New Study Asks: What Does “Value” Stand for in Healthcare?

A new study from the University of Utah revealed that “value” in healthcare means very different things to patients, physicians, and employers. The stark reality of rising healthcare costs shows patients leaning toward money matters as their top value. Patients selected affordability as their top priority, while physicians leaned toward the patients’ health improving as their highest priority through tests or other means, despite costs. 

Stat News reports:  

“Consider this scenario: Over the past six months, you’ve developed persistent headaches. You finally see your doctor, and in order to diagnose the problem, she offers you a choice: For $750, you could have a CT scan that will evaluate 80 percent of the things that could be causing your headaches. Or, if you’re willing to pay $2,500, you could have an MRI scan, which would evaluate 99 percent of the possible causes.

Is that modest increase in accuracy ­­­worth an extra $1,750?

Your answer might differ from what your neighbor would choose, what your doctor would recommend or what your employer is willing to pay for as part of your medical benefits.

As a recent University of Utah Health survey revealed, individuals and different stakeholders in America’s health care system have drastically different interpretations of what ‘value’ means.”

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Three stakeholder groups were surveyed and asked to choose the top five values from a list of a dozen value statements. The groups broke down to 5,301 patients, 687 physicians, and 538 employers. The results were surprising for the researchers.

“Although their responses covered a broad range, patients tended to focus on the bottom line. Their most commonly selected value statement was ‘My out-of-pocket cost is affordable’ (45 percent).

Employers also prioritized affordability, with ‘The cost to the employee is affordable’ (59 percent) their highest-rated value statement, followed by ‘The cost to the company is affordable’ (57 percent).

Among physicians, the most commonly selected value statements prioritized the quality of care over its cost. ‘I know and care about the patient’ (55 percent) was the top response, followed closely by ‘I order the appropriate exams, labs, and imaging,’ (55 percent) and ‘The patient’s health improves or stabilizes’ (50 percent).

Patients appeared to place far less importance on good clinical outcomes than physicians did. In fact, less than a third of patients selected ‘My health improves’ as one of the top five things they value most in health care.

… Follow-up interviews suggested several possible explanations for this surprising result. Some healthy patients said they didn’t need their health to improve; some patients with chronic conditions said they didn’t expect their health to improve.”

The survey results show that health outcomes are not the only thing physicians and healthcare facilities need to be aware of when practicing, as patients value affordable, convenient, friendly and accessible care. This result leans more toward a value-based reimbursement model (which we’ve talked about here and here), where physicians consider the quality of the cost of treatment plans and tests for patients, not the quantity, saving money in the long run. (For details on how savings work under a value-based reimbursement plan, check out our delicious metaphor and explanation using Bojangles chicken and sauces as an example.)

If the survey results are taken seriously, it could facilitate a dialogue among patients, physicians, and healthcare providers about the need for affordability and choice in patient care.  A patient may choose the $750 CT scan over the $2,500 MRI, but they need to be aware of the choice to begin with, and have the power to make that choice.

“Some physicians are uncomfortable taking a view of patient care that’s as nakedly transactional as the choice of diagnoses (and costs) offered in the hypothetical headache scenario above. ‘They don’t like the analogy of shopping for a car, where you acknowledge there are tradeoffs in terms of how much more you’re willing to pay for that one little extra safety feature, or leather seats versus standard seats,’ says Robert Pendleton, MD, chief medical quality officer for University of Utah Health.

Uncomfortable or not, there’s some truth in that comparison. ‘In most areas of our lives, we understand these tradeoffs,’ Pendleton says. ‘But in health care, doctors are ill-equipped to have meaningful conversations with patients about those tradeoffs.’

Nevertheless, Pendleton is hopeful that the survey results ‘are starting to send signals that we can have a discussion around those tradeoffs. Otherwise it’s going to be hard to have a unified vision of how we make the best decisions for individual patients.’

The goal of the Value in Health Care Survey was to provide a framework for a more productive discussion of how to achieve good value. Ultimately, it may come down to recognizing that semantics could play as big a role in improving America’s health care as medicine and economics. Reaching consensus on a definition of terms is a critical first step.”

For more on this story, visit Stat News.

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