Realising the vision of value-based healthcare in cataract surgery

Value-based healthcare (VBHC) is gaining traction across the industry for its potential to improve patient care by standardising clinical and patient outcomes. Erin McEachren and Syed Rashid of Johnson & Johnson Vision describe why cataract surgery is well-positioned for the VBHC model, and how strategic partnerships can help build datasets and practices that improve transparency and outcomes for vision patients.

Cataract operations are one of the most common surgeries, with about ten million performed around the world each year. The procedure, in which a surgeon replaces a cloudy lens in the eye with an artificial one to improve a person’s sight, is widely considered safe and effective. But there’s a high degree of variability in patients’ outcomes following the procedure, and some patients may benefit from it more than others.

In the United Kingdom, the National Health Service (NHS) found that cataract surgery may not improve vision for a particular subgroup of patients. In addition, many people go without the cataract care they need; the World Health Organization estimates that the cost of addressing current global gaps in necessary cataract procedures sits at around $8.8 billion USD.

VBHC, a method of improving patient care by reducing variability in outcomes, presents a unique opportunity in cataract care.

“Among ophthalmic surgical procedures, cataract is the number one procedure in the world – and it’s one of the safest,” Syed Rashid, director of market access and sales training for Europe, the Middle East, and Africa (EMEA) at Johnson & Johnson Vision, says. “Because of its minimal complications and relative high cost to the healthcare system, it has become a prime target to consider for VBHC.”

VBHC involves transparently reporting data on a set of defined measurements, including both clinical and patient-reported outcomes. This information is organised into datasets which can be analysed to inform decisions. “Long-term, patients benefit from this transparency,” says Erin McEachren, regional vice president for surgical vision EMEA at Johnson & Johnson Vision. In addition, by standardising outcomes, VBHC reduces the probability of unsuccessful surgeries, and costs that would have been spent on the procedures can be allocated where they’re needed most.

As today’s global community faces an economic downturn, ageing populations, and continued post-pandemic recovery efforts, the market is ripe for new ways to derive value through the healthcare system. Now, as stakeholders explore value-based arrangements, it’s important to form cross-industry collaborations to ensure high-quality care for all patients.

“We need to remove the barriers between different members of the healthcare system and focus, as a collective, on the patient,” Rashid says. “We’re all treating the same people, and patients and hospitals don’t differentiate outcomes based on which company supplied a product.”

Building value-based datasets to power better outcomes in cataract care

In ophthalmic care, HCPs and patients use several metrics to determine the value of cataract surgery. On the clinical side, for example, physicians need to understand visual acuity, a clinical metric to assess clarity of vision.

Patient-reported outcomes reflect patients’ quality of life before and after a procedure. These may include insights on complications due to surgery or changes to their intermediate vision, which includes seeing anything within an arm’s length. Intermediate vision is an important data point, as patients with poor sight at this distance are more susceptible to trips, falls, and other accidents.

To collect these outcomes, Rashid explains that patients may fill out a survey to evaluate their sight. They repeat the same questionnaire about three months after their cataract surgery to assess how their vision has changed.

Using registries built from the real-world outcomes data, stakeholders across healthcare can run analyses to guide their next steps. McEachren explains that patients can use data to choose between doctors and hospitals, or to learn what post-op recovery may look like. For manufacturers, the data can help companies communicate the value of new products to providers, payers, regulators, and patients.

“When a manufacturer introduces a new innovation, we need to be able to demonstrate the value our product brings,” Rashid says. “Having both clinical data and patient-reported outcomes offers a total package of evidence that differentiates our offering and enables us to approach customers with confidence.”

Opportunities and challenges for VBHC adoption

While clinical measurement is key to understanding the value of a procedure, implementing measurement practices can be a challenge. “It’s a question of creating a mindset and behaviour change. People are open to being measured if they know it’s being done transparently and ethically, and that their data is being used and compared in a fair way that will potentially drive positive benefits for other patients,” Rashid says. McEachren explains that IT infrastructure and data regulations can pose challenges as well.

But once the initial adjustments are overcome, the benefits of VBHC are plenty. For HCPs, Rashid explains, outcomes tracking allows them to show the quality of their work over time to differentiate themselves with payers, patients, and hospitals. Data can also be a powerful tool in managing expectations with patients, McEachren says, and care teams can use data to personalise patients’ care.

