Who benefits from a Learning Health System? Is it worth developing? If there is no clear business case, a private company will be unable to scale and spread. If there is no value to the organisation (eg hospital, GP practice), then it is equally likely to fail. This value can include benefit to patients or improved efficiency.
Value in healthcare is the outcome created per unit of resource spent. Maximising value means achieving the best outcomes at the lowest cost. It must also address issues of value to stakeholders, such as equity, sustainability and transparency . The Learning Health System can enable the measurement of outcomes and generate improved costing data, allowing for routine measurement and comparison of value within healthcare .
HealthTracker had a complex and varied value proposition for government, GPs and patients, making it difficult to assess value as a whole.
PatientsLikeMe had great value to the patients who used it, giving them a feeling of community and sometimes a sense of being believed. It also helped them make decisions about their own care, with many changing clinicians as a result. However, charging patients might have deterred use, while hosting advertisements could damage its independence. The data was valuable to researchers, pharmaceutical companies and to the medicines’ regulator. This was the primary source of funding (alongside grants) and enabled a peak turnover of millions of dollars in revenue per year. For example, it helped analyse the impact from the launch of a new drug. It had limited value to the health system, in which many clinicians ignored the data, although some found it useful to help compare their practice with the community.
CYPHP delivers value to patients and families through more joined-up and safer care, reduced delays and better quality. For example, specialist nurses and doctors work and share data between hospital, primary care, and community organisations to support children. The system also provides access to additional expertise for clinicians, linking clinicians in teams across organisational and professional boundaries. There was concern that additional need might be uncovered that could not be met by existing commissioner budgets. Indeed, CYPHP’s population health approach to early identification and universal coverage has uncovered unmet need: for example, 45% of children in the community with asthma have poorly controlled symptoms requiring clinical support. However, early intervention and joined up care has delivered cost savings, and the service is cost-effective and commissioned. Moreover, the population health management approach has reduced inequalities in access to care, delivering higher levels of early intervention to the children who need it most .
TRANSFoRm was shown to improve diagnostic accuracy in some situations and was acceptable to patients and GPs. However, there were concerns that it might result in increased demand on other parts of the system if deployed more widely .