4 foundational elements for the future of value-based care

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The future of value-based care will rely on creativity in spine care, better cost measurements, multidisciplinary teamwork and technological advancements, according to Philip Louie, MD, of Virginia Mason Franciscan Health in Seattle.

Dr. Louie told Becker's about why those factors will be important to value-based care.

Note: This response was edited for style.

Question: What does the future of value-based care look like?

Dr. Philip Louie: We are currently living in a time where there is a dramatic shift toward a value-based, consumer-driven industry. Today’s healthcare environment asks us to maximize quality and safety while holding costs constant. As such, rigorous energy has been spent increasing cost efficiency, reducing adverse events and improving patient outcomes. In a field where quality and safety are paramount and serve as the backbone to value-based care, we must focus our attention on cost-effectiveness and sustainability of new approaches to address spinal disorders. Here are four areas that I see as foundational elements for the future:

1. The creation and growth of "value-based" pathways in our delivery of spine care: This involves systems in which the care pathway of the patient is understood at a granular level via value streams that are constructed with direct observation and timing of the flow of the patient through the episode of care. Here, variability is studied as episodes of deviation from the value stream map, and areas for improvement are identified (with patient outcomes as the endpoint).

2. A better way to measure cost in our current care models: Traditional accounting methods to evaluate costs in spine care have been shown to be inconsistent and difficult to generalize. One possible costing method to adopt is in time-driven activity-based costing (TDABC), as this method has been suggested as the cost-accounting arm of value-based care organizations seeking to address costing challenges by measuring costs across entire episodes of care through estimating resource utilization from the bottom up by studying the actual processes used in patient care. TDABC traces the path of a patient throughout the continuum of care for a specific medical condition and identifies the actual cost of each resource used, such as personnel, space, consumables and equipment in both inpatient and outpatient settings.

3. The growth of multidisciplinary teams: Multidisciplinary teams and conferences have improved safety and patient outcomes in patients with degenerative and deformity presentations. Spine surgeons are often the primary drivers of these multidisciplinary teams within a healthcare system, so we must find ways to engage and encourage collaboration across medical silos.

4. Technology: Machine learning and artificial intelligence will play a large role in further expanding the use of enabling technologies. The data can be used to create integrated systems of existing technologies that can guide decision-making throughout the whole continuum of patient care, from preoperative planning and risk stratification to real-time solution proposals intraoperatively, as well as expanding patient engagement and support postoperatively.

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