Musings on value-based care (as a Canadian)

this quote will make sense shortly….

Value-based care is one of the most crucial concepts in healthcare today, in both the US and Canada.

But how do we define it? Atul Gawande penned an excellent article in the New Yorker several years ago which hits the main points in a very compelling way. Further, several years ago, the American Board of Internal Medicine (ABIM) Foundation launched the “Choosing Wisely” initiative in part to support value-based care and reduce wasteful procedures/treatments (including that which has little to no evidence of effect).

Value as it relates to ‘value based care’ (VBC) is defined as “the measured improvement in a person’s health outcomes for the cost of achieving that improvement.” It’s crucial to note that while reducing costs/waste is related to VBC, it can’t be equated to VBC — they aren’t the same thing.

This brings us to a more philosophical argument: what does “value” mean generally, and how does this concept apply to both our health, and the systems that support it (the obvious ‘healthcare system,’ but also the places we work and play and live)?

First we can ponder what value means to ‘health.’ We can probably agree that our ‘health’ is inherently valuable, as it’s derivative: without it we’re limited in actualizing our other core needs. As such, we place high value on our health, and are willing to invest in it, though oftentimes it falls by the wayside. Our health is valuable as it links to surviving but also thriving — without our health, our quality of life suffers (the ‘how’ we live), and at the most extreme, we cease to live (ie. we die).

But what about value in healthCARE, i.e. the delivery of services for the purposes of optimizing health/well-being and offsetting/treating morbidities? How might we define that? I think we can conceptualize it in a few different ways.

For one: we can use the Costco example (for my international readers: Costco is described here). Most people would agree that Costco is a place where people seek value for household goods (food, appliances, etc). Why? Because per unit its on average cheaper: the consumer pays less per unit, so Costco remains in business primarily due to this perception of delivering ‘value’ by selling products that, themselves, deliver ‘value.’ Bulk stores are similar…