A patient, physician, insurance executive, and life sciences leader walk into a bar and strike up a debate about what exactly value in health care means. Who most likely is right?
According to our cross-industry research on medical value, they each are—but only in their own eyes.
The fragmented nature of American health care means that each of the above stakeholders approaches the market with distinct goals and metrics for success. The result is misaligned incentives and a "value equation" that often sums to zero.
One particularly vexing tension our research has unearthed is that between patient-centered care and population health. In what ways might our efforts to create more value for patients be eroding value for a population or the ecosystem as a whole?
Take procedural shift to ambulatory surgery centers (ASCs)—often heralded as a win-win-win for patients, physicians, and payers, all of whom benefit from a lower-cost, more convenient site of care. These stakeholders' value is real—yet ASC shift is eroding already razor-thin margins at rural and community hospitals by extracting their lucrative elective surgery volumes. Value for the community erodes when, as a result of falling surgical volumes, one of these hospitals shuts its doors, no matter how much value specific patients, payers and physicians reaped.
In other cases, we fail to engage in a discussion about value at all. Take ultra-high-cost drugs—how should the industry balance serving individuals' needs for advanced therapeutics with the financial stress doing so places on the populations that ultimately foot the bill?