For clinicians, success is measured using the same outcomes as those used for patients. There is also a focus on biologic markers and function, and pathways to achieve goals. “We identify biomarker proxies and timelines for success,” Dr. Lockshin says. “To tailor therapy interventions at early dates, we monitor our adherence to best practice guidelines.”
From a society perspective, it is important to determine direct and indirect (lost productivity) cost for patients under care, distinguishing between short- and long-term outcomes. “We describe the selected value as a function of time, distinguishing between onset of illness, first encounter and other starting points,” Dr. Lockshin says. “We describe endpoints as maximally achieved goals and as intermediate points in illnesses that last decades.”
Then, they distinguish societal value from value desired solely by the patient or caregiver. “We compare and contrast these values, with the goal of having the values align,” Dr. Kasturi says. “We measure value for the different stakeholders in sequence. We have begun with patients; value judged by providers is concurrent. Societal value (i.e., dollar costs) will follow.”
Karen Appold is a medical writer in Pennsylvania.
A History of Determining Value
Value in healthcare is not a new concept. It’s always been of interest to those who pay for it. Value-driven healthcare methodologies have been in place for decades.
Faced with increasing healthcare costs and population data that suggest the U.S. fared less well on measures of health, employers started to question what they were getting for their healthcare dollars in the 1980s. A result of this push was the formation in 1990 of the National Committee for Quality Assurance (NCQA), a not-for-profit that measures the quality of care at the health plan’s level. Although these health plan quality scores were initially constructed to help employers choose health plans, these scores are now used in a variety of transparency tools for consumers, including shopping tools for Medicare Advantage and health exchange insurance policies.
Although the performance on a number of important process measures assessed by NCQA (e.g., beta blocker use after myocardial infarction and routine assessment of glycosylated hemoglobin among diabetics) and other groups has improved—likely due to measurement and reporting—there has been growing interest over the last decade to measure health outcomes, in particular patient-reported outcomes.
Although the HSS in New York is already a top-ranking institution, Catherine MacLean, MD, PhD, chief value medical officer, says there is always room to do better. “Science is constantly moving forward, and we aim to continually incorporate best treatments to improve our patients’ health,” she says. “Within this context, however, we need to be able to measure and report our value. Historically, the U.S. healthcare system has not been very good at doing this.”
