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Looking for value in the items and services we purchase is second nature for most of us. In fact, millions of Americans turn to outlet malls, discount airlines, wholesale clubs, or the internet every day to find the best deals.
When it comes to health care, however, the concept of value can be difficult to understand. How can something so important be focused around cost? Some may even think that the term “health care” and the word “value” don’t belong together.
On its surface, value in health care, like in anything else, can mean more for less. But more may not mean what you think it does when it comes to health care. It’s dependent on honestly reviewing our individual needs and expectations and matching them up against the benefits of the health care product or service being delivered. In short, value – like beauty – is often in the eye of the beholder.
And while the context is slightly different for health care than consumer products and everyday services, the principles are universal. Key components include informed, engaged, and empowered customers – a.k.a. patients – and relationships built on trust and excellent customer experiences.
At SSM Health Medical Group over the past decade, we’ve been gradually transitioning our relationships with both patients and payers (i.e., commercial insurers or public insurers like Medicare or Medicaid) to ones that are focused on value.
Previously, in the old model, care was episodic, fragmented and expensive. Providers delivering health care services and the patients receiving them were not directly paying for those services, so there was little incentive to control costs. In addition, there was no means to establish value.
As a result, the cost of health care has risen steadily for the past 25 years, accounting for nearly 20 percent of our Gross Domestic Product with no top end in sight. When taking into account expanded services and technology, such as advances in screening and diagnostic procedures, new treatment options, and an aging baby boomer population soon eligible for Medicare, one can begin to see the importance of reducing the cost of care where appropriate.
To successfully reduce costs for our patients and for SSM Health, we need to be excellent stewards of our resources, while continuing to provide high quality, affordable health care. That’s led us to transform the way we deliver services in many ways, among them:
Many of us will begin searching for value with renewed energy as we become increasingly responsible for a larger portion of our care, in the form of higher deductibles and copays. Some of us may begin to ask: Do I need to be seen for this condition (cold, flu, sore throat)? If I need to be seen, where do I get the most value for my money (convenience, service, the best treatment)? In addition, providers and patients will begin having more open, honest, and informed discussions around personal health decisions, treatment and procedure options.
Bottom line, value-based care is here to stay with patients, providers, and payers all demanding it and creating accountability for health systems nationwide. That’s good news for SSM Health, as value-based care aligns with our Mission of providing exceptional health care and delivers on our Values of excellence, stewardship, and respect for the dignity and well-being of every person.
Peter Schoch, MD, is Vice President of Value-Based Care Delivery for SSM Health, St. Louis region.
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