Starting a Conversation about Value

08 May 2013

The intensity of health care services received has much to do with rising health care costs. Many health conditions have many treatment options, some being more costly than others. One example is back pain. There are multiple treatment options, including surgery, physical therapy, anti-inflammatory medication, and MRI or CT scans. There is no simple rule for which is the best option in a given situation for a patient.

…the best decisions require shared decision-making.

Risks and benefits vary for each treatment option—that is why the best decisions require shared decision-making. Patients need all the information on the table. If a patient receives surgery but would have selected another option if it had been offered, the appropriateness of care suffers, and along with it the value of care. Patients need to be made aware of the full range of options available to them, along with the risks, benefits, and cost.

The Puget Sound Health Alliance, the leader of the Aligning Forces for Quality initiative based in Seattle, is revealing differences in care among regions so that patients can make informed decisions. The Alliance has been at the forefront of reporting on quality care in Washington State with its Community Checkup project. Now the Alliance is examining the frequency of high-volume hospitalizations, as well as the intensity and the consistency of resources used in surgery for those episodes of care. “Different Regions, Different Care” uses data to reveal variations in treatment within the Alliance’s five-county region. Since frequency intensity can vary a great deal, understanding, measuring, and revealing this variation is an important step in assessing value for patients. Reporting this variation is an important first step.

Why do different regions have different kinds of care? In some areas, providers may not have experience with the full range of treatment options or may have developed preferences over time. For example, a practice may refer patients with lower back pain to surgery much more often than the national average. “One practice may have fallen into a pattern. We are teasing apart those differences between practices so that both patients and the practices themselves can be aware,” said Susie Dade, deputy director of the Puget Sound Health Alliance.

Just because a treatment is more intensive or costly doesn’t mean it’s the best for a patient.

Just because a treatment is more intensive or costly doesn’t mean it’s the best for a patient. The more education on this topic available to consumers, the better. Patients need to know that resting may be equally as (or even more) effective as surgery in treating lower back pain. Unlike what consumers expect when spending money on other purchases, paying more for health care does not necessarily equate to better care. Estimates place as much as 30 percent of all health care spending in the potentially unnecessary category, according to the Dartmouth Atlas Project.

As the system moves away from pay for service toward bundled care, hospitals will need to consider value of care. Resource use is a major component of health care value. The Alliance’s efforts in reporting shed light on resource use across the Puget Sound region to begin assessing value in the system—a difficult concept to understand.

In the future, the Alliance hopes to work with purchasers to make progress on cost and price transparency. The Alliance already has added clinical outcomes results for Medicare patients to bring measures of quality into the equation. Purchasers will be able to assess which delivery systems offer higher value with this new, fuller picture of health care. Delivery systems can use the information to identify efficiencies as they prepare for new payment models, such as bundled care. Purchasers will be able to use the information to determine where they may see the best value in care. The Puget Sound Health Alliance is leading the charge on health care value in Washington, with benefits for those who need care, provide care, and purchase care.

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