Leaders partner for value measurement tool

Leaders from the American College of Surgeons (ACS) andHarvard Business School’s (HBS) Institute for Strategy and Competitivenessgathered on Capitol Hill to announce a new partnership aimed at improvinghealth care value. The two organizations announced a new program to help hospitalsand surgical practices improve patient outcomes while lowering the cost ofdelivering care. Better measurement of quality and costs will enable hospitalsto improve the value they deliver to patients while positioning them forsuccess as reimbursement shifts to bundled payments, an approach that increasestransparency and accountability.

“Clearly defining the value of patient care is critical toour nation’s health care system,” said David B. Hoyt, MD, FACS, executive directorof the American College of Surgeons. “As the patient care model continues toevolve, we must place a premium on providing the utmost quality and efficiencyin our hospitals. This program will help hospitals identify clear opportunitiesto do that.”

At the event on Capitol Hill, leaders of the program, calledACS THRIVE (Transforming Health care Resources to Increase Value andEfficiency), discussed the challenges the nation’s health system faces as itmoves from volume to value-based payment models, the changing team dynamics withinhospitals, and the new care models that health systems must adopt.

“We want to reduce the high costs incurred in the U.S.health care sector, but do this in ways that don’t compromise the quality ofcare or a patient’s access to it,” said Prof. Robert Kaplan, MS, PhD, senior fellowand Marvin Bower professor of Leadership Development, Emeritus, HBS. “Cuttingcosts by arbitrary reduction in headcount is not a sustainable solution. Truecost improvement requires that we first measure what it costs today to treat apatient’s medical condition, and then redesign the care model to deliver thesame or, preferably, better outcomes with a lower-cost mix of resources,especially personnel, equipment, devices and drugs.”

"Surgical care is more than just the operative procedure," said Frank G. Opelka, MD, FACS, medical director, ACS Quality and Health Policy. "Surgical care involves teams of clinicians who begin delivering care in the preoperative phase, include anesthesia, nursing care and medical specialties and continues through to postoperative rehabilitation. As a team, we need to optimize each phase of care to provide the best outcomes for patients and meet their goals."

Initially, ACS THRIVE leaders will pilot thevalue-measurement process with 10-15 hospitals in the U.S., focusing onmeasuring the full cycle of care – including its key surgical, medical,behavioral and social elements – for three surgical conditions. Results fromthe pilot will be used to create a scalable approach that all hospitals can useto measure and improve value. The method will also include risk-adjustedbenchmarks, so hospitals can compare its value with one another to generatesystem-wide improvement. High-value providers will be recognized, while thosewith opportunities for improvement can learn from the best practices of thehigh-value hospitals and health systems.

The new program will build on the two organizations’expertise in cost and quality measurement. ACS first proposed its HospitalStandardization Program in 1912, which evolved to become The Joint Commission.In 1922, the ACS created the Commission on Cancer, which today sets standardsused by 80 percent of U.S. cancer centers. In the 1960s, the ACS Committee onTrauma helped establish the nation’s trauma system. And in the early 2000s, theACS launched the National Surgical Quality Improvement Program (ACS NSQIP) forcollecting clinical, risk-adjusted, 30-day surgical outcomes data.

“We know quality improvement requires accurate and reliabledata, with risk and case-mix adjustment,” said Clifford Ko, MD, MS, MSHS, FACS,FASCRS, director of the ACS Division of Research and Optimal Patient Care.“Clinical data, not claims data, are routinely the best data to use. However,data alone are not sufficient. Appropriate and adequate resources,infrastructure and adherence to evidence-based standards are all likewiseneeded to provide high-value care. ACS has a long history of helping providersand hospitals achieve these aspects reliably.”

The HBS Institute for Strategy and Competitiveness wasfounded by recognized business strategy leader Michael Porter. His 2006 book,Redefining Health Care, laid the groundwork for how to measure value in healthcare. The Institute’s leaders, including Prof. Kaplan, have created some of themost important business strategy and cost-measurement methods in the world,including time-driven activity-based costing, or TDABC, an accounting methodthat is recognized as one of the most effective means of measuring andimproving an organization’s costs.

“We believe the value-based health care approach will expandthe definition of quality and will improve transparency, both of which areessential to delivering truly patient-centered care,” said Mary L. Witkowski,MD, MBA, Fellow, HBS Institute for Strategy and Competitiveness.

“This is the next evolution of our nation’s health system,”Dr. Hoyt said. “We know we can provide world-class care to all patients. Now weneed to make that care affordable and accessible to all in a way that meets thepatient’s goals.”