Creating Value with the Patient- and Family-Centered Care Methodology and Practice: What Trainees Need to Know, Why, and Strategies for Medical Education

Abstract

In 2006, Porter and Teisberg [1] noted that, in keeping with payment models in effect long before the Affordable Care Act of 2010, health care organizations focused on shifting costs, employing financial constraints on insurance coverage to keep patients from seeking health care services elsewhere, and limiting patients' options for accessing health care delivery. Such practices are incentivized in a system in which value is defined differently for patients, insurers, and clinicians and health care organizations, that is, a system in which stakeholders' incentives are not aligned. Porter and Teisberg pointed out that none of these efforts to be competitive created value for patients; instead, they resulted in today's fragmented and costly care delivery system, in which clinical outcomes and patient experiences got much too little attention [2, 3]. A response they suggested was redesigning care delivery models that create value for patients, where value is defined as exceptional experiences and better clinical outcomes at lower cost [1]. The redesign they proposed was to reform the nature of competition itself by making the competition all about value. So organizations that provide the best patient experiences and the best clinical outcomes at the lowest costs-and rigorously measure and report these results-will succeed. Earlier, in 1999, Pine and Gilmore [4] suggested that engaging customers in a memorable way is critical for creating value. Applied to health care, the idea, they said, is to create a more engaging experience. There is clinical evidence that increased patient and family engagement and partnership in patients' health care experiences are associated with improved clinical outcomes [5]. Neither value in health care nor patient-centered care (both of which are central tenets of health care reform) are widely taught in medical school curricula. Nor are the concepts that support these tenets, such as engaging with patients in clinician-patient partnerships, evidence-based design and co-design as mechanisms for viewing care through the eyes of patients and families, team-based care, patient activation, and close links between health care organizations' financial and clinical performance. Consequently, medical students don't learn any specific implementation mechanisms for achieving all of these goals. This paper discusses the conceptual and operational components of value and patient-centered care, the importance of introducing them to clinicians-in-training, and ways in which this can be accomplished.

Pay-for-performance in orthopedics: how we got here and where we are going

“…As regulatory pressures mount, there is an ever-increasing need for physicians and hospitals to work together toward common goals; this will be critical to success moving forward in a value-based payment model [7,8,27]. Through successful cooperation between a hospital and its providers, value can be increased with improving quality and efficiency of care.…”