For patients, the lack of access to affordable care renders high quality and efficiency meaningless and potentially leads to financial toxicity. There are many promising solutions to this problem, one of which includes a proposed measurement tool to assist patients, clinicians, health care organizations, and payers in better understanding a patient’s share of the cost of care and ability to handle that cost: a patient health care affordability scale.
Our Costs of Care team has developed the “COST” (Culture, Oversight accountability, System support, and Training) framework to guide value improvement project design and educational efforts. This approach leverages principles from implementation science to ensure that value improvement projects successfully provide multi pronged tactics for overcoming the many barriers to high-value care delivery.
|Interventions||Description||Example||List Predisposing Factors (Barriers or Assets) in Your Clinical Enviroment||List Potential Strategies to Apply in Your Local Clinical Enviroment|
|C||Valuing cost-consciousness and resource stewardship as practiced standards of medical professionalism at the individual and team level.||Hospital-wide campaign led by peer-champions to raise awareness regarding appropriate transfusion preactices.|
|O||Requiring accountability for cost-conscious decision-making at both a peer and organizational level.||Regular audit and feedback, using data visualization strategies, regarding individual and team-based transfusion practices.|
|S||Creating supportive systems to make cost-concious decisions using institutional policy, decision-support tools, and evidence based clinical guideline.||Ordering system in the electronic health record that provides default options and adviced based on pre-transfusion hemoglobin level.|
|T||Providing the knowledge, skills, and tools clinicians need to make cost-conscious decisions in their clinical environments.||Lecture or workshhop providing the evidence behind appropriate transfusion practices and harms of excessive transfusions.|
In 2013, our Costs of Care team put forth a framework for integrating the concept of “financial harm” into clinical decision-making, with an article in JAMA called “First, Do No (Financial) Harm.” The article advocated for four general steps that physicians can take to help avoid patient financial harm:
The High Value Care Culture survey is a free, tool that is used to assess areas of improvement in value-based decision making. It can be used by health system managers and education leaders to assess this culture in divisions, departments, practices, and training programs.
The pressure on delivery systems to provide high-value care has been increasing in the US due to the growth of value-based purchased payment models, consumer awareness, and payment reform measures like the Value-Based Purchasing (VBP) Program of 2012 and The Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act of 2015. Despite these changes and pressures, health systems often lack tools to identify areas for improvement and to engage clinicians in the cultural changes needed for a shift to value-based practices.