If you are anything like me you keep hearing about "value" in healthcare. Low-value care, high-value care, improving value--but what is most troublesome is the lack of a definition or context in many articles or discussions. I think Michael Porter put it most succinctly in his seminal article of the topic "What is Value in Healthcare?" when defining value as outcomes relative to costs. This definition is quite problematic though in the US health economy as evaluation of costs in relation to access or value unleashes unparalleled vituperative discussion.
In any field, improving performance and accountability depends on having a shared goal that unites the interests and activities of all stakeholders. In health care, however, stakeholders have myriad, often conflicting goals,including access to services, profitability, high quality, cost containment, safety, convenience, patient-centeredness, and satisfaction. Lack of clarity about goals has led to divergent approaches, gaming of the system, and slow progress in performance improvement.--Michael Porter, PhD
Defining "value" to various stakeholders...
What healthcare systems outside of the US seem to appreciate is the variance in perception between different stakeholders. I would like to argue that your perception of value shifts based on your role or identity within the healthcare ecosystem.
Should we define value based on quality arguments from the general public? After all, we are the ones funding the services that we are seeking. How about patients? There are many unique nuances that are difficult to anticipate unless you have truly experienced a diagnosis or underwent treatment. Could this lead to bias? Do we lack the understanding of downstream outcomes beyond the treatment seeking episode of care? What about the healthcare provider? Certainly all of the medical and scientific knowledge should inform what should be considered a positive outcome. We have learned that the patient needs a voice but how and when should we integrate patient centricity in the cycle of care? What about the decision makers such as the CMS, insurance industry, FDA, or governance of healthcare law?
I am sure you can imagine how these perspectives can be influenced by what specific lens you choose to evaluate care decisions.
Should we define value based on quality arguments from the general public? After all, we are the ones funding the services that we are seeking. How about patients? There are many unique nuances that are difficult to anticipate unless you have truly experienced a diagnosis or underwent treatment. Could this lead to bias? Do we lack the understanding of downstream outcomes beyond the treatment seeking episode of care? What about the healthcare provider? Certainly all of the medical and scientific knowledge should inform what should be considered a positive outcome. We have learned that the patient needs a voice but how and when should we integrate patient centricity in the cycle of care? What about the decision makers such as the CMS, insurance industry, FDA, or governance of healthcare law?
I am sure you can imagine how these perspectives can be influenced by what specific lens you choose to evaluate care decisions.
Now what?
As value emerges as an optimized outcome perhaps the goal is actually similar regardless of your role as a pharma company, provider, or payer. Do you know how to define value in your content strategies? How are you going to decide what to measure?
Let's begin having these discussions...
- Objective vs. subjective measures
- Condition specific vs. generic measures
- Clinician (or proxy) vs. patient reported measures
- Health related quality of life vs. overall well-being measures
Let's begin having these discussions...
