Introducing a High-Value Solution for Enhanced Hip Fracture Management in Singapore

This case study centers on Tan Tock Seng Hospital (TTSH), an acute care hospital in Singapore and a major provider within the National Healthcare Group (NHG). The case invites students to assume the role of CEO of TTSH and formulate recommendations to implement a high-value solution in Singapore, supporting a transition to the Harvard High-Value Health System Model (HVHS). The narrative unfolds in three phases: Phase 1: IHFCP Initiative (2010-2016): The case begins with the Integrated Hip Fracture Care Pathway (IHFCP) initiative, pioneered by Professor Eugene Fidelis Soh. This program sought to optimize hip fracture care within TTSH by implementing an integrated care pathway, necessitating other HVHS components such as outcome measurement and integrated provider networks. The initial phase focused on improving patient outcomes and streamlining care delivery for hip fractures. Phase 2: IHFCP Expansion (2017-2022): The focus shifts to promoting sustainability and value in Singapore’s health system. A key turning point occurs when the MOH commissions IHFCP as part of its Value-Driven Care initiative. The IHFCP refines its value creation framework, introduces new HVHS components (cost measurement systems, value-based payments, and integrated provider networks) emphasizing value for payers, providers, and patients. Phase 3: Refining and Sustaining the Solution (2022 and Beyond): The final phase explores challenges, such as refining targets, translating outputs to better outcomes, and enabling clinicians. The approach shifts from optimizing care to preemptive strategies to prevent hip fractures, aligning with NHG’s ‘River of Life’ and the MoH’s ‘3 Beyonds’ strategy to emphasize prevention, holistic care, and cost-effectiveness. In summary, this case study examines TTSH’s journey and invites students to engage in strategic thinking that bridges theory and practice, contributing to health system transformation and the HVHS transition.