It is a central tenet of healthcare reform – repeated so often it has become a kind of policy mantra – that our healthcare system must stop paying for procedures and begin paying for results. As President Barack Obama says, “create a system where we are paying for quality not quantity.” Policymakers on both sides of the aisle talk about the need to incentivize providers to improve outcomes while reducing costs.
The shorthand policymakers use for this approach is “value-based purchasing.” The concept makes sense, right? Our healthcare system should be creating incentives for those who deliver the services – hospitals, physicians, nurses, device manufacturers, drug companies, etc. – to produce the best possible outcome for the money. That's what we do in making other purchases. When we choose a car, we weigh the price against those attributes we consider important, such as safety, size, design, speed, miles per gallon, and maintenance costs. But each buyer views those attributes differently; we value different things. That's why Chevrolet can sell gas-guzzling Suburbans, speedy Camaros, and electric Volts all in the same showroom.
The challenge in applying this same notion of “value” to healthcare is that the underlying system is not designed to accommodate variations in taste and desire. For example:
- A patient might most value a procedure or drug that allows him to enjoy everyday life;
- A physician could see value in treatment that improves the likelihood of long-term patient survival;
- A hospital might see value in the approach that is least likely to result in the patient being readmitted;
- An insurer – public or private – would likely look at value as something like “return on investment.”
So whose notion of value should we choose as the measure in rethinking our healthcare system?
It is unlikely, even in the age of comparative effectiveness research, that insurers will reimburse one and only one approach to treatment. But the calculus is changing. It is important to understand what is driving this focus on value and outcomes. It isn't improving health that guides the discussion, it is reducing healthcare costs. We have run out of ways to cut payments to hospitals and physicians, hoping that the quality of patient care will not suffer. We are now looking for new models of care – like accountable care organizations and other bundled payment approaches – in the hope that better communication and alignment of incentives will lead to cheaper care without impacting the quality
But before we head down this path, there is an opportunity for discussion – a teachable moment – about what all stakeholders value in healthcare and what trade-offs should be made in pursuit of slowing in the rise in healthcare costs and health insurance premiums. While there have been many such discussions inside-the-beltway among and between the usual suspects, there has been little input from practicing physicians and nurses, hospital administrators, or patients.
As communications professionals, we understand the importance of stakeholder engagement and the value of outreach to key audiences. Most of all, we understand the necessity of listening to those who will be asked to implement change, produce a product, or lead troops into battle. Our experience suggests that before we begin discussing how to align incentives to produce an outcome, we first reach agreement on where we want to go.
Robert L. Chandler is principal of Chandler Chicco Companies and SVP of marketing and communications and head of inVentiv Health Communications Europe.