Barriers and facilitators of implementing value-based care: The case of SwissDiabeter

Global spending on diabetes care soared to $966 billion in 2021, a 316% surge over the past 15 years. This sharp increase underscores a need for more efficient and cost-effective care strategies. Value-based care (VBC), which prioritizes patient outcomes while controlling expenses, presents a promising solution. However, its real-world implementation remains challenging, particularly in diabetes care. This study examines SwissDiabeter, a proposed diabetes clinic initiative in Switzerland inspired by a Dutch VBC-based Diabeter clinic. We examine key barriers and facilitators during Diabeter's implementation in the Netherlands and assess forthcoming challenges and enablers for SwissDiabeter in Switzerland.

We employ a deep, extensive embedded single-case design conducting 27 interviews with healthcare professionals, insurers, and patient groups in Switzerland and the Netherlands. The main interview data were complemented by various secondary sources to enhance contextual comprehension, widen perspectives, and validate findings.

We identify four key factors for successful VBC adoption: leadership in driving change, financial restructuring, operational improvements, and enabling digital technologies. We next derive practical recommendations to guide the implementation of value-based diabetes care, redesigning financial incentives for healthcare providers, partnering up with key stakeholders such as insurers or policy makers, and measuring outcomes on a voluntary and anonymous basis.

This study enhances the global discourse on VBC by analyzing key barriers and facilitators in implementing SwissDiabeter, drawing insights from the Diabeter model in the Netherlands. Our findings highlight the need for strong leadership, financial incentives, digital infrastructure, and interdisciplinary collaboration to drive outcome-driven care. Beyond diabetes, these insights provide a framework for scaling VBC across chronic disease management, promoting cost-effective, high-quality healthcare.