Page 34 - Layout 1

BUSINESS OF
MEDICINE

Value-Based
health Care

By Joseph P. Gonzales, MHA, LFACHE

When one thinks about value with respect to health care, it can be part of a line of thought with
respect to perspective. Is the perceived value based upon the perspective of the patient, the provider,
or the payer? This article will explore various aspects of value-based health care and its intent is to
provide some points of discussion for physicians, patients, and insurers.

What Is Value in health Care? improvement of value is the best way to measure system improve-
In an article written by Michael E. Porter in the New England ment. This all seems understandable, yet “value in health care”
seems to escape the ability of all people concerned to define, much
Journal of Medicine, Dec. 23, 2010, the discussion of Value in less measure and understand.
Health Care identified that “…In any field, improving perform-
ance and accountability depends on having a shared goal that Value should always be defined around the recipient of care,
unites the interests and activities of all stakeholders. In health the patient, and in a well-functioning health care system, the cre-
care, however, stakeholders (limited in this article to patients, ation of value for patients should determine the rewards for others
providers, and insurers) have myriad, often conflicting goals, in- (providers and insurers) in the system. Since value depends on re-
cluding access to services, profitability, high quality, cost contain- sults, not inputs, value in health care is measured by the outcomes
ment, safety, convenience, patient-centeredness, and satisfaction. achieved, not the volume of services delivered, and shifting focus
Lack of clarity about goals has led to divergent approaches, gam- from volume to value is a central challenge. This is the challenge
ing of the system, and slow progress in performance improve- of going from a fee-based system to a value-based system.
ment. Achieving high value for patients must become the
overarching goal of health care delivery.” For any medical condition, no single outcome captures the results
of care. Cost, the equation’s denominator, refers to the total costs of
In Dr. Porter’s discussion, value is defined as the health outcomes the full cycle of care for the patient’s medical condition, not the cost
achieved per dollar spent. This goal is what matters for patients and of individual services. To reduce cost, the best approach is often to
unites the interests of all participants in the system. If value im- spend more on some services to reduce the need for others.
proves, patients, payers, and providers can all benefit while the eco-
nomic sustainability of the health care system increases. Dr. Porter further opines that the proper unit for measuring
value should encompass all services or activities that jointly de-
Value can be framed by rigorous, disciplined measurement and termine success in meeting a set of patient needs. These needs are

34 San Antonio Medicine • September 2016