Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The opinions expressed here are that of the authors and not Medical Economics.
The ever-escalating crisis of U.S. healthcare costs has stimulated many great and not-so-great ideas about how best to disrupt, transform, or simply improve the relationship between dollars spent and health outcomes achieved. A global outlier, the U.S. spends more on healthcare than any other country, with spending approaching 18 percent of the GDP. Yet our healthcare outcomes are mediocre at best, ranking 31st in life expectancy and 45th in infant mortality.
A 2006 book by Michael Porter and Elizabeth Olmstead Teisberg, titled Redefining Health Care – Creating Value-Based Competition on Results, is frequently credited as giving rise to the current push towards “value-based healthcare.” In it, value is most often defined (somewhat nebulously) as the ratio of healthcare outcomes to cost.
In every other aspect of our lives we look for value, so the idea of holding healthcare spending to a similar standard is neither novel nor contentious. The challenge is how to execute this idea. Our healthcare system has long rewarded prestige, complexity, effort, and volume over value.
I have been fortunate to practice medicine in both academic and private-practice settings, hold leadership roles at some of the country’s leading pharma and medical device companies, lead a healthcare policy institute, and, most recently, head up an organization building a specific value-based healthcare solution. At different points in my career as a practicing physician, I was rewarded for working in prestigious healthcare delivery systems, performing complex procedures, and using high cost/high tech tools. In practice, I was rarely, if ever, asked to justify costs (to the hospital, to my practice, or to the patient) or prioritize a ‘value-based’ approach.
This was before it became abundantly obvious that our excessive healthcare spending was a clear and present threat to our nation’s economy. Now, more than a decade after the defining of value-based healthcare, surely things have changed. Or so I thought.
For the last five years or so, I have been working to bring to market a value-based solution in the post-acute care space. To avoid the specter of promotion, I will only say that we have gone to great lengths to prove the value of said solution to the patient, the clinicians, and the healthcare system (writ large). I will ask you to temporarily suspend your disbelief and imagine that such proof of value does indeed exist, and yet adoption is slow. Why?
Some are skeptical. Even the pinnacle of proof of value—the prospective randomized controlled trial with cost as the primary endpoint, conducted by an independent academic clinical research organization—does not immediately move hearts and minds and ledgers, There is and likely always will be a cohort of clinicians and systems that want to know that such study results are representative of what they can expect in their setting, with their patients.This flows from the reality that healthcare is intensely local, that workflows are not standardized, and that utilization of resources varies greatly from place to place and practitioner to practitioner.