By now we have heard the stories about unconscionable medical bills causing financial harms for patients. We have read about more Americans then ever before on high-deductible health insurance plans. Some of us even helped our parents navigate the deceptively simple-looking bronze, silver, and gold tiers of the insurance exchanges, weighing the gamble of increasingly unaffordable monthly premiums against catastrophically high deductibles and out-of-pocket costs.
We have accepted that healthcare costs are out of control and causing real constraints on every level from individuals to communities to businesses to states to our nation.
OK, but now, what are we supposed to do about it?
For starters, we can supply a pipeline for change by embedding the principles of value-based care into the apprenticeship of health professional education. Recently the leaders of the soon-to-open Dell Medical School at UT Austin to build their entire curriculum around teaching students to root out waste and to care for the health of the community. This is the clearest example that medical educators are taking the calls to action from the ACGME, AAMC, ACP, and other leaders to address healthcare value in training very seriously.
However, the frontlines are not waiting for new medical schools to open up or for massive curricular overhauls. The 2nd annual Teaching Value and Choosing Wisely Challenge that we organized resulted in 80 submissions spanning the country (and Canada). The authors -- which included five students, 30 residents or fellows, and at least 41 faculty members -- described their for integrating healthcare value into education.
Education is fundamental but will not be enough. We must also practice what we preach. Practicing clinicians can deflate medical bills for their patients through advocating for appropriate care, considering patient affordability in customizing treatments, and leading local initiatives to improve value of care.
Clinicians can advocate for appropriate care through avoiding low-value services at the point-of-care. Specific targets for improving appropriate resource utilization may be identified from resources such as , guidelines, and appropriateness criteria. Physicians will need to understand the true risks and benefits of recommended therapies and learn ways to communicate this balance with patients.
Considering patient affordability is increasingly important with more patients now facing astronomically high out-of-pocket bills even for simple medical treatments or procedures. A December 2014 CBS/New York Times found that 80% of Americans now think their doctor should discuss the cost of recommended medical treatment with them ahead of time.
Clinicians can screen their patients for and can help them navigate the tradeoffs of lower cost options. Physicians should seek to provide high-value prescribing, which entails providing the simplest medication regimen that minimizes physical and financial risk to the patient while achieving the best outcome. In other words, decreasing either cost, complexity, or risk of medications can improve value -- and clinicians should aim to improve all three simultaneously.
In addition to reducing waste and considering patient affordability, clinicians are ideal leaders of local value initiatives, whether it be through running value improvement projects or launching formal . Our to guide value improvement project design is "COST": culture, oversight accountability, system support, and training. This approach leverages principles from implementation science to ensure that value improvement projects successfully provide multipronged tactics for overcoming the many barriers to high-value care delivery.
At some locations across the country, individual efforts have matured into entire groups dedicated to designing and implementing value-improvement initiatives, including the UCSF Value Improvement Committee, the Johns Hopkins High-Value Care Committee, Johns Hopkins Bayview Physicians for Responsible Ordering ("PRO"), and "High-Value Carolina" in North Carolina.
Health professionals are now faced with a responsibility to help deflate medical bills. To achieve this goal, clinicians can advocate for appropriate care, consider patient affordability, and lead local value improvement initiatives.
For those ready to tackle this challenge, we elaborate on and explain some of these necessary tools in our book, .
, is an assistant professor at the University of California at San Francisco, Director of the program for the UCSF Center for Healthcare Value and Director of Implementation Initiatives at .
, is associate professor at the University of Chicago and Director of Educational Initiatives at Costs of Care.
.Disclosures
Neel Shah, MD, MPP, is an assistant professor at Harvard Medical School and Executive Director at Costs of Care. Arora, Moriates, and Shah showed no relevant financial payments from industry.