CREATING VALUE-BASED HEALTHCARE

THE OUTCOMES VALUE AND STEWARDSHIP NETWORK

THE ESSENTIAL GLOSSARY FOR REALISATION OF THE 10 YEAR PLAN’S OBJECTIVE OF A VALUE-BASED APPROACH

THE ESSENTIAL GLOSSARY FOR REALISATION OF THE 10 YEAR PLAN’S OBJECTIVE OF A VALUE-BASED APPROACH

Prepared for NHSE/Frimley ICB by the Outcomes, Value and Stewardship Network & Association of Professional Healthcare Analysts

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OVERVIEW

Version 6.4_arj — November 2025. Source: Oxford Value & Stewardship Programme / AphA.

The Glossary has been prepared based on principles from many sources including the creation of the Oxford English Dictionary. A quote from a document is included when possible but when no succinct clear definition can be found in the main OVSP Glossary , which is 250,00 words long a short definition is created There is also a longer version of this glossary and a book on the Fundamental Language for creating Value-Based Healthcare and a book on forty of the key source books titles the Fundamental Books for understanding Value-Based Healthcare

This sets out the meaning of key terms not only in words but also by defining the data that need to be collected and the information that needs to be produced. A J Ayer argued in his 1935 book Language, Truth and Logic, written at the age of 24, that the best way to assess the meaning of someone’s proposition such as “this hospital is more efficient than that hospital, and more efficient than it was last year” was to decide if he knows what observations would lead him, under certain conditions, to accept the proposition as being true, or reject it as being false” i.e. what data should be collected and what information produced. So our Glossary , developed by the Outcomes, Value and Stewardship Network which includes Analytic Professionals and Economists defines terms by measures as well as by words

PROCESS KEY TERMS

The leadership of a health service should ensure that everyone in that service understands the terms and uses them consistently in terms of Process and Outcome.

Process term

Commissioning

The written definition of the key terms

Commissioning is the continual process of planning, agreeing and monitoring services. Commissioning is not one action but many, ranging from the health-needs assessment for a population, through the clinically based design of patient pathways, to service specification and contract negotiation or procurement, with continuous quality assessment.

NHS website www.england.nhs.uk 14/4/25

The key terms defined by measures and data required to produce that information

In order to monitor the efficacy of the commissioning function, metrics need to cover outcomes, quality, efficiency, and patient experience, and should draw on multiple complementary data sources.

Outcomes

Mortality rates from ONS/SHMI
Disease incidence & prevalence (e.g. diabetes, COPD, CVD) from OHID/PaPi
Health inequality gaps – life expectancy, deprivation related from Fingertips/JSNAs
Service uptake by demographic group (ethnicity, socioeconomic status, geography).
Equity audits (e.g. immunisation, screening uptake).

Quality & Patient Safety

Readmission rates
Never events and serious incidents from quality outcomes data, StEIs/LFPSE
CQC reports
Compliance with NICE standards through audit e.g. stroke, cardiac, cancer

Efficiency/Value/Service Access

Cost per patient or per outcome from Model Hospital/System & NHS Benchmarking Network
Greenhouse gas (GHG) emissions per patient or per outcome
Variation in service utilisation and outcomes from Programme Budgeting data
Prescribing efficiency from MHRA and NHSBSA
RTT waiting tines, A&E waiting times, cancer 62 day target
GP appointment availability and access
Rates of hospital admissions for ambulatory care sensitive conditions (a proxy for effective primary/community care).

Patient Experience

Surveys such as Friends & Family and GP Patient Surveys
PROMS/PREMS
NIHR feedback studies
Complaints and compliments – PALS, Healthwatch
Staff reported experience – quality of support

Equity and Reducing Health Inequalities

Service uptake by demographic group (ethnicity, socioeconomic status, geography) from NHSE EDS
Equity audits and reports (e.g. immunisation, screening uptake) – UKHAS, PHOF

OUTCOMES KEY TERMS

Outcome term

Cost-effectiveness, productivity, and efficiency

The written definition of the key terms

Productivity relates the outputs of a service to the inputs.

Efficiency relates the outcomes of care to the inputs, namely the resources used for that group of patients; this is the meaning of Value as used in the USA whereas the term value has a broader meaning in countries committed to population healthcare, with technical value one of the four types of value which is related to and includes efficiency but includes population outcomes, including equity

Cost-effectiveness relates the outcomes of a technology or intervention to the costs. Usually can be defined as a cost per QALY or cost per unit of health gain for a specific intervention or technology

The key terms defined by measures and data required to produce that information

Make all resources visible in diagram – Technical Value (aka ‘Sustainable Value’) = patient & population outcomes / environmental & social & financial resources

Productivity

Outputs (activity) can be sourced from routine data submissions –

Number of admissions, outpatient attendances, GP consultations, A&E attendances, Diagnostic tests (e.g. imaging, pathology)

Inputs (Resources) can be sources form workforce statistics, reference costs, PLICS –

Workforce FTE’s, Total expenditure, bed days, capital assets, environmental resources, e.g. greenhouse gas (GHG) emissions, water use, eco-toxicity

ONS healthcare productivity index

Efficiency

Outcomes (quality) can be sourced from routine data submissions –

Number of admissions, outcomes frameworks, patient experience feedback – 30 day mortality, readmission rates, Patient-reported outcome measures (PROMs, e.g. hip/knee QALYs, complication rates

Inputs (Resources) Same as productivity (costs, workforce, bed days, GHG emissions)

Efficiency ratios – Cost/GHG per QALY, £ per reduction in readmission rates, £ per improvement in PROMS scores, using PROMS + PLICS + Reference costs, kg CO2e per [outcome measure]

Cost – effectiveness from Reference costs and PLICS, supply chain pricing, NHSE finance, PROMS, ONS, clinical trials data, NICE tech appraisals

Economic Evaluation - Incremental Cost-Effectiveness Ratio (ICER) = (Cost_new – Cost_current) ÷ (QALYs_new – QALYs_current)

Cost Inputs - Direct medical costs – workforce, drugs, equipment. Indirect costs – follow ups, complications

Effectiveness – QALYs, disease specific measure e.g. HbA1c

Example

Hip replacement efficiency

Inputs: £5,000 average cost (PLICS), average GHG emissions
Outcomes: 0.4 QALY improvement at 6 months (PROMs EQ-5D)
Efficiency: £12,500 per QALY
Productivity: X procedures per £million spend

Directory of Acronyms and Terms

APPENDIX 1 — THE CAUSAL DETERMINANTS OF HEALTH BY ANANT JANI

CREATING VALUE-BASED HEALTHCARE