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In Depth

Making a Dent in the Trillion-Dollar Problem: Toward Zero Defects

Authors: Peter J. Pronovost, MD, PhD, John W. Urwin, MD, Eric Beck, DO, MPH, Justin J. Coran, PhD, MPH, Abirammy Sundaramoorthy, MD, MBA, Mark E. Schario, MS, RN, FACHE, James M. Muisyo, MSc, Jonathan Sague, MSN, RN, Susan Shea, FAA, MAA, Patrick Runnels, MD, MBA, Todd Zeiger, MD, George Topalsky, MD, Andrew Wilhelm, PhD, Sandeep Palakodeti, MD, MPH, and Amol S. Navathe, MD, PhDAuthor Info & Affiliations
Published January 1, 2021
NEJM Catal Innov Care Deliv 2021;2(1)
DOI: 10.1056/CAT.19.1064
VOL. 2 NO. 1
Hero illustration of hands cupping a gold medal ribbon with a star and the words zero defects.

Summary

Health care harms too many patients, costs too much, and improves too slowly. Progress in improving value has been slow. Most efforts to eliminate defects in value have been piecemeal rather than systematic. In this article, the authors describe a framework for identifying defects in value and provide estimates for cost savings if these defects were to be eliminated. The authors then provide a framework for how health systems may work to systematically eliminate these defects in value. Finally, they provide an example of one academic health system that embarked on a journey to implement this framework and the initial results and lessons learned. In the current study, the authors found that: (1) the U.S. health system spends in excess of $1.3 trillion per year on suboptimal behavior; and (2) their organization was able to reduce the annual per-member-per-year cost by 9% over the course of 12 months by reducing specific defects in care. Although it is early in the journey and the framework is only 25% deployed, the authors believe that this model offers a hopeful path forward for improving value.

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Notes

Peter J. Pronovost, John W. Urwin, Eric Beck, Justin J. Coran, Mark E. Schario, James M. Muisyo, Jonathan Sague, Susan Shea, Patrick Runnels, Todd Zeiger, George Topalsky, Andrew Wilhelm, and Sandeep Palakodeti have nothing to disclose. Abirammy Sundaramoorthy works for and has equity in Somatus, Inc., a company that works to improve quality and overall value of care for patients with or at risk of developing kidney disease. Amol S. Navathe has received grant support from Hawaii Medical Service Association, Anthem Public Policy Institute, The Commonwealth Fund, Oscar Health, Cigna, Robert Wood Johnson Foundation, The Donaghue Foundation, Pennsylvania Department of Health, Ochsner Health, UnitedHealthcare, BCBS of North Carolina, and Blue Shield of California; personal fees from Navvis Healthcare, Agathos, Inc., Nava Health, Yale New Haven Health Services Corporation/Center for Outcomes Research and Evaluation, MaineHealth Accountable Care Organization, Maine Department of Health and Human Services, National University Health System-Singapore, Ministry of Health of Singapore, Elsevier, Medicare Payment Advisory Commission, Cleveland Clinic, Embedded Healthcare; and other fees from Integrated Services, Inc., outside the submitted work.

Information & Authors

Information

Published In

NEJM Catalyst Innovations in Care Delivery
Volume 2 • Number 1 • January 1, 2021

Copyright

Copyright ©2021 Massachusetts Medical Society.

History

Published online: January 1, 2021
Published in issue: January 1, 2021

Topics

  1. Accountable Care Organizations (ACO)
  2. Bundled Payments
  3. Care Coordination
  4. Chronic Disease
  5. Clinical Quality
  6. Patient Incentives
  7. Patient Safety
  8. Payers

Authors

Affiliations

Peter J. Pronovost, MD, PhD
Chief Clinical Transformation and Quality Officer, University Hospitals, Cleveland, Ohio, USA
Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
Weatherhead School of Management, Case Western Reserve University, Cleveland, Ohio, USA
John W. Urwin, MD
Clinical Fellow in Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Eric Beck, DO, MPH
Chief Operating Officer, University Hospitals, Cleveland, Ohio, USA
Justin J. Coran, PhD, MPH
Senior Data Scientist, University Hospitals, Cleveland, Ohio, USA
Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
Abirammy Sundaramoorthy, MD, MBA
Senior Vice President, Clinical Innovations, Somatus, Inc., McLean, Virginia, USA
Mark E. Schario, MS, RN, FACHE
Vice President, Population Health, and President of University Hospitals Quality Care Network, University Hospitals, Cleveland, Ohio, USA
James M. Muisyo, MSc
Data Scientist, Analytics, University Hospitals, Cleveland, Ohio, USA
Jonathan Sague, MSN, RN
Vice President, UH Ventures Clinical Operations, University Hospitals, Cleveland, Ohio, USA
Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
Susan Shea, FAA, MAA
Senior Actuarial Analyst, University Hospitals, Cleveland, Ohio, USA
Patrick Runnels, MD, MBA
Chief Medical Officer, Population Health-Behavioral Health, and Director of Population Health Education, University Hospitals, Cleveland, Ohio, USA
Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
Todd Zeiger, MD
Vice President, UH Primary Care Institute, University Hospitals, Cleveland, Ohio, USA
George Topalsky, MD
Vice President, UH Primary Care Institute, University Hospitals, Cleveland, Ohio, USA
Andrew Wilhelm, PhD
Analyst, University Hospitals, Cleveland, Ohio, USA
Sandeep Palakodeti, MD, MPH
Chief Medical Officer, Population Health, University Hospitals, Cleveland, Ohio, USA
Amol S. Navathe, MD, PhD
Assistant Professor of Health Policy and Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA

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Cited by

    • David W. Dietz,
    • William V. Padula,
    • Hanke Zheng,
    • Peter J. Pronovost,
    Costs of Defects in Surgical Care: A Call to Eliminate Defects in Value, Catalyst non-issue content, 2, 6, (2021)./doi/10.1056/CAT.21.0305
    Abstract
    • Patrick Runnels,
    • Heather Wobbe,
    • Kipum Lee,
    • Randy Jernejcic,
    • Peter Pronovost,
    Designing for Value in Specialty Referrals: A New Framework for Eliminating Defects and Wicked Problems, NEJM Catalyst, 2, 6, (2021)./doi/10.1056/CAT.21.0062
    Abstract

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