We First Need to Establish the Definition of Value to Deliver Value-Based Healthcare

Dr. Adam Tabriz

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A good understanding of individual value is essential to determine the quality of care delivered. Healthcare is a tool and means for providing medical service by the physician to a patient. But what is value, and how is it perceived?

A recent post by Harvard Business Review stated that we wouldn't provide value-based healthcare until we can agree on what "value" stands for. The findings of a U.S. Health Care survey conducted by the University of Utah Health's The State of Value revealed no single agreed-upon definition of value.

The survey included more than 600 physicians, 500 employers of nationwide medical service providers, and 5,000 patients who answered questions on the state of service, quality, and healthcare costs in the USA. The researchers chose these stakeholders of healthcare because their ideas haven't been considered in the value discussion.

The results showed fundamental differences in how the respondents perceived value in healthcare and the parties they hold responsible for achieving it.

Value has become a buzzword short of a concrete meaning which is constantly shifting based on who gets to set the agenda.

Consequently, the stakeholders of healthcare thought that they were striving for a shared destination. But in reality, it was a part of a fragmented rush without a final and defined destination.

The True Nature of Value in Healthcare

Health and healthcare are constantly changing, driven by the factors that are economically, politically, and socially motivated. Some of the changes are for good, while others are biased with alternate motivations.

The die-hard proponents of social values of health and healthcare are likely to overlook the negative implications of deals originating from the collective healthcare delivery model. They will defend the model citing the significance of popular solutions for the majority based on a populist ideology responsible for the cost-effectiveness of the population health approach.

Since the 18th Century, the practice of medicine and healthcare has focused on efficiently delivering healthcare to most of the population at the lowest possible cost to the community. Momentum has gathered around providing "evidence-based medicine" that uses treatment options that have been statistically proven effective for a considerable percentage of the population with minimum side effects or unpredictable outcomes.

The above therapeutic model has its own set of qualities and values, and any deviation would suggest derailment from the standard of care within a given community. As the community sample grows, the departure from the bar is subject to be equally significant.

The drawback comes from unavoidable circumstances, which are not uncommon. The standard of care can deviate if the diagnosis and treatment rendered do not fit the established criteria, simply due to the shortage of available technology and evidence-based and economic resources. The minority with poor access to the statistically validated treatment options may not benefit from a particular medical service and create a milieu that would constitute negligence or medical malpractice. Although in specific medicolegal scenarios, lack of resources in a community as the cause of the deviation from the standard of care may be accounted for, these are still some of the unavoidable professional and ethical drawbacks of a collective approach to delivering healthcare.

The Transformation of Value in Healthcare Delivery

I want to emphasize the effectiveness of the population-based approach, which was the advancement in itself in a time of limited technology and scientific advances. Without any doubt, the model has been successful in saving countless lives, especially during the Great Depression and other infectious disease epidemics when technology was in line with or exceeded expectations

But during the last three centuries, we have experienced an overwhelming advancement and shift of technology, scientific awareness, and expectations in all aspects of human life, including healthcare. The trend has generated heightened awareness and diligence to ensure increased uniformity in medicine delivery, where the standard of care is uniformly distributed across geographic, demographic, and socioeconomic variables.

We have seen many attempts to change the situation with little progress being made.

The failure can be tied to the poor and inconsistent definition of quality and value. We are trying to fulfill the criteria of optimal healthcare based on the traditional model but at the expense of overlooking the variables that cannot meet statistical standards.

Before the 18th Century, personalized medicine was the standard of the healthcare revolution. But now, it is making a solid comeback instilled with modern values but with the same values highlighted by Hippocratic medicine.

The advance of technology has given rise to high-level expectations that necessitate patients' inclusion in the standard of medical care. We hear the buzzword "value" all the time but have to remember that only science, technology, and innovations can ensure value delivery to the patients. The same is being applied to the context of the population health model by engaging and empowering patients.

Unfortunately, our attention is being diverted from the true meaning of value and personalization. We are creating a hybrid version of the original system- which doesn't consider the fact that the value of healthcare and human life is a measure of the quality of care perceived by the patient subjectively- and provided after objective evaluation by the physician at the individual level at a specific time and place.

Instead, we are following the guidelines developed based on profiling specific traits and predetermined qualities. As a result, we cannot deliver quality healthcare with valid values because we lack a concrete definition!

I can sense significant challenges in establishing personalized medicine that will primarily originate from the lack of proper definition of what value, quality, and standard of care are. Once we can show an accurate description, the following steps will become simpler.

We know that the definition of value and quality will not serve the interests of groups with political motives and alternate ambitions. The first step is to put patients in control of their health information, empower the independent physicians and bring back the almost disappearing free market.

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Adam Tabriz is a Physician, Writer, Entrepreneur, and public health policy, expert. He is an advocate for Personal liberty. The combination of his experience and expertise underlines his passion for advocating true “Personalized Healthcare” and “Healthcare without Borders.” His favorite slogan is: “Peace of mind would come to all people through the universal respect for the basic human rights of everyone”

San Francisco, CA

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