from AcademyHealth Blog at http://bit.ly/2vosN6X on July 31, 2018 at 02:02PM
Widening Our Lens: Researchers Challenge Narrow Definitions of Value
Health care cost was at the forefront of conversation at this year’s Annual Research Meeting, (ARM). This is not surprising, given the high cost of health care in the United States – the highest among developed countries – coupled with outcomes that rank among the lowest of developed countries. This reality begs the question – what value does our current health care system produce?
Broadening Our Conversations about Value
Value is defined as outcomes relative to cost, and attempts to measure the “bang for your buck” – essentially if what you’re getting is worth what you paid for it. Alternative payment models are often seen as a way to increase value, i.e. improve outcomes and reduce costs. One panel at the ARM discussed Value-Based Care in Medicare, such as bundled payments and merit-based payment systems. These systems are particularly hot-button issues, as Medicare is currently implementing these types of programs. The panelists provided context for these models, and noted that more research is needed in order to accurately pinpoint how they can decrease spending.
Conversations about value often turned to reducing spending – but one panel on pediatric health drove home the point that perhaps we are spending too much time examining the wrong side of the equation. Yes, reducing spending is important, but shouldn’t improving outcomes be the first priority? Panelists shared studies that had examined the impact of integrating mental health into pediatric care, and came away with several notable findings. First, they saw that intervention groups spent twice as much overall on treatment, but less per patient because they treated more children. Second, they found that these brief, low-dose treatments may not have long-term cost impacts. If we focus too heavily on the cost side of the value equation, it could be interpreted that these mental health interventions failed – they did not reduce costs in the long run. But the intervention group, while spending more, was able to treat more children. Doesn’t that matter, too? During the discussion, panelists made this point: Children’s health care is not expensive compared to other health care costs – so why are we trying to save on costs?
In the case of children’s mental health, there could be benefits further down the line that are not reflected in the cost of healthcare. Improved education outcomes in school, decreased drug and alcohol use, better high school retention rates – how can we add these outcomes to the value equation?
Our Culture of Health Care
Another panel at the ARM examined value in maternal care, looking at the outcomes and costs of childbirth. Childbirth is a large contributor to the cost of overall hospital expenditures in the U.S., with highly varied outcomes and costs between hospitals, across geographical differences, and between racial and ethnic groups. Panelists discussed the value of care for commercially-insured women with low-risk births, a group they identified as one that should be receiving relatively standard care. Despite the homogeneous nature of that sub-population, they found significant variation in rates of C-sections and well as cost of overall care. The panel explored how these variations can be influenced by factors such as the culture of care at a hospital, organizational factors, and the individual attitudes of health care providers. These factors shape the process of care, and play a crucial role in determining value.
Looking Beyond the Dollar Value
The presentations at the ARM underscored the importance of looking beyond the numbers to assess value, both in terms of the ultimate cost/benefit of an intervention as well as the factors that we assume influence value. Panelists challenged attendees to consider the public benefit of certain health interventions, even if they do not reduce costs up front, and to question how we measure outcomes more broadly. Additionally, panelists connected conversations about value to necessary considerations of equity, and underscored the importance of understanding value as a key component of a larger health care culture.
Tue, 07/31/2018 – 08:42