The conversation on value versus volume has emerged from the conversations, policies and programs driven by the Department of Health and Human Services and Centers for Medicare & Medicaid Services. Elevated by the Hospital Value-Based Purchasing program (VBP), an initiative launched as a result of the Affordable Care Act, the view of value here is a focus on rewarding acute-care hospitals with incentive payments for the quality of care they provide to Medicare beneficiaries.
This move away from payments on volume dramatically shifted the pendulum of the healthcare conversation--organizations are now being reimbursed primarily on outcomes, not simply the number of people crossing their threshold.
This commitment to outcomes far outweighs simple volume models, as it hopes to incent organizations to act with broader purpose for those they care for and serve. Yet in this perspective of value, we still see a divergent and troublesome trend that underlies the healthcare marketplace. In its simplest reading, this concept of value is not necessarily what patients and families want from their healthcare encounter. And while I believe that this focus on value has shifted the healthcare conversation and resulting actions for the better, in many ways, it still misses a fundamental point.
First, the experience of patients and families in our healthcare environment cannot be segmented so easily. Experience, from the viewpoint of those seeking care in our system, does not distinguish between quality, safety or service or the broad range of segmentation found in the VBP.
While typical healthcare consumers may not know the delineations of quality measures such Surgical Site Infections or AMI mortality, they do know that everything they encounter during their healthcare journey both inside and out of clinical encounters frames their experience of healthcare. That is the focus we must be committed to if we are to act as a healthcare system.
If we believe broadly that experience, as I framed above, drives the outcomes we hope to achieve in healthcare, then we must focus more broadly on what that experience is. In doing so, we shift our own perspective on value itself. The value conversation is not simply about measures of outcomes as incentives for reimbursement. This remains, albeit with good intention, a provider-centric model based on a universal declaration of what is best.
I do not question the critical importance of measuring and focusing on improving these outcomes in the practice of medicine; rather, I suggest we have a broader opportunity to shift our healthcare intent, levels of engagement and outcomes with a broader viewpoint of value.
Value is simply about what people themselves see as having worth, usefulness or importance. The question, then, on the real value in healthcare is what is important to both those delivering and receiving care. What value do they hope to see from their own care encounters and their broader engagement in the healthcare system itself? I believe the policy value conversation has been a turning point for healthcare in general--whether you agree with it or not. My challenge is that we need to complement that shift with a focus on a bigger conversation of value in our practice of healthcare itself.
As part of this effort, The Beryl Institute is seeking to understand what people value about experience in general--what do you see as the value in a broader focus on the patient and family experience in healthcare from this integrated view? I invite you to join the conversation and share your thoughts via this brief virtual inquiry.
In the end, we must ask if we are seeking what matters to people in their own engagement, acknowledging their needs to the best of our ability, and striving to support that value in ways that can lead to better outcomes. So many of us who chose healthcare as a vocation--either clinical or nonclinical--came with a greater purpose. It is the conversation on what people value where we find that purpose reaffirmed and re-energized. That is the real value conversation at the heart of healthcare.