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.
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.
NEJM Catalyst Innovations in Care Delivery
Copyright ©2021 Massachusetts Medical Society.
Published online: January 1, 2021
Published in issue: January 1, 2021
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