Transforming Value

By Jordan Harmon

If you haven’t noticed, our health system is extremely complex.  There are hundreds of surgical and non-surgical sub-specialties, thousands of hospital systems, and billions of medications prescribed each year.  Physicians have more treatment options than even just a few years ago and patients today have an overwhelming amount of care information available; yet, we struggle to provide holistic, coordinated care.  As a patient, you can now get various hospital quality data online, compare a hospital to those in other cities, and rate a physician on both quality as well as bedside manner.  There are literally thousands of locations to get a hip replacement and just as many options on who you want to perform it.  It is no wonder that patients are feeling confused and looking to find value in healthcare.

While there is no single solution to fix the “healthcare system,” our non-profit organization Costs of Care seeks to address the issue of costly care by integrating cost decision making at the point of care and provide the clinical team with educational tools to do it effectively.  Today, front-line clinicians are being asked to provide even more cost-efficient care to patients yet few understand how to do so.  There is a new focus on efficiency in treatment options and today’s patients are more cost savvy than their predecessors. We must ensure value while reducing costs and improving quality outcomes.

To assist organizations and individual clinicians with providing more cost-conscious care, the Costs of Care Team has developed a clear framework to address over-treatment and non-value added treatment.  The “COST” framework outlines 4 key areas of focus:

  1. Culture– organizations must value cost-consciousness and resource stewardship
  2. Oversight– there must be clear accountability for cost-conscious decision making
  3. Systems Change– systems should guide cost-conscious decisions and be supported by policy
  4. Training– information sharing needs to exist to increase the skills and knowledge of clinicians

The main objective of the framework is to drive cost-conscious decision making but the framework itself is not sufficient in reducing costs.  Individual practitioners and organizations must instill the framework daily in order to see results.

Applying the Framework

At my hospital, we have a dedicated department that works to improve processes throughout the organization and partners with physicians to test theories on ways to reduce waste.   We have formed interdisciplinary teams of clinicians and administrators from the front-lines and empowered them to change the way we provide care- it has been engrained in the culture.  All levels of management and clinical staff are involved with transforming the organization and there is clear support/oversight from senior leadership to empower our teams to enable change and ensure our success.   Our progress has been remarkable though not yet complete.  We are also currently working to install a new electronic medical record system and have designed future workflows to enable these changes.  Finally, throughout the past year, we have asked our teams to spend a lot of time on this initiative and it has pulled them away from their daily responsibilities. However, we are currently engaging our teams to align a comprehensive training program that both encompass our newly designed workflows along with system changes.  Only by applying all areas of the “COST” framework will we be truly successful in impacting value at the hospital.

As the healthcare industry continues to transform and progress towards providing more value-based care to patients while improving quality outcomes, patients should continue to be the focus.  Other industries are indeed years ahead of healthcare when it comes to providing value-based services or products to consumers.  However, “value” and “transformation” have finally come to healthcare and through our “COST” framework, we are shaping the way value is defined with our patients.


Jordan Harmon (@jordansharmon) is the Director of Advocacy Initiatives at Costs of Care and Associate Director of Operational Excellence at Hospital for Special Surgery (HSS) in New York. The views expressed here are solely those of the author and do not in any way represent the views of  his employer.

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