Key thoughts:
• Much of healthcare reform focuses on the definition of Value as the Outcome divided by Cost.
• As we emerge into the patient cycle of care, system coordination, and population health, Time to diagnosis and resolution becomes supremely important.
• Efficiency as defined as Outcome over Cost and Time ultimately determines benefits to society, patient productivity and their quality of life.
The emphasis on Value is dominant in today’s discussion on the cost of healthcare and our outcomes. In this equation, value increases with improved outcomes and lower cost [1]. There is profound beauty in its simplicity, which is a snapshot that can be applied to each individual patient, or to a whole population.
The limitation of this value proposition is that it is often used as an argument to reduce testing or interventions, and most physicians are currently experiencing these insurance denials in their patient care. Sometimes the extra test results in a quicker diagnosis which expedites a return to a normal life. A more aggressive approach at disease management may arrest it’s progression with the associated complications. Slowing care and testing at the point of service is not efficient from a patient standpoint and results in dis-coordination. Delay in diagnosis, disease progression, and indirect costs associated with delayed return to work and impaired quality of life are not commonly recognized by the value equation.
Physicians are ultimately responsible for the cycle of care until disease resolution or stabilization, and we share these goals with our patients. On a larger scale, population health is better recognized over time and the care continuum as interventions may take time to show benefits. From a health system standpoint, expediting transfer to specialty centers and shortening length of stay results in greater provider efficiency and better outcomes. And the insurance companies already use actuarial data that draw on disease processes over time.
In this age of cost containment we must not lose sight of the time horizon for the patient and population as a whole when considering value. Efficiency in the patient cycle of care, system coordination and population health needs to reflect this important quality for us to move beyond our next fiscal year.
[1] Bohmer RMJ, “The four habits of high-value health care organizations,” N Eng J Med 2011; 365:2045-2047.
This column is part of a series devoted to clarifying and enhancing the physician-health system relationship. Dr. Ken Altman is Chief of Otolaryngology at Baylor St. Luke’s Medical Center in Houston, TX. He is also Secretary/Treasurer-Elect of the American Academy of Otolaryngology – HNS, and past-President of the American Laryngological Association.