What is Value?
"Achieving high value for patients must become the overarching goal of healthcare delivery, with value defined as the health outcomes achieved per dollar spent. This goal is what matters for patients and unites the interests of all actors in the system"
- Porter, 2010.
Value-based healthcare delivery is being discussed in a variety of healthcare forums. This concept is of great importance in the reform of the U.S. healthcare delivery system. Defining and applying the principles of value-based competition in healthcare delivery models will permit future evaluations of various delivery applications. However, there are relatively few examples of how to apply these principles to an existing care delivery system. We strive to assess the value created when treating cancer patients in a multidisciplinary care setting within a comprehensive cancer center.
Alternative payment models, including bundle payments, have attracted more attention as US healthcare costs continue to grow. These models have shown limited success for some conditions, but are untested in multi-disciplinary cancer care. In November 2014, MD Anderson partnered with United Healthcare to launch a 3-year bundled payment pilot for head and neck cancer. Working together, both organizations are testing the feasibility of prospective bundles payment for one year of cancer care.
Time Driven Activity-Based Costing (TDABC) has helped MD Anderson measure the true cost of cancer care delivery since 2010. The Institute has since partnered with Financial Planning and Analysis and Business Analytics departments to implement an enterprise Oracle Hyperion-based solution to aid in time-driven bottom-up costing and resource capacity analysis. Although, the solution has not been adopted by the institution as the primary costing methodology. ICCI continues to advocate for more accurate cost measurement in healthcare.
Patient-centered outcomes are a foundation of value-based healthcare and a priority for ICCI since 2008. Faculty and internal experts have helped us expedite the development of disease-specific outcomes sets. Our approach aims to incorporate the patient’s ‘voice’ through routine use of validated patient-reported outcome questionnaires and strives to prioritize measures that are most relevant to patients, providers and insurers. Recently, we have dedicated efforts to prioritize the clinical workflow integration and systematic reporting of outcomes into MD Anderson’s new electronic health record.
The evolution of paper-based physician notes to today’s electronic medical records has enabled greater transparency and information sharing in healthcare. We continue to challenge our faculty leaders and care providers to allow for new opportunities to engage our patients and outside providers in care through the use of our new EPIC® electronic medical record, internet technology, and patient/provider portal. More recently, our team has partnered with the Texas Medical Center to uncover barriers to electronic health record interoperability.
MD Anderson’s Enhanced Surgical Recovery Program (ESRP) is a collaborative effort co-led by anesthesiologists and surgeons in each of the surgical services we offer. The vision for the multidisciplinary teams is “implementation of proven and emerging innovations in perioperative care to deliver safe, effective, and value-based cancer care for an increasing number of patients.” Extrapolating the initial results, to the entire surgical practice it is possible to return an estimated 14,000 inpatient hospital days to patients and their families each year. Likewise, associated patient care and administrative support resources can be used to support clinical engagements with new patients. Perhaps more motivating than either of these outcomes however, is that patients undergoing care on enhanced recovery pathways benefit significantly from reduced symptom burden, improved functional capability and an expeditious return to adjuvant therapies when included in their care plan. Efforts to achieve the goals are now integral drivers of the ongoing effort. Under the ESRP, we’ve taken action to clearly define, document and implement patient-centered perioperative care pathways to improve post-surgical outcomes for every patient.
- Upcoming Courses
- Value Measurement for Health Care (Boston, November 29 - December 1, 2017)
- Strategy for Health Care Delivery (Boston, January 3-5, 2018)
- Value-Based Health Care Delivery: An Intensive Seminar for Students & Practitioners (Boston, January 2018 dates TBD)
ICCI Research Assistants