Transforming Health Care from Volume to Value: A Health System Implementation Road Map

Abstract

The modern Hippocratic Oath includes the following pledge: “I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.” 1 Wikipedia: Hippocratic Oath. Available at: https://en.wikipedia.org/wiki/Hippocratic_Oath. Accessed January 2, 2023. Google Scholar Written in 1964, this statement has never been more relevant. Nearly 20% of American households reported medical debt in 2019, and medical bills remain the leading cause of bankruptcy. 2 Himmelstein DU Dickman SL McCormick D Bor DH Gaffney A Woolhandler S. Prevalence and risk factors for medical debt and subsequent changes in social determinants of health in the US. JAMA Netw Open. 2022; 5e2231898 Crossref Scopus (6) Google Scholar ,3 Himmelstein DU Lawless RM Thorne D Foohey P Woolhandler S. Medical bankruptcy: still common despite the Affordable Care Act. Am J Public Health. 2019; 109: 431-433 Crossref PubMed Scopus (99) Google Scholar Medical debt contributes to food insecurity, utility debt, eviction, foreclosure, and bankruptcy. 2 Himmelstein DU Dickman SL McCormick D Bor DH Gaffney A Woolhandler S. Prevalence and risk factors for medical debt and subsequent changes in social determinants of health in the US. JAMA Netw Open. 2022; 5e2231898 Crossref Scopus (6) Google Scholar Unfortunately, the high cost of US healthcare driving this financial burden does not ensure superior clinical effectiveness, efficiency, or experience. Berwick et al estimate that $700 billion to $900 billion of the annual US healthcare expenditure is wasted, and 3 of the 6 primary contributors of waste relate to direct patient care: failure of care delivery, failure of care coordination. and overuse of resources that do not improve outcomes (Table 1). 4 Shrank WH Rogstad TL Parekh N. Waste in the US health care system: estimated costs and potential for savings. JAMA. 2019; 322: 1501-1509 Crossref PubMed Scopus (442) Google Scholar Table 1Estimates of Wasted Expenditure that Relate to Direct Patient Care 4 Shrank WH Rogstad TL Parekh N. Waste in the US health care system: estimated costs and potential for savings. JAMA. 2019; 322: 1501-1509 Crossref PubMed Scopus (442) Google Scholar Domain Estimated Wasted Expenditure Potential Savings from Performance Improvement Failure of care delivery $102.4 to $165.7 billion $44.4 to $97.3 billion Overuse/low value care $75.7 to $101.2 billion $12.8 to $28.6 billion Failure of care coordination $27.2 to $78.2 billion $29.6 to $38.2 billion Open table in a new tab