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An Employer Opportunity for Health Improvement and Global Consistency

By focusing on outcomes that matter most, multinational employers can use their market influence to drive value in the health care benefits offered to employees worldwide.

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February 01, 2024

Driving Value in Health Care Around the Globe
The goal of this three-part guide is to inform multinational employers about ways to use value-based approaches and outcome-driven strategies in their global health benefit strategy.
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Employers, no matter where they are in the world, have an interest in ensuring a healthy, productive and engaged workforce. As health care costs rise across the globe, employers gain a strategic advantage from connecting employees to health care providers who deliver high-quality, affordable care. While value-based care is a concept that is traditionally associated with the U.S., there are opportunities for multinational employers to leverage their influence, communications and scale to help employees access high quality, affordable care. A value-based approach can also support employers’ efforts to provide consistent, high-quality benefits across countries.

According to the World Health Organization (WHO), quality of care is the degree to which services increase the likelihood of desired outcomes and are consistent with evidence-based knowledge.1 The WHO attributes multiple elements to quality care, including services that are effective, safe, equitable, people-centered, timely, efficient and integrated.

Large multinational employers can benefit from investing in a strategy that connects employees to high-quality care because it contributes to an overall healthier, more productive enterprise.

Employers can take steps to achieve this by:

  • Establishing purchasing arrangements with fronting networks that emphasize quality improvement and cost mitigation;

What Are Value-based Purchasing and Value-based Care?

Value-based purchasing (VBP) is generally associated with employers and health plans in the U.S. using their purchasing leverage to change the way they pay for health care services to drive down costs and enable reforms in health care delivery.

Value-based care exists the world over and describes health care delivery that achieves good health outcomes and patient satisfaction at a reasonable cost to both the patient and whatever private or public insurance system funds most of the cost.

  • Providing high-quality, comprehensive health services directly via on-site clinics (where feasible);
  • Striving for more globally consistent standards for health care and well-being benefit offerings by working strategically with vendor partners and other stakeholders; and
  • Promoting the use of high-quality provider groups in the community among employees.

Adoption of a globally consistent benefit plan is fast emerging as a core strategy for many multinational employers. Implementing this strategy requires thoughtful consideration and planning; see Business Group on Health’s guide, Creating a Globally Consistent Benefits Strategy, for further information on this topic.


Self-insured employers pay directly for health care services in the U.S. more so than in any other country. For this reason and others, employers’ interest and activity in steering employees to high- value care has held more of a foothold in the U.S. In countries outside the U.S., employers may perceive they have less ability to influence where employees receive care given the differing level of health care infrastructures and technological capabilities around the world.

Nevertheless, employers across the globe can use their influence strategically to help employees access value-based care. Although the definition for what constitutes “value” in health care can vary depending on the specific demographic needs and/or population preferences, there are some high-level elements that are universal. Quality in health care pertains to the effectiveness of clinical processes and interventions, while outcomes in this context are the ultimate result of the medical interventions on a patient's health and well-being. Typically, the value of health care services received rises with improved quality, outcomes and patient experience; cost also has an impact on determining value (see equation below). Circumstances impacting this equation, including the ability to measure its elements, will vary widely across countries.

Value = Quality + Outcomes + Patient Experience/Cost


Country Highlights

Listed below are a few notable highlights of provider groups delivering value-based care around the world:

  • Denmark: Denmark has a decentralized universal health care delivery system. Many residents receive supplemental insurance through their employers to enhance access to providers, creating a shared public-private interest in driving value-based care.2 For example, there is a health care organization known as the Steno Diabetes Center Copenhagen (SDCC) that employers can work with directly to further value-based care in the treatment of diabetes. SDCC offers evidence-based diabetes care directly and supports research efforts to improve outcomes for diabetes patients. The center also uses a holistic and collaborative approach to patient care, and their “research targets the social network of people with diabetes including health care professionals, social workers, employers, relatives and families.”3
  • Sweden: Sweden’s health care delivery system is one of few countries in the world that already has very high alignment with a value-based care model. Sweden closely monitors its population's health outcomes through comprehensive disease registries, utilizing interconnected electronic health records (EHRs), outcome-driven reimbursement (e.g., bundled payments for hip and knee replacements in Stockholm) and a decentralized health system that encourages local-level experimentation.4 In addition, Sweden has a system structured to use decades of evidence-based treatment guidelines and disease registries as well as a health care workforce that is largely salaried.
  • Kenya: For expectant mothers in Kenya and other parts of Africa, MomCare provides a value-based care model reimbursed through bundled payments to improve maternal and neonatal health outcomes.5 Their services are paid for through public-private partnerships, creating opportunities for people to get access to health insurance. MomCare uses real-time utilization data to enable a better understanding of how to drive improvements in outcomes and affordable costs.6
  • Netherlands: In the Netherlands, people covered by the national insurance plan can access Diabeter, which provides comprehensive diabetes care through a bundled payment arrangement with the insurer. Diabeter’s performance is measured on HbA1c levels of people living with type 1 diabetes.7 In fact, Diabeter won international accolades in 2013, the ValueBased Healthcare (VBHC) Prize’s Inspiration Award, for its work in “helping patients towards a complication-free future by making use of the latest technologies and cutting-edge clinical research.”8 While employers help fund the universal public insurance system and don’t directly contract with Diabeter, their employees benefit by being able to take advantage of high-quality care through Diabeter.
  • United Arab Emirates (UAE): As part of international efforts to expand operations and drive further adoption of value-based care and purchasing arrangements outside the U.S., Cleveland Clinic opened a hospital, Cleveland Clinic Abu Dhabi (CCAD), employing physicians spanning more than 55 subspecialties, 14 institutes and six Centers of Excellence (COEs). CCAD helped introduce innovations in several different types of disease specialties and became the leading market provider for cardiology and digestive disease services.9 Other well-known U.S.-based hospital systems, such as he Mayo Clinic, have opened similar facilities in certain markets across the globe.10,11
     

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