6. Focusing on Outcomes

MODULE 1 | Section 6 of 9

Focusing on Outcomes

WHAT ARE OUTCOMES?

Decreasing waste is a powerful way to simultaneously improve outcomes and decrease costs. It is critical for us to understand outcomes and how to improve them for patients.

Outcomes are the results of care on the health of patients, families and populations. Beyond survival, outcomes include improved functional capabilities, reduction of pain and suffering, and ability to engage in one’s normal life.

For example, if fewer people die after receiving influenza vaccines, then this mortality benefit would be an outcome measure.

While mortality is an obvious outcome measure, it is not always the appropriate or even most important. Mortality is not a meaningful outcome measure for the success of a dental cleaning or wart removal, where mortality would be a travesty. And for patients in some situations, how well they live is more important than how long they survive.
Another outcome measure is the number of days until a patient can walk after a hip replacement surgery.

Outcomes reflect the fundamental reason for health care: did the care you received help you?

When outcomes are not tracked, clinicians and teams don’t get feedback on what really helps patients. Conversely, when a strategically designed and meaningful set of outcomes are tracked, individuals and teams figure out how to improve them. Professionalism is supported by identifying, measuring and improving outcomes that matter for your patients.

The challenge is that value must be defined by multidimensional measurements and cannot be compressed to a single number.

We will discuss measurement and how to use different measures, such as outcome, process, and structural measures, in the following module.

VALUE-BASED HEALTH CARE DELIVERY VS. VOLUME-BASED HEALTH CARE

The Current System: Volume-Based Health Care

The Goal: Value-Based Health Care

Individual care interactions organized around the clinician’s medical expertise (e.g. an orthopedic surgeon)

Team-based care interactions organized around patient medical needs and conditions (e.g. “musculoskeletal pain”)

Fragmented care that is organized at the level of individual units or facilities

Integrated care across units and facilities, such as in an integrated practice unit (IPU)

Measurement largely based on process measures and “billable activities”

Measurement focused on patient health outcomes

Costs are poorly captured and often are estimated by using poor proxies such as charges and reimbursements

The actual costs of providing patient care are measured and captured

Providers – physicians and health systems – are reimbursed based on individual services provided

Providers are reimbursed based on value of care provided across a full care cycle for medical conditions

Health information technology maximized for capturing billing processes and reporting necessary metrics

Health information technology is leveraged to help restructure care delivery and accurately measure results

Value-based health care requires appropriate teams, organized around providing the best care for specific patients, with a commitment to measuring and improving outcomes.

When a team is created around a set of patients with shared needs – such as similar circumstances and/or conditions – they share a core set of critical concerns. For example, in future modules we will discuss how care teams and practices can be formed around a condition, such as musculoskeletal pain. The clinical team can understand this set of patients and conditions and better anticipate and respond to issues, which then enhances the ability to personalize care.

A key concept of value-based health care delivery is “positive-sum competition” or “win-win” based on creating value for patients.

Here we have just touched the surface of identifying these concepts. Throughout our modules, we will dig into each of these components and provide clear examples of early successes in moving to value-based health care delivery.

Source: Redefining Health Care: Creating Value-Based Competition on Results. Porter, Michael E., and Teisberg, Elizabth O. Boston: Harvard Business School Press, 2006. Used with permission.

“At Dell Med we are working on reorganizing the delivery system around patient needs while integrating other providers and resources, both human and technological, to create a single-center location for diagnosis and treatment. When possible we will locate care close to the patient’s home or workplace, or provide convenience for the patient to access these services through virtual methods that are being developed.”

Amy Young MD

Chair of Women’s Health, Dell Medical School

November 2016

REFERENCES

1- Dell Medical School. Improving women’s health in central Texas. November 14, 2016. Accessed January 16, 2018. Retrieved from http://blog.dellmedschool.utexas.edu/2016/11/14/improving-womens-health-central-texas/