Value Analysis Program

Value Analysis Program

Transcript
  • Douglas L. Wood, M.D.
    • Director
    • Value Analysis Program

Douglas L. Wood, M.D.: I'm Douglas Wood, a cardiologist, and I direct the Value Program in the Center for the Science of Healthcare Delivery. When the Affordable Care Act was being drafted several years ago, there was considerable interest on the part of legislators to understand how Mayo actually created value. And in many of our visits to Washington, and the visits of legislators here, we had a number of discussions with them about the concept of value. So the Value Program is intended to help Mayo express to others what value in health care means, how it should be measured, how it should be rewarded in payment systems, and how consumers, in fact, should understand the importance of finding or seeking value.

Going back to the story, that in the United States we're wasting a third of what we spend on health care every year. The discipline of the science of health care delivery is one of the ways that we can find the opportunities to eliminate that waste. It's not enough simply to know the basic knowledge about biology and medicine. We have to know how to deliver that. What's the most efficient way? What's the most effective way? And increasingly we also have to know what works better.

In the high-value health care collaborative, our goal is to identify best practices of care that we can then export across the country and everybody who's interested can copy. The secondary goal for that is to help then inform payment policies so that we would understand what costs should be for the best care. So we need to fundamentally change the payment system away from this fee-for-service, volume-oriented engine to one that really reflects value. The payment methods that hold the most promise are those that are bundled payments, that is, will make a payment for an episode of care, an operation for example, or maybe even for a year of care for diabetes. The reason that's better than fee-for-service is that it avoids the stimulus of fee-for-service to do more that might not necessarily add anything for patients. It also provides the physicians involved and others involved the opportunity to innovate or experiment and find what might work best.

The Center for the Science of Health Care Delivery's Value Analysis Program studies the value of health care delivery at Mayo Clinic and other organizations. This includes analyzing cost, utilization, quality, safety, patient-reported outcomes and other measures. Four projects are under way.

High-Value Health Care Collaborative

The High-Value Health Care Collaborative was launched in late 2010 by a group of six leading health care organizations, including Mayo Clinic. Together, these organizations have more than 150,000 patients. Eight more organizations are slated to join the collaborative in the near future, which will expand the patient population to more than 3 million people.

Toward a goal of improving health while reducing costs, organizations in the collaborative are:

  • Collecting and exchanging data on quality, outcomes and cost for expensive, high-variation conditions and treatments
  • Identifying and evaluating best-practice health care models and innovative, value-based payment models
  • Sharing knowledge and lessons learned with the public

Making this collaborative particularly unique is not only its comprehensive patient population, but also the geographic diversity of those patients. This enables the group to more quickly and accurately compare the effectiveness and efficiency of specific health care practices, payment methods and treatments.

Southeastern Minnesota Beacon Community

One of 17 such communities designated by the Department of Health and Human Services, the Southeastern Minnesota Beacon Community encompasses an 11-county area around Mayo Clinic's campus in Rochester, Minn.

Mayo Clinic, through its Center for the Science of Health Care Delivery, serves as the coordinating point for all Southeastern Minnesota Beacon Community activities. In doing so, Mayo provides access to extensive resources in health information technology, quality improvement, health care policy and research, and grant and financial administration.

Though the 11 counties in this Beacon community are already very advanced when it comes to health information technology — nearly 100 percent of the area's primary care providers use electronic health records — a key goal is to expand the counties' ability to exchange health information in order to:

  • Enhance patient involvement in the management of chronic illness through shared decision-support tools
  • Incorporate patient-reported outcomes and quality-of-life measures in the standard set of disease metrics used to treat people with diabetes
  • Reduce costs associated with hospitalization and emergency services for people with diabetes or childhood asthma
  • Address health disparities for underserved populations and rural communities

Future plans include expanding into 10 more counties, as well as identifying innovative ways to use the connections made by Beacon to bring about better health care coordination and improvements in clinical practice within the community's clinics, hospitals, public health departments and schools.

Ultimately, Beacon community leaders believe this work will result in lower health care costs, improved management of disease and better community health.

Health value and quality index

Through this project, the Center for the Science of Health Care Delivery is studying the value and cost-effectiveness of patient care at Mayo Clinic.

At Mayo, "value" is defined as outcomes — quality, safety and patient satisfaction — divided by cost over time. This project will help quantify "value" for a wide range of medical procedures and use that information to identify and implement best practices.

One initial area of focus is hip and knee replacements, where there is significant variability in the type of artificial joint given to patients. Mayo researchers are examining patient outcomes to find out which type works best over time.

Payment reform and policy analysis

The Center for the Science of Health Care Delivery, in collaboration with the Division of Government Relations and other leaders at Mayo Clinic, are actively engaged in payment reform discussions at both the state and federal levels.

For example, Douglas L. Wood, M.D., co-leader of the Value Analysis Program, has chaired a Minnesota Department of Health committee that began outlining "baskets of care" — bundles of health care services — for several chronic diseases and procedures, which may eventually reform how the state pays for health care.