A Shift to Value-Based Care

Maya Son, MD

Resident in Psychiatry at Massachusetts General Hospital/McLean Hospital 

PGY - 4

01/31/2020

Case Readings

Almost four years of psychiatry residency has come and gone, and I still stand steadfast in my desire to help those in need, but with increasing awareness of how directly the political, economic, social climate, and healthcare delivery affect my patients' health and care. I was confused about our current healthcare system and frustrated about the lack of available resources (especially in psychiatry), despite the rising cost of healthcare. I've learned that being an effective and competent physician is as much about knowledge and compassion as it is about learning how to navigate insurance companies, being thoughtful of structural inequalities, and becoming well versed in how our fragmented healthcare system functions.

In my search to deepen my knowledge of our healthcare system, I was fortunate enough to participate in the several COE opportunities offered to the Partners program during my four years of psychiatry residency at MGH/McLean  -  the COE Health Policy and Management, and most recently, the Value-Based HealthCare Delivery (VBHD) course co-sponsored by Harvard Business School and Center of Expertise in Health Policy and Management. The VBHD course was a three-day seminar with Michael Porter, author of Redefining Health Care and economist; world-renowned HBS faculty members; and senior leadership from Partners, including but not limited to, several Partners physician leaders who reviewed and applied business strategy principles to real-world healthcare organizations. It was three days filled with illuminating case readings, healthy scrumptious food, and interactive thought-provoking case-based discussions from and with various specialties about how to restructure healthcare delivery around value for patients, as well as strategies for health plans, employers and government.

The VBHD brought a basic business principle of measuring cost and outcome into light. Admittedly, a very simple concept that appears to be evident in most other industries but healthcare apparently. I became so focused on the treatment of the individual patient in front of me that I lost sight of the downstream impact of being a part of a system that lacked transparency about cost delivery and health delivery outcomes.  How are we to optimize resources for mental / healthcare and provide cost effective quality care when we can’t and don’t quantify cost or outcome? We can do better.

When it comes to measuring the cost of mental healthcare and its impact on the rising healthcare cost, it would be remiss not to acknowledge that it’s a complicated endeavor as there are many indirect costs associated with it. The economic burden of mental health disorders goes far beyond medication costs, clinic visits, and hospitalizations. What contributes to this complex picture is not only the difficulty in undertaking such a task, but also incomplete data collection; variability and deficiencies in psychiatric disorders; incomplete cost categorization, among many others.  I hope and envision a future where we move away from our current payment model of “direct” diagnostic and treatment costs (fee for service, DRG) as it inadequately captures the economic cost of providing mental healthcare.

From the course, I quite resonated with the approach taken by many of the primary care clinics that provide value-based care, and the idea of organizing care around patient’s needs and grouping patients with similar psychiatric needs and severity of illness for improved full cycle care treatment as well as for cost categorization. In doing so, one hopes to shift the organizational framework and better equip our patients and physicians alike to serve a heterogeneous patient population that emphasizes cost-effective quality care, all the while rewarding physicians for improved outcomes and valued care along the way.

Overall, VBHD provided foundational knowledge in healthcare systems, adding depth and breadth to my interest surrounding healthcare systems and operational issues. Beyond the benefits of enhancing my own knowledge base and shaping me into a better clinician who can navigate our current system, it will also provide me the tools to advance dialogue and hopefully shape the discourse about health advocacy, policy, and reform in a thoughtful and impactful way. 

Moving forward, I look forward to applying health economics to our mental health system with hopes of optimizing resource allocation for mental healthcare, and ultimately provide cost effective quality care with improved outcomes to our patients by further investigating and applying the aforementioned approaches as a psychiatrist and as an administrator. While there’s still uncertainty of what the future holds and inherent frustration with our system, after the VBHD course, I am excited about the shifting landscape of healthcare to come and am ready for change.