“VBHC is about making sure we reach the best results for patients,” McEachren explains. “It’s not always easy, because we’re asking clinicians to be very transparent. This can be especially challenging in vision, but it’s key to normalising patient outcomes.”

Early results from VBHC programmes are promising:

“We’ve seen evidence already in NHS Wales and other parts of Europe that there’s a 20% reduction in variation of outcomes by using this way of working,” Rashid says.

Maximising VBHC’s impact through pilots and partnerships

Rashid and McEachren both emphasise the importance of cross-functional partnerships in driving VBHC success.

“No individual company can do it alone,” McEachren says. “We need to work together to show the value of VBHC and ensure it gets adopted across the board.”

There are many programmes aimed at building datasets and outcomes-based arrangements in the ophthalmic space. Rashid tells us that the European Registry of Quality Outcomes for Cataract and Refractive Surgery, for example, has established a registry with transparent data to improve outcomes for patients, as has the UK, with a National Ophthalmology Database.

Among other pilots, Johnson & Johnson is engaged in a project with French non-governmental organisation (NGO) PromTime to test a new incentive scheme that prioritises transparent data collection, Rashid explains. McEachren discussed how PromTime developed a calibrated questionnaire for patients to record their functional vision, and then implement the system through hospital IT infrastructures. “This helps us identify trends among patients,” she says.

Over time, additional partnerships and cross-functional projects will be key to advancing VBHC in cataract care and other sectors of healthcare.

Continuing the momentum for VBHC

As VBHC manifests across healthcare, ophthalmic stakeholders can learn from examples of partnerships and initiatives in other disease areas. Rashid shares that pharmaceutical companies developing diabetes treatments are considering partnerships with diagnostic or medical device manufacturers to share resources and generate real-world evidence. Manufacturers are also increasingly considering real-world outcomes in their evidence generation strategies to inform innovative payment models and run more effective clinical studies.

Continuing to power innovative work requires more high-quality data, especially that which comes directly from patients. “We would like to see more patient diaries,” Rashid says. “Similar to how diabetes patients record their food intake, vision diaries can allow cataract patients to track the ways they use their vision in daily life. We can use this information to become more bespoke in how we partner with HCPs and decide on the best vision option for patients.”

In addition, by fostering collaborative relationships between the often-siloed members of the healthcare system, we can bring together diverse perspectives to work toward a world in which patients truly benefit from medical interventions.

For Johnson & Johnson, the opportunity to contribute to strategic partnerships is a privilege the organisation looks forward to exploring through further collaborations. “We’re delighted to see how patient outcomes influence ecosystems,” Rashid says. “In vision care, we should be more open to having more strategic partnerships that could be of value to all.”

“We have an opportunity to support providers and surgeons with their own, validated, real-world evidence that they can learn from to help their patients,” McEachren says. With more data, more stakeholders on board, and a greater understanding of the value new methods can bring to healthcare, Rashid and McEachren’s VBHC vision can become a reality.

Erin McEachren is regional vice president for Johnson & Johnson Surgical Vision, EMEA, leading the team to address the unmet needs of patients and eye care professionals around the world.

Erin was previously a top-level skier and after suffering injury, has a deep connection to medical devices, in which she now excels. She is an exceptional leader, with a track record and breadth of experience in commercial leadership, franchise development, and sales execution across medical devices and in growth areas, such as robotics.

Syed Rashid is director of market access and sales training at Johnson & Johnson Vision, EMEA. He is a highly experienced professional with a demonstrated history of working in the medical device and pharmaceutical industry. His passion is for value-based healthcare and ophthalmology.

At Johnson & Johnson Surgical Vision we are passionate about changing the trajectory of eye health and dedicated to partnering with our customers to help more people around the world preserve and restore sight. For over 130 years we have been guided by our CREDO, focusing on improving the lives of the patients and the communities we serve.

Our mission is to bring science driven innovation to life through our products and our customer partnerships to elevate eye health for the benefit of all patients. Our commitment to innovation sees us offer a broad range of eye health solutions in ophthalmic care. Our TECNIS® IOL portfolio, for example, delivers unsurpassed visual outcomes using a combination of proprietary and industry leading optics technologies. We also offer advanced astigmatism management solutions and are a global leader in refractive laser surgery, with an innovative suite of technologies to deliver best in class outcomes.

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