The article’s author, David A. Shaywitz, MD, contends that in order for a value-based system to deliver significant cost savings and quality improvements to healthcare, the system should be designed to deal with the patients who are the exception, rather than the rule. Dr. Shaywitz points out that the majority of healthcare costs come from a minority of people, also known as “super users,” who often have the most complicated combinations of conditions.
He argues that quality measures should be less defined on compliance and more defined on outcomes, as compliance predicts but does not necessarily track outcomes themselves, which is problematic, when outcomes are the most important metric of quality care for patients. Ultimatley, Dr. Shaywitz notes that “[value-based care] will also require the ability to embrace the messiness of disease and the complexity of patients, rather than providing idealized solutions that impress in the boardroom but flop in the examination room.”
