A New Lens.

Mariam Fofana, M.D. 

Resident in Emergency Medicine

Brigham and Women's Hospital/Massachusetts General Hospital 

PGY 4

06/08/2021

I came to the VBHD course as a skeptic. I consider health to be a public good and was wary of treating it as a business/industry like any other. Although the course takes a business school approach to examining specific healthcare delivery models, I very much appreciated the focus on value for patients. The concept of value as articulated in the course was new to me and I found it very helpful in framing the challenges encountered by healthcare systems and developing solutions. 

It is also very helpful to understand how to speak the language of business to convey ideas to certain stakeholders such as executives and funders. My primary career interest is in research and I don’t necessarily anticipate being involved in major healthcare transformation efforts, but I also have a significant interest in global health, and thinking about value as part of outcome assessment of interventions could help make healthcare more accessible and more equitable. The course has given me a new lens through which to consider how we deliver care and will likely prompt me to be more critical of some of the practices that we take for granted, or the systems that we think immutable.

Improving Quality and Value in Healthcare Delivery.

Matthew Joseph Best, M.D. 

Fellow in Orthopaedic Sports Medicine

Massachusetts General Hospital 

PGY 6

06/09/2021

Matthew Joseph Best, M.D. 

The value based healthcare delivery course allowed me to understand important concepts of the providing high quality medical care by improving outcomes and decreasing costs. The principles emphasized in this course will be important in various areas of my future career including my clinical practice, research groups, and in leadership positions. 

An understanding of how to improve value, accurately track outcomes, reduce costs, and provide high quality medical care are vital aspects of physician education and can benefit trainees from all medical disciplines.

Currently, I am utilizing some of the skills learned from this course in multiple research projects to accurately assess and measure costs and reduce cost variability in different domains of orthopedics. These themes can help to ultimately reduce healthcare costs and improve overall value. Additionally, I plan to use these skills in future clinical and research based leadership roles.

COE Healthcare Policy Course Through HBS

Martina Mustroph, M.D., Ph.D. 

Resident in Neurosurgery 

Brigham and Women's Hospital 

PGY 4

06/08/2021

I enrolled in this course at the recommendation of my coresidents who had taken it last year. In particular, they had stressed that for trainees to have access to some of this country’s experts in healthcare policy is one of the many benefits of training at an academic medical center with affiliated professional schools.

The course was held over zoom, and in my opinion successfully so. I particularly got a lot out of the daily evening hour-long small group discussions, in which 4 of my peers and I would be in an individual zoom room. We would complete the guiding questions pertaining to the day’s reading, but we also informally exchanged our experiences of training in different departments currently or (for fellows) in the past for residency. For instance, a fellow in a related specialty I have worked with closely for the past year spoke candidly about his residency experience as it compares to his current institution.

For me, the course was an excellent way to take a step back and look at the broader healthcare system in the U.S. and abroad. I think this is sometimes hard to remember to do while immersed in training. The course has given me a conceptual framework and vocabulary for assessing healthcare delivery. I am looking forward to my thinking about healthcare being less myopic.

A Valuable Perspective.

Laura Nicholson, M.D. 

Resident in Internal Medicine/Primary Care

Brigham and Women's Hospital 

PGY 3

06/09/2021

The Value-Based Healthcare Delivery course was a valuable educational experience and provided a unique opportunity to engage in discussions of healthcare payment and policy during residency. After three years of residency focused on learning clinical skills, this course offered an important systems-perspective that will inform how I think about the systems I deliver clinical care in the future. One of the most unique aspects of the course was the chance to engage with residents from different programs and levels of training. 

As an internal medicine resident, I do not often enter discussions with surgeons, emergency medicine, or radiology residents around these type of topics, and I found this to be a great learning opportunity. The case-based discussions allowed for a deep engagement with the various principles we discussed; they offered insights into payment systems and hospital programs that are different from those I have encountered as a trainee. The case discussion related to strategies hospitals have taken to address social determinants of health at both the individual and population level were especially informative. As an internal medicine resident going into primary care and hospitalist medicine, I am eager to apply these principles and ideas from this course to my future career as a generalist.

A Valuable Foundation.

Kelly Marie Scheuring, M.D. 

