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Defining Health Care Value: Why Do We Have to Agree?

Principal Consultant, Freedman HealthCare, LLC

Mary Jo Condon, MPPA, sees information and collaboration as the foundation for improving our nation’s healthcare system.

The Harvard Business Review recently published an article titled, “We Won’t Get Value-Based Health Care Until We Agree on What ‘Value’ Means.” The title begs a simple question, “Why do we have to agree?”

Why can’t patients and the employers and health plans that foot much of their health care bills make individual and situational determinations of value?

In every other product and service, consumers choose the relative mix of cost, quality and features that define value for them – for that product or service and on that day.

Think about shopping for hotels. You pop online and adjust sliders and filters to the right mix of price, amenities and star ratings for that trip. For me, sometimes I’m more price conscious. Other times, I prioritize location. Every once in a while, I’m just feeling fancy. Data and technology allow me to make informed, personal and situational choices in a matter of seconds.

My son recently had a minor surgery. I rejected the facility recommended by the physician’s scheduler. I was willing to wait two weeks for a CMS Five-Star Hospital that also has Straight As from The Leapfrog Group. For this procedure, I cared little about location and wait times and even less about cost. But, if he broke his arm and needed a simple x-ray, I probably would choose the cheapest, closest, fastest place to take the image.

With meaningful transparency, tiered networks, reference pricing and other value-based insurance design and provider payment constructions could allow purchasers to install cost and quality guardrails but let consumers do the driving.

If you’ve ever wondered how Amazon could change health care, this may be your answer.


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