Bending the Value Curve

Abstract

In health care policy circles, "bending the cost curve down" may qualify as the phrase of the decade. More than 1 million web search references are testament to its widespread use, intended to express a focus on reducing health care costs. Yet it should not surprise anyone familiar with technocratic vocabulary that there is no clear agreement on what the phrase means. 1 Nonetheless, with health care spending nearing one-fi fth of the nation's gross domestic product, 2 the nationwide clamor to "bend the cost curve down" is understandable. In this commentary, however, we discuss the shortfalls of focusing on costs alone and instead propose a national commitment to "bending the value curve up."Although fi nding ways to control health care spending is certainly important, focusing on cost alone is neither suffi cient nor appropriate. Calling out costs in isolation may be disconcerting to many stakeholders, including those whose health care services or livelihoods rely on this important sector of the economy. For example, patients might associate cutting costs with decreased access or hastily provided care, and clinicians may fear lower salaries or undue administrative pressures. Moreover, slicing away at high-quality and lifesaving programs for the poor, the young, the disabled, or the elderly or increasing the fi nancial burden for disadvantaged populations is shortsighted and unfair. 3,4 Beyond this, focusing on cost alone ignores the benefi ts to life and well-being that result from high-quality health care spending, even if it is associated with a high price tag. Rather than simply asking whether we are spending too much, we should also ask whether we are achieving the kind of care experiences and outcomes we would expect for the price we are paying.Value is the quality of an output divided by the cost to achieve it. The numerator of the value ratio can be defi ned by using the 6 Institute of Medicine domains of quality: safety, effectiveness, effi ciency, timeliness, patient-centeredness, and equity. 5 The denominator would be the resources consumed in terms of money, time, and labor. Applying the value ratio includes determining which outcomes should be targeted for quality and cost measures. For example, Michael Porter's value framework organizes outcomes for any given medical condition into 3 successive tiers: health status achieved or retained, process of recovery, and sustainability of health. 6 Although relevant metrics and outcomes will vary immensely across medical conditions and patient populations, it seems far more sensible to place these value-based measures at the center of the discussion about improving health care rather than a blunt attempt to cut costs regardless of outcomes.Despite $2.8 trillion spent on health care, health outcomes in the United States are not consistently good. Research has demonstrated that evidence-based care AUTHORS

Development and Evaluation of High-Value Pediatrics: A High-Value Care Pediatric Resident Curriculum

“…15 A few successful projects have revealed that a focused HVC curriculum can be implemented, 16 although the development of such a curriculum can be extremely expensive and time consuming. Necessary educational resources are available through journal sections on value, 17,18 Choosing Wisely resources, 19 and various other HVC curricula. [20][21][22][23] Despite these resources, data reveal that only 10% of pediatric program directors and 15% of internal medicine residency programs report having a formal curriculum on HVC.…”

Teaching High-Value Care in Pediatrics: A National Survey of Current Practices and Guide for Future Curriculum Development

“…10,11 Some physicians have even advocated for advancing HVC as a seventh core competency within the Accreditation Council for Graduate Medical Education's requirements. 12 In the past decade, we have made progress establishing needed educational resources around HVC with the introduction of journal sections on value, 13,14 the Choosing Wisely campaign, 15 and HVC curricula. [16][17][18][19] Despite this increase in resources, there remains a significant gap in uptake.…”

No Cause for Alarm: Decreasing Inappropriate Pulse Oximetry Use in Bronchiolitis

“…As the call for "bending the value curve" has echoed through hospital systems and training programs, it is essential that we not only teach trainees about health care value but also empower them to identify examples of low-value care and give them tools and resources to be a more effective part of the solution. 1 As part of the Hospital Pediatrics Bending the Value Curve series, we describe how low-value patient care stories such as the one above inspired a resident-led quality improvement (QI) initiative.…”