Should Value-Based Care Measures Become Patient-Centric?
By Patient Engagement HIT | May 9, 2017
The healthcare industry must make value-based care assessments more patient-centric, ensuring that value measures consider variables that are important to patients, stated a pair of industry leaders in a Health Affairs op-ed.
As patients increasingly face higher financial responsibility for their own healthcare, patients will need this value information to make more informed decisions about treatments and where they access care, said Alan Balch, CEO of the Patient Advocate Foundation, and Darius Lakdawalla, the Quintiles Chair in Pharmaceutical Development and Regulatory Innovation in the School of Pharmacy at the University of Southern California.
“From a pragmatic perspective, it is time to shift the discussion toward helping patients understand what value actually means in choosing their health care and discharging their financial responsibilities,” Balch and Lakdawalla wrote. “Any plan that is enacted, whether a full replacement of the Affordable Care Act or ‘fine-tuning’ of the law, will likely require that patients make decisions about what constitutes value.”
The healthcare industry must tackle this challenge in two steps. First, policymakers must incorporate value-based measures that are important to patients.
“As we define value — and much work remains to be done in that area — we must be sure that value assessments adopt the patient perspective,” Balch and Lakdawalla said. “Assessments must be salient to the decisions that patients make in choosing and using health care.”
Second, patients must be able to access data about value-based care and effectively use that information. Patients need to leverage that data to engage in value-based, shared decision-making, the pair asserted.
Using patient perspectives to inform value measures
This approach boils down to the most logical method for measuring value to yield a positive result, Balch and Lakdawalla noted.
“Economics, the science of measuring value, holds that the value of any good rests in the eye of its consumers,” the two explained. “In health care, this has meant that value is defined by how patients perceive it, rather than by how much they actually pay for the services they receive.”
Using patient perspectives to inform value measures can be as simple as asking patients which characteristics are important to them. Industry leaders can use surveys, focus groups, and analyses of behavioral-based preferences, Balch and Lakdawalla suggested. Healthcare professionals can also glean how much value patients place on individual attributes.
Doing so will assist patients who are making decisions on the individual level. While offering holistic value scores may be helpful for payers making decisions on a population level, collecting more nuanced value scores will be more helpful for single patients making care decisions. This is becoming more relevant as more patients make their own healthcare decisions and pay higher out-of-pocket costs.
These efforts must be rooted in an overall theme of transparency, Balch and Lakdawalla said. Patients should have access to this information prior to visiting the hospital or selecting a treatment to ensure patients can make the decision that best suits their needs.
“We need to do a much better job of providing patients with more timely, usable information about their financial responsibility,” Balch and Lakdawalla said.
“This means patients need information in advance not only about the potential benefits and side effects of treatment alternatives but also about the copayments, deductibles, and other financial obligations associated with those alternatives,” the duo continued. “Transparency is key to developing better health care consumers capable of making wise decisions.”
Delivering value information to patients
Efforts to collect patient-centered value information will be for naught if patients cannot access or make sense of the data, Balch and Lakdawalla asserted.
“Several vehicles we depend on to disseminate new information — for instance, peer-reviewed journals and academic meetings — often do not advance the cause of informing patients,” the two said. “We need to develop tools that support patient decision making about value in the real world and help to fill this gap.”
The healthcare industry already has several tools to help patients make their own care decisions, including the Agency for Healthcare Research and Quality (AHRQ) Question Builder platform and the PREPARE Tool for advance care planning.
CMS also has the hospital star ratings, which the agency posts for patients to make decisions about where to access care, but not necessarily which treatments to choose. Critics say the ratings oversimplify care quality and don’t paint an accurate picture of value for patients.
There is also little consistency between these various tools, Balch and Lakdawalla said.
“The problem is that patients face a fragmented landscape littered with an array of different tools,” Balch and Lakdawalla noted. “Many use different approaches, or language, and demand different types of interaction. They may require higher levels of health literacy or may not address the core issues of what most matters to patients in ways that can be applied to actual decisions.”
Value-based decision-making tools must also take into account the relationship patients have with their clinicians and healthcare payers. All parties need access to these tools, and the tools must be easily integrated into the care encounter so that patients can consult with their clinicians or payers about the decision at hand.
Healthcare professionals can also consider developing tools that help patients determine the variables that are important to them in general, separate from an individual care encounter or treatment.
“This simple tool could help the patient think about his or her preferences and translate those values into actual shared decisions about ranking treatment options,” Balch and Lakdawalla suggested. “From the provider’s perspective, such patient input complements and enhances, rather than supplanting, clinical expertise.”
Supporting patients and considering their preferences when assessing value-based care will eventually serve all healthcare stakeholders, Balch and Lakdawalla said. By putting the patient at the center of value-based care measures, healthcare professionals can prop up both clinicians and healthcare payers.
“Ultimately, a patient-centered approach to assessing value serves every stakeholder in the health care Marketplace,” Balch and Lakdawalla concluded. “Providers can better meet the needs of their patients. Payers will compete more successfully by producing higher levels of patient satisfaction, and policy makers will benefit from Marketplace decisions that align more closely with value.”