I've always found that Vlad's core identity is sustained DPS tanky mage. The fact that he heals is his way of having a unique engagement prolonging tool and is central to his identity as well. I say Riot should hammer out this core concept and make Vlad a long engagement, in-your-face fighter and pace out his healing so it's consistent instead of large spikes every Q cast.
Here's a few radical ideas that I know won't get anywhere:
Passive: enemies hit by his abilities gain a stacking debuff that makes Vlad heal when he deals damage to them. The heal would be minimal per stack, but build up to a rather dangerous amount if Vlad is given the chance to stay on you.
Q: targeted (NOT skillshot) blood spike projectile that goes through enemies in the way, dealing less damage per enemy hit and fizzling out if it goes through too many (#counterplay). Low damage, low cooldown, no more heal. Instead, blood is drained into his bloodball (the sphere of blood he carries around) per enemy hit.
W: keep as-is, though the health drained now goes to his bloodball instead of directly healing him.
E: activate to make his bloodball drain the blood enemies close to Vlad every half-second or so. After a short duration, the orb bursts, dealing damage in a small radius around Vlad based on amount drained (to a maximum cap, like 
ult). Q and W build up blood even if E isn't currently active.
R: perfect. Keep as-is.
Key points:
-Itemization would be virtually unchanged here when it comes to his go-to items. Because of his sustained damage and need to stay in the fight, 
, 
, 
, 
, 
, etc. would all still find a comfy home in Vlad's inventory.
-Laning as and against Vlad would now have actual interaction instead of "Does his sustain outdo my ability to trade? If yes, stay away. If no, smash his face in."
-Overall gameplay tactics remain relatively similar (dance about and sustain while pressuring key targets).
-His feast/famine Q-sustain-spam gameplay that have made him such a hot mess for balance is fixed through leveling out his power budget across his abilities.
-His inevitability in lane is gone because his Q no longer near-insta-heals a truckload of health on a targeted, unavoidable nuke with an extremely low CD.
-Farming and laning are now considerably easier due to Q hitting multiple targets and E being more of a nuke than a spammable tiny poke.
I absolutely love his blood mage fantasy :3
I also love beefy champions, so yeah... :p
