Health care is an industry that involves the goods, services and payment mechanisms used to promote, maintain and improve people’s health. The primary sector includes hospitals, physician offices, diagnostic and radiology centers, pathology clinics, residential health facilities and pharmaceutical companies, while allied health services include nursing, midwifery and physiotherapy.
The goal of every stakeholder in the health care sector must be to improve value for patients, where value is defined as health outcomes achieved that matter to the patient relative to the cost of achieving those outcomes. Improving value requires either improving one or more outcomes without raising costs or lowering costs without compromising outcomes, or both.
Value-based systems require providers to reorganize their organization and service lines so they can achieve high levels of value for patients. That typically means reducing or eliminating service lines that do not deliver the highest quality of care, especially in complex areas such as cardiac surgery or rare diseases. For academic medical centers with large resources, this may mean developing partnerships or affiliations with lower-cost community providers in those service lines to achieve a greater level of value for their patients.
Changing the way clinicians are organized to deliver care is key to achieving value-based reimbursement models and will ultimately change the entire healthcare landscape. Today, most health care organizations are still siloed by specialty departments and discrete service lines. This model has served the sector well, but it no longer serves the needs of patients or provides the opportunity for rapid improvement.
In an era of increased pressure to achieve a balance between delivering value and controlling costs, it is essential that health care providers develop comprehensive outcome measurement systems to provide meaningful data. Outcomes that matter to patients by condition must be measured consistently to enable universal comparison and drive rapid improvement.
Outcomes by condition, as defined by the International Consortium for Health Outcomes Measurement (ICHOM), should be measured by physicians at every level of care, beginning with the initial consultation and continuing through discharge. These data are critical to enabling clinicians and others to monitor patient progress and to compare results across hospitals and providers.
The most effective outcome-based systems are patient-centered and oriented around the care cycle and recovery process. This approach allows a team to identify the most critical issues that need immediate attention and to prioritize them with the patient, while minimizing delays in achieving those outcomes. For example, significant delays in the emergency department before a patient is seen by a specialist can increase anxiety and prolong recovery.
It also can reduce costs by avoiding unnecessary hospital readmissions, thereby reducing the number of visits to the emergency room and length of stay. In addition, it can improve the experience of care for patients who have a variety of needs.
The challenge of cost control is exacerbated by the lack of accurate cost information in health care, which is essential to understanding the true cost of patient conditions and how they relate to the outcomes achieved. Many existing systems are fine for determining the overall department budget, but they are not adequate to understand costs by condition and to report those costs to stakeholders.