Value in Health Care Accounting for Cost, Quality, Safety, Outcomes, and Innovation: Workshop Summary (2010) / Chapter Skim
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2 Stakeholder Perspectives on Value
2 Stakeholder Perspectives on Value
Pages 29-38
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From page 29... ...
In September 2008, the Institute of Medicine (IOM) Roundtable on Value & ScienceDriven Health Care met to explore key stakeholders' perspectives on value in health care, seeking to understand the meaning of value and the approaches to assessment among patients, providers, economists, health product and device manufacturers, payers, and employers.
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From page 30... ...
Yet it was also mentioned that patients do not necessarily believe they need more care to achieve better health provided that transparency of information, evidence, and treatment options exists. Overlapping with these views, representatives from the employer sector asserted that they value not only maintaining healthy and productive workers and families at the lowest cost possible, but also focusing on enhancing community health.
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From page 31... ...
Unlike assessments of spending in other economic sectors, value in health care -- that is, the clinical benefit achieved for the money spent -- is frequently excluded from the current dialogue on how to solve the nation's healthcare dilemma, he explained. Despite the relative lack of attention to the value proposition, Paul B
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From page 32... ...
Medical services span a continuous scale, ranging from those with positive benefits to those without benefit and even to those that cause harm. Ginsburg said that although some may argue that enough evidence exists to enable distinguishing useless and harmful interventions from those that could provide utility, recent history has demonstrated our inability to determine the harms of many medical products prior to their widespread use in clinical practice.
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From page 33... ...
She stated that there is an unwillingness to accept the idea that the doctor they see and personally chose is not a high-quality doctor. She cited a recent poll by the National Business Group on Health that found that 72 percent of the employees surveyed thought their doctors were very or completely trustworthy sources of health information compared to 66 percent for nurses, 43 percent for health plans, and only 22 percent for employers (National Business Group on Health, 2008)
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From page 34... ...
He explained that unrelenting market competition and the imperative of competitive labor costs have driven employers to unprecedented levels of engagement in healthcare transformation and cost control. The marginal impact of employer innovations -- for example, pay-for-performance and total health management to address chronic conditions such as diabetes and the exploding epidemic of obesity -- together with logical limits to employee cost shifting in the face of escalating healthcare expenditures, referred to as the "PacMan" of the federal budget by Helen Darling, have compelled employers to demand accountability for value in current healthcare expenditures.
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From page 35... ...
This model requires that each service offered be evaluated for appropriateness based on the best available evidence. Expanding on this idea, Bruce Ferguson articulated that evidence generated by comparative effectiveness studies can inform the development of appropriateness guidelines, and HIT resources can be designed to collect information about the quality of care delivered and potentially be utilized as a tool for the dissemination of guidelines.
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From page 36... ...
He stated that providers additionally need access to a combination of clinical quality data and cost data at the point of care, which is being done by the Virginia Cardiac Surgery Quality Improvement Project; otherwise healthcare providers lack knowledge of a critically important denominator of the value equation. The discussants concluded that without the implementation of these changes in focus, payment structure, and information delivery, providers will not be able to make the right decisions in terms of value for the patients with whom they are entrusted.
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From page 37... ...
Weisman believes that cost alone should not be used to assess the value of treatments or to limit access. Rather, value should consider the individual patient, should consider actual improvements in patient health and costs over time, and should include assessment of patient satisfaction for services provided.
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From page 38... ...
Washington, DC. National Business Group on Health.
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