimbursement & Access Policy, Risk-sharing Approaches
Disease
No Additional Disease & Conditions/Specialized Treatment Areas