Guest commentary: The journey toward value-based care delivery

The transition from volume to value happens through a journey, not a leap. The journey starts when leaders define the purpose of their organization as improving value for patients. The goal of achieving improvement in meaningful patient outcomes supports clinicians' professionalism and their aspirations as healers.

The cultural and strategic shift to improving health with patients rather than just increasing the volume of patients is a significant transformation. In practice, we've noted four key transformation elements that move organizations onto the path of value without a need for giant leaps. These are the steps leaders can take to get the organization walking the value talk.

Clinicians bemoan the burden of reporting long lists of mandatory process and input measures, but don't typically measure the health outcomes of their patients. They ask how patients are feeling, but don't systematically collect outcomes data, an omission that impedes learning. Many presume that thankful patients have good results, and patients who don't come for follow-up appointments must be well. Neither is necessarily true.

Systematically collecting meaningful outcome measures provides insights that fuel transformation. Many value-based care transformations begin when a clinician starts measuring a few meaningful outcomes. One administrator measured the mortality rate of serious trauma patients brought to his rural urgent-care center to be stabilized before being transported to a regional trauma center. Approximately 90% of those patients died, compared to about 40% who were taken directly to the trauma center. That simple, shocking measure drove an immediate change in practice.

Outcome measurement supports professionalism. Clinicians who know their patients are succeeding are both proud of and more satisfied by their work. Feedback on excellent outcomes and insight for further improvement led to both reduced co-morbidities for patients and high retention of surgeons at another hospital.

The Dartmouth Atlas exhaustively documents unwarranted variations in care. Despite this, clinicians presume that they and their organizations follow consistent care delivery processes. When clinicians discuss care processes, most are surprised by their lack of shared norms.

Documenting and discussing care paths allows organizations to understand how care is actually delivered to patients. While it can be uncomfortable to expose otherwise hidden discrepancies in care and redundant services, it leads to invaluable discussion of how to improve practices. Using care paths, organizations can establish as baseline for good practices and see avenues to increase value by improving outcomes and reducing costs. Care paths aren't straitjackets. Clinicians' professional judgment should still be applied and, when outcomes are tracked, practice variations can be analyzed for insights and improvements.

Value-based care delivery relies on interdisciplinary teams that integrate delivery across the full cycle of care. Although they often use the word team, most clinician groups lack key characteristics of team dynamics. Teams share clear objectives, have high degrees of trust, communicate consistently and effectively, and measure results together. As a result, teams learn together and drive improvement as a shared activity. Working together toward meaningful goals, team dynamics improve the professional engagement of members creating professional satisfaction and a sense of belonging that are potent antidotes to burnout.