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Value-based healthcare (VBHC) is a widely approved logic for financing services, using innovative care models and evaluating healthcare outcomes. It is consistent with the Triple Aim framework of simultaneously improving population health, patient experience and the costs of care. In Nordic countries, VBHC has been mainly implemented as a strategic concept in developing hospitals. Despite the evident interest in VBHC as a management trend in healthcare organisations, the studies concerning the implications of VBHC logics on health policies have been scant. This study aimed to fill this gap by building a conceptual bridge between national health policy and value-based care. Through the Triple Aim framework, we explored how VBHC goals have evolved in Finnish Government Programmes from 1995 to 2015 by using qualitative document analysis and interviews. The study addresses the evolution and national impacts of VBHC. Our results show that the goals of Triple Aim gradually become evident at the Finnish health policies. All three Triple Aim goals were present, though the equal prioritisation of these goals only emerged in 2015, also highlighting patient experience. We argue that VBHC logics have indeed affected Nordic welfare policies, not only at the organisational level but also concerning performance measurement and care delivery. This may imply that the diffusion of VBHC logics evolves from healthcare organisations to policymaking instead of top-down. Particularly in publicly financed systems, VBHC indicates a transformation to a new public governance ideology, accelerating policy goals that promote customer responsiveness and value creation for citizens. acceptedVersion

Purpose The purpose of this paper is to shed light on the potential of organizational learning for developing effectiveness of care. Value-based healthcare measurement recognizes patient value as a driver for improving health outcomes at the societal and individual levels. By using the action learning method, this paper examines the phases of organizational learning in a private healthcare organization that has developed a novel Big Data screening tool for the treatment of patients with type 2 diabetes mellitus (DM2). Design/methodology/approach Relying on triple-loop learning as a conceptual framework and by applying the action learning method to case study design, this paper illustrates the phases of organizational learning and efforts to utilize value-based measurement in healthcare. Findings The case organization was able to identify patients at risk and to improve their care balance. Although the results for the measurement of patient outcomes led to questioning of previous care processes and practices in the organization, increasing value for all stakeholders by incorporating social needs to business opportunities remains under process. Originality/value With the focus on organizational learning and organizational value creation processes, this paper demonstrates incorporation of measuring patient outcomes in re-structuring care processes, enhancing organizational performance and improving effectiveness as well as quality of care.

Purpose – Poor access to healthcare and increasing demand for services represent a management dilemma how to balance between needs and costs. Scrutinising the concept of demand management and using a case study from Finnish primary care, the purpose of this paper is to examine the complexities of managing demand for health services. Design/methodology/approach – Convenience has explained the popularity of walk-in clinics (WIC), making it an attractive demand management tool. By analysing the quantitative service utilisation data of frequent attenders at WIC, the paper exemplifies what enhanced access to care means for demand management of public welfare services. Findings – High user rates and satisfaction indicate demand for this type of service; however, the establishment of WIC provided supplementary care for the high users of health services, most suffering chronic diseases. Research limitations/implications – Better understanding of the structure of service demand is needed in order to develop a more coordinated service system and to manage demand for public welfare services. Practical implications – The study demonstrates the importance of identifying service utilisation patterns in managing demand. Instead of single solutions, a wider system-level perspective is essential. Originality/value – Managing demand and facilitating access are core primary care attributes but there is little evidence about the impact of demand management strategies. The paper ties together important healthcare management issues: how to control demand and improve the access? Moreover, few studies have examined the frequent attendance at WIC. This paper presents a practical illustration of demand management tool and indicates some demand management problems to be considered in healthcare management.