Calculating ‘Value’ in Healthcare
You have heard the mantra about searching for “value” in healthcare. There have been dozens, hundreds, or thousands of federal policies — depending on how you parse the Federal Register — and entire organizations such as AHRQ, MedPAC and the CMS Center for Clinical Standards and Quality dedicated to this one goal. Why has finding value been so elusive?
To a large extent, our struggle to find value dates back to 1942 when, after the Roosevelt administration froze wage hikes to forestall inflation during World War II, employers turned to healthcare benefits as a major recruiting tool. The subsequent growth of employer-sponsored insurance limited the impact individual consumers could have on the market. Today, we are seeing advances in computing transform the calculus of consumer choice in almost every industry – telecom, retail, travel, entertainment, banking, publishing – but healthcare still lags. Much of the “value” measurement space represented by tools such as quality measures and prior authorization have been attempts to provide proxies for value to consumers / patients to fill the void in choosing what to pay for in healthcare.
What would it take to bring transformation to healthcare? The near-unanimous passage of the 21st Century Cures Act laid a foundation for a new dynamic in healthcare based on getting patient’s their patient data from providers enabling them, their apps, and their payers to explore entirely new ways of shopping for and getting care. Central to this dynamic are the Cures Act requirements for “application programming interfaces (APIs) without special effort” – i.e. standardized rather than vendor-specific APIs and the requirement that patients actually get that data — meaning no more information blocking by providers and vendors.|
This blog entry is provided courtesy of Oliver Wyman and may be viewed at this link.