What a difference an “S” makes: From Value-based Care to Values-based Care
June 30, 2022
“Value-based Care” was developed by The Centers for Medicare and Medicaid (CMS) to create accountability regarding healthcare reimbursement. In 2020, new rules pushed equity between cost and service/outcomes further; what we refer to as “getting our money’s worth”.
Measuring outcomes is a challenge. For example, we have an absolute mortality number but we do not know, nor have we measured, the results of suffering caused by medical interventions. What are the costs of suffering? Or even more challenging, what is a life worth?
Value-based care models can provide road-markers to assist healthcare organizations in distributing their resources. This helps an organization evaluate the quality of care they are providing according the CMS metrics. However, without considering the values that are the foundation of the whole system, everything done can become a mere commodity to be accounted for on a balance sheet.
The system includes people, community, clinical treatments, consultations, hospitalizations, emergencies, clinical and non-clinical staffing, and the economic structure.
A 2021 systematic review of value-based care in practice by the Journal of Healthcare Management revealed that “the hospital usually measures the increase in the quality of care and clinical outcomes, not necessarily by patient perceptions, and the financial results are not being reported with highly precise accounting methods.”
We are slowly finding out that the human condition, the balance of life and death, cannot be monetized without diminishing the very meaning of life.
That said, what if we added the letter “S to” Value-based care? One simple letter changes the meaning behind these efforts to measure the human condition and experience. Let’s discuss “Values-based Care”.
What is Values-Based Care?
When we talk about our personal “values” we generally mean our principles, our ethics, and what matters to us. Similarly, healthcare organizations also have missions and values but their values are often evaluated by reviewing their budgets.
Our budget should not control our values. Rather, our values should be actualized in our budgets, brought to life.
Values-based care, when aligned with the mission of improving the patient experience, does not compete with it. Patient satisfaction is not related to the patient experience. Ultimately, the set of values an organization owns should be translated into actions, policies, and clinical practices. Compassion and empathy can both be used as guides in budgeting to ensure our values are expressed in bedside care.
Compassionate nursing care, for example, is a practice and a value. It may include ample time for the nurse to communicate with the patient and family. It may include back-up staff to allow a nurse to take a break while also ensuring that the hand-off is with someone familiar to the patient.
C.A.R.E.: A Values-First Organization
The C.A.R.E. Channel will be 30 years old this June. From the start in 1992, we believed and continue to believe that patients deserve a healing environment. The clinical setting should feel and be clean, safe, calm, stress reducing, and should support recovery. “Continuous Ambient Relaxation Environment” is the promise we make with C.A.R.E.
Thus, everything we have done about pricing and accessibility has been inspired by, and leads to, that goal. We have hospitals that have had C.A.R.E. for 29 years. Which means we’ve made it through 29 different fiscal budgets. We had to make it possible for our clients to provide C.A.R.E. for their patients, families, and staff, and also make is possible for them to keep it. Each of our clients must make that decision based on their own mission and values, and what matters to their patients and caregivers, with every budget cycle.
Rather than “either-or,” “both-and”
Value-based care and values-based care are best merged, one informing the other. They are not mutually exclusive. Seeking equity between expenses and outcomes within an economic framework that is not humanized can result in all outcomes becoming commodities.
The language that refers to patients as customers, clinical staff as providers, hospitals as businesses, and treatments as products further undermines the lived-experience and humanity of those served.
Values-based care calls for a direct relationship between resources and the promises implied in the organizational values. The values that inform how care is provided should be obvious; they should be demonstrated in all interactions, in every patient place and space, and in the resilience of individuals and organizations.
In every person, every space, every moment, all the time for everyone.
Teisberg,E PhD, Wallace,S JD, MBA, O’Hara, S MPH, “Defining and Implementing Value-Based Health Care: A Strategic Framework,” Acad Med. 2020;95:682–685. First published online December 10, 2019; doi: 10.1097/ACM.0000000000003122
Zanotto, Bruna Stella; Etges, Ana Paula Beck da Silva PhD; Marcolino, Miriam Allein Zago PT; Polanczyk, Carisi Anne PhD, MD Value-Based Healthcare Initiatives in Practice: A Systematic Review, Journal of Healthcare Management: September-October 2021 – Volume 66 – Issue 5 – p 340-365 doi: 10.1097/JHM-D-20-00283