Value operating system: a practical framework to measure outcomes-per-cost at the episode level

Area of Science:

• Health Services Research
• Value-Based Healthcare
• Health Economics

Background:

• Current healthcare metrics often fail to adequately capture the complex relationship between patient outcomes and costs.
• There is a need for a standardized, transparent, and equitable system to measure healthcare value at an episode level.

Purpose of the Study:

• To define a Value Operating System (VOS) and its executable metric, the Value Index (VI), on a 0-100 scale with 95% CIs.
• To incorporate transparency guardrails and equity checks within the VOS/VI framework.
• To outline prospective exemplars for clinical deployment and evaluation.

Main Methods:

• A methods framework employing prospective service evaluation with a predefined sensitivity plan.
• Utilized a hospital-based integrated practice unit for sarcoma care with real-world data flows.
• Interventions included cross-cycle pathway optimization and causal machine learning-assisted radiotherapy targeting, both assessed using VI.

Main Results:

• Defined the VOS architecture, VI formulation, uncertainty treatment, and governance guardrails (e.g., prospective registration, transparency, equity checks).
• Developed operational playbooks for two clinical exemplars, including reporting templates and sensitivity analyses.
• Ensured interpretability and comparability over time and across subgroups through a priori sensitivity analyses.

Conclusions:

• The VOS/VI system provides an auditable, episode-level value signal linking patient-centered outcomes with full episode costs.
• Enables iterative redesign of clinical pathways and promotes cost stewardship.
• Prospective evaluations will assess usability, fairness, and impact on cost-drivers, supporting scalability and value-aligned contracting.