9 From volume to value: dissecting value-based healthcare adoption, execution, and the potential impact on the NHS

Introduction The National Health Service (NHS) in the UK faces significant challenges including rising costs and demand alongside declining performance. Value-based healthcare (VBHC) has emerged as a potential solution, focusing on improving patient outcomes while reducing costs. However, there has been limited research into factors affecting VBHC adoption and implementation in the NHS context. Aims and objectives of the research project or activity This study aimed to 1) identify general adoption and execution factors for VBHC models; 2) evaluate these factors specifically within the NHS context; and 3) assess the novelty and significance of findings compared to existing literature. Method or approach A narrative literature review of over 20 studies on VBHC implementation was conducted, identifying key themes related to adoption and execution factors. Additionally, 25 semi-structured interviews were carried out with VBHC experts globally using thematic analysis to generate insights. Findings The literature review revealed six key themes: organizational culture/leadership; care coordination; financial incentives; IT/infrastructure; policy; and outcome measurement. The interviews uncovered four main dimensions: conceptualization of VBHC; system reorganization and realignment; value-based delivery; and data/technology. Significant barriers identified include clinician disengagement, lack of outcome data, IT limitations, and regulatory complexities. Enablers highlighted workforce expansion, data-driven decision making, patient-centered measurement, and value-based payment models. Key messages This study's findings echo and build on previous evidence that successful VBHC implementation in the NHS requires substantial system changes, better clinician-manager engagement, robust data infrastructure, patient-focused priorities, and sustained senior leadership. By providing actionable insights tailored to the UK healthcare context, this research can support the advancement of VBHC to enhance value for patients in the NHS.