Excerpt

Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation summarizes a two-day workshop held in November 2008, convened by the Institute of Medicine (IOM) Roundtable on Value & Science-Driven Health Care as part of its Learning Healthcare System workshop series. While the purpose of the workshop was not to yield a single definition of value, and, as a result, no single consistent definition of value was identified by the participants, this meeting did provide a forum for the broad spectrum of stakeholders in health to discuss the range of issues relevant to defining, assessing, and measuring the benefits received from our healthcare investments. This collection of papers and insights reflect the serious, reflective engagement of patients, providers, manufacturers, economists, payers, and employers—from both public and private sectors—in the central issues of value in health care. Participants discussed issues such as the mandate for improving value given rising expenditures on health care and the turbulent economic climate; the importance of perspective when defining value; the importance of communication between all involved stakeholders—but especially between patients, consumers, and providers—in order to improve outcomes while reducing costs; the tools available to incentivize value creation, including pay-for-performance, value-based insurance design, and electronic health records; and the opportunities and barriers for implementation and change.

Contents

• The National Academies
• Roundtable on Value & Science-Driven Health Care
• Reviewers
• Institute of Medicine: Roundtable on Value & Science-Driven Health Care: Charter and Vision Statement
• Foreword
• Preface
• Summary
  • ABOUT THE WORKSHOP
  • COMMON THEMES
  • PRESENTATION SUMMARIES
  • REFERENCES
• 1. The Need to Improve Value in Health Care
  • INTRODUCTION
  • THE NEED TO IMPROVE VALUE IN HEALTH CARE
  • REFERENCES
• 2. Stakeholder Perspectives on Value
  • INTRODUCTION
  • REFERENCES
• 3. Approaches to Assessing Value—Illustrative Examples
  • INTRODUCTION
  • MEASURING VALUE OF AMBULATORY CARE SERVICES
  • ASSESSING THE VALUE OF SURGICAL CARE
  • INFORMATION FLOW IN DIAGNOSTIC IMAGING: CONSUMER, CLINICIAN, FACILITY, PAYER? WHY IMAGING VALUE IS DIFFICULT TO MEASURE
  • ASSESSING THE VALUE OF PREVENTION
  • EVIDENCE-BASED DECISION MAKING OR DECISION-BASED EVIDENCE MAKING? EVIDENCE AND DECISIONS ALONG THE LIFE CYCLE OF PHARMACEUTICAL PRODUCTS
  • APPROACHES TO ASSESSING VALUE: PERSONALIZED DIAGNOSTICS
  • MEDICAL DEVICE VALUE AND INNOVATION
  • REFERENCES
• 4. Approaches to Improving Value—Consumer Incentives
  • INTRODUCTION
  • VALUE-BASED INSURANCE DESIGN: RESTORING HEALTH TO THE HEALTHCARE COST DEBATE
  • CONSUMER-DIRECTED HEALTH PLANS: WHAT ARE THEY, WHAT DO WE KNOW ABOUT THEIR EFFECTS, AND CAN THEY ENHANCE VALUE?
  • THE ROLE OF TIERED BENEFIT DESIGNS FOR IMPROVING VALUE IN HEALTH CARE
  • POLICY PERSPECTIVES: HEALTH PROMOTION AND DISEASE PREVENTION (AKA WELLNESS)
  • REFERENCES
• 5. Approaches to Improving Value—Provider and Manufacturer Payments
  • INTRODUCTION
  • PAY FOR PERFORMANCE
  • INCENTIVES FOR PRODUCT INNOVATION—PRODUCT MANUFACTURER PERSPECTIVE
  • INCENTIVES FOR PRODUCT INNOVATION—PAYER PERSPECTIVE
  • APPROACHES TO IMPROVING VALUE: COVERAGE AND REIMBURSEMENT
  • REFERENCES
• 6. Approaches to Improving Value—Organization and Structure of Care
  • INTRODUCTION
  • THE VALUE OF ELECTRONIC HEALTH RECORDS
  • MEDICAL HOMES AND MEDICAL “HOME RUNS”
  • DISEASE MANAGEMENT
  • REFERENCES
• 7. Aligning the System to Promote Value—Now and in the Future
  • INTRODUCTION
  • PLENARY ADDRESS: PERSPECTIVES ON VALUE FROM THE UNITED KINGDOM
  • VALUE IN HEALTH CARE: THE PATH TO VALUE
  • OPPORTUNITIES FOR CHANGE
  • REFERENCES
• 8. Common Themes and Opportunities for Action
  • INTRODUCTION
  • COMMON THEMES
  • LOOKING AHEAD TOWARD NEXT STEPS
• Appendixes
  • Appendix A Workshop Agenda
  • Appendix B Biographical Sketches of Workshop Participants
  • Appendix C Workshop Attendee List

This project was supported by the Agency for Healthcare Research and Quality, America’s Health Insurance Plans, AstraZeneca, Blue Shield of California Foundation, Burroughs Wellcome Fund, California Health Care Foundation, Centers for Medicare and Medicaid Services, Department of Veterans Affairs, Food and Drug Administration, Johnson & Johnson, the Moore Foundation, the National Institutes of Health, sanofi-aventis, and Stryker.

Suggested citation:

IOM (Institute of Medicine). 2010. Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes and Innovation: Workshop Summary. Washington, DC: The National Academies Press.

Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.