Resident in Internal Medicine and Primary Care

Brigham and Women's Hospital/Atrius Health 

PGY 2

05/26/2021

Kelly M. Schuering, MD

Participating in the Value-Based Health Care Delivery Course helped me to further develop the skillset I will continue using to advocate for higher value care for the medically complex and socially vulnerable in society. Despite trials of many unique approaches within complex care over the past decade, providing consistent value remains a major challenge. Through case studies of successful health care institutions, the course expanded my understanding of integrated practice units, outcomes measurement, time-driven activity-based costing, culture change, and expanding a care network, all of which are critical tools to increase value. The course also introduced me to like-minded trainees across MGB that I hope to continue to work with in the future, not to mention exposure to world-class leaders in business!

Though my focus has been primarily clinical to date, I know my desire to improve the flawed systems that I see failing patients will inevitably lead to administrative roles in the future. This course has helped prepare me to be a more effective agent in change in building a more efficient, but equitable health care system throughout my medical career as a primary care provider.  Though it is just the beginning, this course laid a strong foundation upon which I can hope to build a career and a system that warrants it’s own case in the future! Thanks so much for such a transformative experience!

The Value Proposition of Standardized Care Processes

James C. Etheridge, M.D. 

Resident in General Surgery 

Brigham and Women's Hospital 

PGY 3

06/02/2021

James C. Etheridge, M.D. 

The benefits of standardized care processes are well-established.  Clinical pathways and protocols, when properly implemented, have been shown to improve adherence to evidence-based practices, efficiency of healthcare, and patient outcomes.  Enhanced recovery pathways, for example, have been enormously successful in surgery.  However, the benefits of these approaches are seldom explored from a value perspective.  As such, the Value Based Healthcare Delivery Course helped me to see these approaches in a new light.

Standardized care processes tend to be discussed from a “high-reliability” perspective.  The argument is logical and reasonable: if we can ensure timely adherence to evidence-based practices, patients will do better and leave the hospital sooner.  There is a tacit emphasis on process measures from this perspective – outcomes are frequently presumed to follow improved process adherence.  The only element of value routinely explored is the denominator, most commonly in terms of length of stay.

Certainly, there is a benefit to improving best-practice adherence and streamlining care.  From a value perspective, however, these process-oriented advantages are secondary.  Standardized care practices are, rather, a prerequisite to value-based healthcare delivery.  A health system has no way to assess the costs of care processes and the return on investment for these processes without standardization.

Consider a patient with uncomplicated appendicitis.  A system with a systematic approach to care delivery will be able to predict the choice of antibiotics, operative or non-operative management, surgical devices used, and postoperative care provided.  With this data, the system can anticipate costs and likely outcomes.  Process improvements to reduce costs or improve outcomes can be made and studied with confidence.  A system comprising a conglomeration of individual providers, lacking standardized approaches to patient care, can do none of these things.  Failure to standardize thus does not simply promote errors – it prohibits the functions necessary to a well-designed, value-based healthcare delivery system.

This realization was one of many insights I gleaned from the Value-Based Healthcare Delivery Course.  Sessions on costing methods, organization of care around common conditions or organ systems, and rationalization of increasingly consolidated healthcare systems were thought provoking and stimulating.  Nonetheless, as an implementation researcher with an interest in care standardization, I found this realization profound.  I am thankful for this opportunity to refocus my efforts from processes and outcomes to value.

Necessary for All Residents

Hilary Gallin, M.D. 

Resident in Anesthesiology 

Massachusetts General Hospital 

PGY 4

06/08/2021

Massachusetts General Hospital

I had the pleasure of attending the Value Based Healthcare Delivery Course. It was an opportunity to step outside my clinical duties and explore patient centered care, quality in healthcare, and payment structures. The course taught us how to be successful leaders with a range of leadership styles. In addition to the outstanding faculty, I had the opportunity to meet a number of trainees across the MGB system with different perspectives from multiple specialties and institutions. 

As an anesthesiologist, I hope to use these lessons when approaching projects to improve operations, patient safety, and patient experience. This course was a reminder that as a physician we have a duty to engage not only in medicine but broader healthcare delivery. It provided a vocabulary and structure to start improving care.