Friday, April 3, 2009

Creating Value

As a member of the Mayo Clinic Health Policy Center, I would like to take time to talk about creating value.

From our website, and one of the cornerstones of the MCHPC's recommendations:

Create Value
One of the four cornerstones of the Health Policy Center recommendations, creating value involves improving patient health outcomes and satisfaction with U.S. health care and decreasing medical errors, costs and waste. Creating value is the responsibility of providers, medical industry leaders and patients.

Specific recommendations
Develop a definition of value based upon the needs and preferences of patients; measurable outcomes, safety and service compared to the cost of care over time.
Measure and publicly display outcomes, patient satisfaction scores and costs as a whole. Create competition around results through pricing for appropriate bundles of services and quality transparency.
Increase support of health care delivery science, which allows providers to improve the care, efficiency and business processes that support the practice of medicine.
Create a trusted mechanism to synthesize scientific, clinical and medical information for both patients and providers.
Hold all health care sectors accountable for reducing waste.
High-value care delivery.
Develop care programs for patients who need intense, high-cost medical services, such as patients who have complicated diabetes or heart failure.

Quality and efficiency: Increasing support for health care delivery science (systems engineering) will allow for continual analysis of the outcomes and processes of care, a key step to improving quality, reducing waste and lowering costs.

Easier decision-making: Understandable, public reporting of outcomes, patient satisfaction scores and prices will arm individuals with the information required to make better value-based choices.

I've heard some physicians, especially those in primary care grumble about this concept, and especially the pay for performance. There is some concern, and rightfully so about managing a non-compliant patient population and then suffering decreased reimbursements because the patient is not following prescribed treatments. For example, the non compliant diabetic who continually forgets to take their medications, and therefore has an A1C score consistently in the mid 8's. This would indicate poor control, and the physician may likely spend MORE time with this patient in counseling, yet face decreased reimbursements.

I think that that is a legitimate complaint. However, we need to attempt to aggressively measure healthcare outcomes, and reign in spiraling healthcare costs.

What say you?


Qkwan said...

I would think that if providers were posting outcomes then a non-compliant patient would have a hard time keeping a provider b/c they would negatively affect outcomes and income.

physasst said...

That's kinda the idea, although it may result in some patients ending up without adequate healthcare, which is a problem. For example, juvenile onset IDDM, these patients are notoriously non compliant. They are typically angry, and tend not to always follow medical advice. (the why can't I be like all the other kids phenomenon)